Exposición a plaguicidas con toxicidad dérmica en agricultores de la Comunitat Valenciana

Introduction: Dermal route has a toxicological importance, as well as substances such as entry, but by frequent local effects. In applications of pesticides by farmers is common and important the dermal exposure to pesticides, so the dermal route in this sector of activity could be of particular relevance. Objective: To determine the hazard of dermal exposure in farmers using pesticides and to propose specific preventive measures. Material and methods: A transversal descriptive study based on a questionnaire designed by the researchers, replying to the 238 attendees at the courses for pesticide handler card basic level Department of Health Xativa-Ontinyent (Valencia) in 2009. Pesticides used were collected over the past 12 months and reviewed their R phrases (risk phrases) looking for dermal effects. Results: 55 % of pesticides had some phrase R on skin problems. The phrase R38 "Irritating to skin" was found in 16 products, used by 59.05 % of respondents and the R43 "Possibility of sensitization by skin contact" at 7, used by 23.91 %. Conclusions: The skin irritation effect was related to more dermal exposure to these pesticides. It is necessary to emphasize the skin protection in the courses for workers who apply these products. Skin problems should be included damages for workplace exposure to pesticides.Introducción: La vía dérmica tiene importancia toxicológica, además de como entrada de sustancias, por los frecuentes efectos locales. En aplicaciones de plaguicidas realizadas por agricultores resulta habitual e importante la exposición dérmica a plaguicidas, por lo que la vía dérmica en este sector de actividad puede resultar de especial relevancia. Objetivo: Conocer los riesgos cutáneos de los agricultores que utilizan plaguicidas, para poder así proponer medidas preventivas específicas. Material y métodos: Se realizó un estudio descriptivo transversal basado en un cuestionario diseñado por los investigadores, contestando al mismo 238 asistentes a cursos para obtener el carné de manipulador de plaguicidas de nivel básico del Departamento de Salud Xàtiva Ontinyent (Valencia) en 2009. Se recogieron los plaguicidas utilizados en los últimos 12 meses y se revisaron sus frases R (frases de riesgo), buscando especialmente efectos dérmicos. Resultados: El 55 % de los plaguicidas tenían alguna frase R relacionada con problemas dérmicos. La R38 “Irrita la piel” fue encontrada en 16 productos, utilizados por un 59,05 % de los encuestados y la R43 “Posibilidad de sensibilización en contacto con la piel” en 7, utilizados por un 23,91 %.Conclusiones: La irritación cutánea fue el efecto relacionado con la vía dérmica más asociado a estos plaguicidas. Resulta necesario poner énfasis en la protección de la piel en los cursos para trabajadores que aplican estos productos. Los problemas cutáneos deben incluirse entre los daños por exposición laboral a plaguicidas

Exposure to pesticides with dermal toxicity in farmers of Community of Valencia

Introducción: La vía dérmica tiene importancia toxicológica, además de como entrada de sustancias, por los frecuentes efectos locales. En aplicaciones de plaguicidas realizadas por agricultores resulta habitual e importante la exposición dérmica a plaguicidas, por lo que la vía dérmica en este sector de actividad puede resultar de especial relevancia. Objetivo: Conocer los riesgos cutáneos de los agricultores que utilizan plaguicidas, para poder así proponer medidas preventivas específicas. Material y métodos: Se realizó un estudio descriptivo transversal basado en un cuestionario diseñado por los investigadores, contestando al mismo 238 asistentes a cursos para obtener el carné de manipulador de plaguicidas de nivel básico del Departamento de Salud Xàtiva Ontinyent (Valencia) en 2009. Se recogieron los plaguicidas utilizados en los últimos 12 meses y se revisaron sus frases R (frases de riesgo), buscando especialmente efectos dérmicos. Resultados: El 55 % de los plaguicidas tenían alguna frase R relacionada con problemas dérmicos. La R38 “Irrita la piel” fue encontrada en 16 productos, utilizados por un 59,05 % de los encuestados y la R43 “Posibilidad de sensibilización en contacto con la piel” en 7, utilizados por un 23,91 %.Conclusiones: La irritación cutánea fue el efecto relacionado con la vía dérmica más asociado a estos plaguicidas. Resulta necesario poner énfasis en la protección de la piel en los cursos para trabajadores que aplican estos productos. Los problemas cutáneos deben incluirse entre los daños por exposición laboral a plaguicidas.Introduction: Dermal route has a toxicological importance, as well as substances such as entry, but by frequent local effects. In applications of pesticides by farmers is common and important the dermal exposure to pesticides, so the dermal route in this sector of activity could be of particular relevance. Objective: To determine the hazard of dermal exposure in farmers using pesticides and to propose specific preventive measures. Material and methods: A transversal descriptive study based on a questionnaire designed by the researchers, replying to the 238 attendees at the courses for pesticide handler card basic level Department of Health Xativa-Ontinyent (Valencia) in 2009. Pesticides used were collected over the past 12 months and reviewed their R phrases (risk phrases) looking for dermal effects. Results: 55 % of pesticides had some phrase R on skin problems. The phrase R38 "Irritating to skin" was found in 16 products, used by 59.05 % of respondents and the R43 "Possibility of sensitization by skin contact" at 7, used by 23.91 %. Conclusions: The skin irritation effect was related to more dermal exposure to these pesticides. It is necessary to emphasize the skin protection in the courses for workers who apply these products. Skin problems should be included damages for workplace exposure to pesticides

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research