RESUMEN
BACKGROUND: We previously screened 400 elderly Costa Ricans for neurodegenerative disease. Those reporting occupational pesticide exposure (18%) had an increased Parkinson׳s disease (PD) risk (OR 2.57, 95% CI 0.91-7.26), and worse cognition (Mini-Mental States Exam (MMSE) 24.5 versus 25.9 points, p=0.01). We subsequently measured long-lasting organochlorine pesticides (ß-HCH, DDE, DDT, and dieldrin) in a sub-sample (n=89). Dieldrin and ß-HCH have been linked to PD, and DDE to Alzheimer׳s disease. METHODS: We ran regression models for MMSE and tremor-at-rest to assess associations with pesticides in 89 subjects. RESULTS: The percent of ß-HCH, DDE, DDT (parent compound for DDE), and dieldrin above their limit of detection (LOD) were 100%, 93%, 75%, and 57%, respectively. Tremor-at-rest was found in 21 subjects, and the mean MMSE was 25. Those who reported occupational pesticide exposure (n=36) had more detectable dieldrin samples (p=0.005), and higher mean levels of dieldrin (p=0.01), than those not reporting exposure. Other pesticides did not differ between those with and without self-reported occupational exposure. There was a positive but non-significant trend of higher risk for tremor-at-rest with higher dieldrin (p=0.10 for linear trend). Neither DDE nor DDT showed a relationship with MMSE. However, after excluding two outliers with the lowest MMSE scores, higher DDT levels showed some modest association with lower MMSE (p=0.09 for linear trend). CONCLUSIONS: Our data are limited by small sample size. However, dieldrin was high in our population, has been previously linked to PD, and could be partly responsible for the excess PD risk seen in our population.
Asunto(s)
Contaminantes Ambientales/toxicidad , Hidrocarburos Clorados/toxicidad , Enfermedades Neurodegenerativas/inducido químicamente , Anciano , Costa Rica , Femenino , Humanos , MasculinoRESUMEN
El objetivo del presente estudio fue construir una escala que evaluara factores vinculados a la adherencia terapéutica en pacientes oncológicos y evaluar sus propiedades psicométricas. A la muestra conformada por 120 participantes provenientes del Servicio de Oncología del Hospital Clínico Regional de Antofagasta, se aplicó el cuestionario creado y validado previamente en una muestra piloto en similar tipo de pacientes. Se analizó la consistencia interna y la estructura factorial del cuestionario, así como la relación entre las dimensiones evaluadas. De acuerdo a los resultados, la escala presenta un alfa superior a 0.9, tanto a nivel total como en las diversas dimensiones, y una estructura factorial consistente con los factores teóricos elegidos. La conclusión de la investigación es que la escala construida puede constituirse en una herramienta de utilidad pronóstica de uso en pacientes oncológicos.
The aim of this study was to build and evaluate the psychometric properties of a scale to assess factors related to adherence in patients with cancer. In a sample of 120 patients from the Oncology Service from Hospital Clínico Regional de Antofagasta, we applied the questionnaire developed and previously validated in a pilot sample in similar patients. The internal consistency and factor structure of the questionnaire, and the relationship between the dimensions was assessed. According to the results, the scale has an alpha greater than 0.9, both overall and in various dimensions, and a factor structure consistent with the theoretical factors chosen. The research concluded that the scale is constructed can become a useful prognostic tool for use in cancer patients.
RESUMEN
CONTEXT: Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin. OBJECTIVE: To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures. DESIGN: Case-control study, cohort study, and laboratory toxicologic evaluation. SETTING: Pediatric population of Haiti. PARTICIPANTS: Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects. MAIN OUTCOME MEASURE: The odds of exposure to suspected etiologic agents among cases and controls. RESULTS: We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG. CONCLUSIONS: An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.