Search

ObjectivesWe evaluated studies that used the World Health Organization’s (WHO) AirQ and AirQ+ tools for air pollution (AP) health risk assessment (HRA) and provided best practice suggestions for future assessments.MethodsWe performed a comprehensive review of studies using WHO’s AirQ and AirQ+ tools, searching several databases for relevant articles, reports, and theses from inception to Dec 31, 2022.ResultsWe identified 286 studies that met our criteria. The studies were conducted in 69 countries, with most (57%) in Iran, followed by Italy and India (∼8% each). We found that many studies inadequately report air pollution exposure data, its quality, and validity. The decisions concerning the analysed population size, health outcomes of interest, baseline incidence, concentration-response functions, relative risk values, and counterfactual values are often not justified, sufficiently. Many studies lack an uncertainty assessment.ConclusionOur review found a number of common shortcomings in the published assessments. We suggest better practices and urge future studies to focus on the quality of input data, its reporting, and associated uncertainties.

El enfoque de salud planetaria actualiza la visión que tenemos de la relación entre el ambiente y la salud en el contexto de la crisis ambiental y climática global. Se basa en el análisis de los límites planetarios y las consecuencias de su transgresión. En este artículo hacemos un análisis de la situación de estos límites y sus consecuencias en la región de Latinoamérica y el Caribe. A partir de una crítica presentamos una reconceptualización de la salud planetaria considerando aspectos de justicia ambiental y de desigualdades Norte/Sur. Se muestra la situación de los límites planetarios en diferentes países de la región. Finalmente se propone un abordaje basado en escenarios sindémicos locales, así como de programas y políticas exitosas para responder a los grandes retos de la crisis ambiental y climática en la región.

(1) Background: Evidence on the association between air pollution and the risk of exacerbations of chronic obstructive pulmonary disease (COPD) is scarce and inconsistent. We aimed to analyze the association between long-term exposure to particulate matter with a diameter of less than 2.5 µm (PM2.5) and nitrogen dioxide (NO2) and exacerbation of COPD (COPD-E) in Bogotá, Colombia. (2) Methods: We conducted a retrospective cohort study of 722 COPD patients in the AIREPOC program of the Fundación Neumológica Colombiana between 2018 and 2021. Exposure to PM2.5 and NO2 was estimated for residential locations using the inverse squared-distance weighted regression (IDWR) method. Hazard ratios (HRs) were calculated for the first COPD-E during follow-up using Cox models, adjusted for meteorological, demographic, and clinical variables. (3) Results: COPD-E was associated with long-term exposure to PM2.5 (HR: 1.03, 95%CI: 1.02–1.05) and NO2 (HR: 1.05, 95%CI: 1.03–1.07), controlling for the effect of quality of life, history of COPD-E, forced expiratory volume in one second (FEV1) pre-bronchodilator, and exposure to solar radiation. An association was found between COPD-E and concentrations ≥ 25 µg/m3 of NO2 (HR: 1.49, 95%CI: 1.12–1.98) but not with concentrations ≥ 15 µg/m3 of PM2.5. (4) Conclusions: This study suggests that people with COPD exposed to higher concentrations of PM2.5 and NO2 had an increased risk of COPD-E. Solar radiation was also associated with an increased risk of COPD-E. The results highlight the importance of continuing efforts to reduce air pollution. COPD patients should be aware of air quality indices and follow the recommendations, as well as participate in air governance spaces.

Abstract Background Satellite-based PM2.5 predictions are being used to advance exposure science and air-pollution epidemiology in developed countries; including emerging evidence about the impacts of PM2.5 on acute health outcomes beyond the cardiovascular and respiratory systems, and the potential modifying effects from individual-level factors in these associations. Research on these topics is lacking in low and middle income countries. We aimed to explore the association between short-term exposure to PM2.5 with broad-category and cause-specific mortality outcomes in the Mexico City Metropolitan Area (MCMA), and potential effect modification by age, sex, and SES characteristics in such associations. Methods We used a time-stratified case-crossover study design with 1,479,950 non-accidental deaths from the MCMA for the period of 2004–2019. Daily 1 × 1 km PM2.5 (median = 23.4 μg/m3; IQR = 13.6 μg/m3) estimates from our satellite-based regional model were employed for exposure assessment at the sub-municipality level. Associations between PM2.5 with broad-category (organ-system) and cause-specific mortality outcomes were estimated with distributed lag conditional logistic models. We also fit models stratifying by potential individual-level effect modifiers including; age, sex, and individual SES-related characteristics namely: education, health insurance coverage, and job categories. Odds ratios were converted into percent increase for ease of interpretation. Results PM2.5 exposure was associated with broad-category mortality outcomes, including all non-accidental, cardiovascular, cerebrovascular, respiratory, and digestive mortality. A 10-μg/m3 PM2.5 higher cumulative exposure over one week (lag06) was associated with higher cause-specific mortality outcomes including hypertensive disease [2.28% (95%CI: 0.26%–4.33%)], acute ischemic heart disease [1.61% (95%CI: 0.59%–2.64%)], other forms of heart disease [2.39% (95%CI: -0.35%–5.20%)], hemorrhagic stroke [3.63% (95%CI: 0.79%–6.55%)], influenza and pneumonia [4.91% (95%CI: 2.84%–7.02%)], chronic respiratory disease [2.49% (95%CI: 0.71%–4.31%)], diseases of the liver [1.85% (95%CI: 0.31%–3.41%)], and renal failure [3.48% (95%CI: 0.79%–6.24%)]. No differences in effect size of associations were observed between age, sex and SES strata. Conclusions Exposure to PM2.5 was associated with non-accidental, broad-category and cause-specific mortality outcomes beyond the cardiovascular and respiratory systems, including specific death-causes from the digestive and genitourinary systems, with no indication of effect modification by individual-level characteristics.

ObjectivesThis study aims to estimate the short-term preventable mortality and associated economic costs of complying with the World Health Organization (WHO) air quality guidelines (AQGs) limit values for PM10 and PM2.5 in nine major Latin American cities.MethodsWe estimated city-specific PM-mortality associations using time-series regression models and calculated the attributable mortality fraction. Next, we used the value of statistical life to calculate the economic benefits of complying with the WHO AQGs limit values.ResultsIn most cities, PM concentrations exceeded the WHO AQGs limit values more than 90% of the days. PM10 was found to be associated with an average excess mortality of 1.88% with concentrations above WHO AQGs limit values, while for PM2.5 it was 1.05%. The associated annual economic costs varied widely, between US$ 19.5 million to 3,386.9 million for PM10, and US$ 196.3 million to 2,209.6 million for PM2.5.ConclusionOur findings suggest that there is an urgent need for policymakers to develop interventions to achieve sustainable air quality improvements in Latin America. Complying with the WHO AQGs limit values for PM10 and PM2.5 in Latin American cities would substantially benefits for urban populations.

Objetivo. Analizar la asociación entre la exposición crónica a contaminantes atmosféricos y la tasa de mortalidad por Covid-19 en ciudades mexicanas. Material y métodos. Estudio ecológico en 25 ciudades mexicanas utilizando el reporte de casos diarios de muertes por Covid-19 (febrero a junio 2020) y datos validados de contaminantes atmosféricos, considerando concentraciones promedio en cada ciudad en el último año. Se utilizaron modelos de regresión Poisson, con modelos aditivos generalizados y variables de ajuste. Resultados. Se encontró un incremento significativo de 3.5% (IC95% 2.3-4.7) en la tasa de mortalidad por Covid-19 por incremento de 1μg/m3 de NO2. La asociación con PM2.5 fue no significativa, con un incremento de 1.8% por cada μg/ m3. Conclusiones. Los resultados sugieren una asociación entre la mortalidad por Covid-19 y la exposición a NO2. Esta primera aproximación del riesgo asociado con la contami­nación del aire requiere de análisis más precisos, pero es consistente con estudios de otras regiones.

The Latin America and the Caribbean (LAC) region makes up 8.4% of the world’s population. Human biomonitoring (HBM) programs, which can shed light on population-level exposure to environmental contaminants such as toxic metals and thus, improve the health of the populations are inexistent in LAC countries. We call for the creation of HBM programs in the region and identify three viable design options for HBM at the individual level, through national surveys, newborn blood collection, and biobanks. We highlight some of challenges to the implementation of HBM programs, including financial and human resources, technical constrains (laboratory), sample, and data logistics. Finally, we provide the case studies of Brazil, Chile, Mexico, and Uruguay, to illustrate a range of responses to toxic metal exposure in non-occupational populations. Although different in many respects, the individual country responses share two commonalities: 1) academic centers drive the research to raise awareness of governmental entities; 2) reference levels are adapted from international norms rather than arising from the studied populations. Well-designed and sufficiently funded biomonitoring systems need to be established in each country of the LAC region. HBM programs are key to promoting human health by informing the public and contributing to policy processes that establish sustainable environmental controls and health prevention programs.

Objetivo. Resumir y analizar la evidencia de la asociación entre Covid-19 y factores climáticos. Material y métodos. Se utilizó la metodología de revisiones rápidas de Cochrane. Se buscaron artículos publicados del 1 de enero al 27 de abril de 2020 en una base de datos académica y preprints. Los títulos y resúmenes fueron revisados por dos investigadores y los textos completos por cinco investigadores. Resultados. De 354 artículos identificados, 26 cumplieron los criterios de elegibilidad establecidos. De éstos, 20 observaron una asociación inversa. Al evaluar su calidad, nueve calificaron con validez moderada, porque si bien ajustaron por covariables en el análisis, son estudios ecológicos. Conclusiones. A pesar de la homogeneidad de resultados, los factores climáticos explican un porcentaje pequeño de la variación de Covid-19. Son necesarios estudios con periodo de análisis más largo que capten tendencia y estacionalidad e incluyan factores de riesgo individuales.

Objetivo. Estimar el riesgo de mortalidad asociado con la exposición a partículas finas (PM2.5) y gruesas (PM2.5-10) en la Zona Metropolitana de Monterrey (ZMM). Material y métodos. Estudio ecológico con análisis retrospectivo de series de tiempo (2004-2014) de mortalidad total y especí­fica diaria, y promedio de PM2.5 y PM2.5-10. Modelos aditivos generalizados Poisson con rezagos distribuidos ajustados por tendencia, estacionalidad, día de la semana, condiciones meteorológicas y contaminantes gaseosos. Resultados. El promedio (DE) de PM2.5 y PM2.5-10 fue 26.59 (11.06) y 48.83 (21.15) μg/m3. Cada 10 μg/m3 de aumento de PM2.5 (lag 0) incrementó el riesgo de mortalidad respiratoria en menores de cinco años 11.16% (IC95% 1.03-21.39) y de neumonía e influenza en mayores de 65 años 6.60% (IC95% 3.91-9.37). El riesgo de mortalidad asociado con las PM2.5-10 fue menor. Conclusiones. Se observaron asociaciones positivas y significativas entre exposición a material particulado y la mortalidad diaria en población de la ZMM.

Objetivo. Analizar la evidencia sobre la relación entre la contaminación del aire y un riesgo mayor de morbimortalidad por Covid-19. Material y métodos. Se utilizó una adaptación de la metodología de revisiones rápidas de Cochrane. La búsqueda se realizó en PubMed y MedRxiv y se limitó hasta el 28 y 26 de abril, respectivamente. Los títulos y resúmenes fueron revisados por cinco investigadores que, a su vez, revisaron los textos completos de la selección final. Resultados. Se encontraron 450 manuscritos, 15 cumplieron los criterios de inclusión. La evidencia encontrada reporta que la incidencia y el riesgo de morbilidad y mortalidad por Covid-19 se incrementan con la exposición crónica y aguda a la contaminación del aire, particularmente a material particulado (PM2.5, PM10) y dióxido de nitrógeno. Conclusiones. Se requieren más estudios especialmente en ciudades latinoamericanas. Es necesario fortalecer las recomendaciones en las ciudades con mayores niveles de contaminantes y reducir sus emisiones.

Background: Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region.Methods: We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid).Results: Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake −0.009% (95% CI: −0.019, < −0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was −0.03 (95% CI: −0.05, −0.01) and 0.03% (95% CI:

Climate change (CC) is the most important challenge of our time, a long-term global problem and one of the most serious global threats to human health in the future. CC is the expression of changes in temperature and water cycle, floods and drought events, extreme heat waves and sea level rise. Children are particularly vulnerable because they are highly sensitive to climate changes. The main environmental hazards affecting children’s health are poor household drinking water quality and availability, lack access to adequate sanitary facilities, poor hygiene practices, outdoor and indoor air pollution, vector-borne diseases, chemical hazards, and unintentional injuries. Except for some unintentional injuries, these environmental hazards are associated to CC.

Objective. To design and analyze the efficacy of an Ecohealth competency-based course on the prevention and control of vector-borne-diseases for specific stakeholders. Materials and methods. Multiple stakeholders and sectors of the region were consulted to identify Ecohealth group-specific competencies using an adjusted analysis matrix. Eight courses based on the competencies were implemented to train EA tutors. The effectiveness of the course was evaluated through the use of paired- t-tests by intervention group. Results. Strategic, tactical, academia and community stakeholder groups and their competencies were identified. An overall gain of 43 percentage points (p

Objetivo. Evaluar la asociación entre la exposición a contaminantes atmosféricos y marcadores de estrés oxidativo, por un lado, y la función pulmonar, por el otro, en escolares, con y sin asma, de las ciudades de Salamanca y León, en Guanajuato, México. Material y métodos. Se realizaron determinaciones de marcadores de estrés oxidativo y pruebas de función pulmonar en 314 escolares, y se obtuvo información sobre contaminantes atmosféricos (ozono, dióxido de azufre, monóxido de carbono y partículas menores de 2.5 μm y menores de 10 μm) de las estaciones de monitoreo correspondientes. Para evaluar la asociación se corrieron modelos de regresión lineal múltiple. Resultados. Con un día de retraso a la exposición a partículas menores de 10 μm (PM10), se observó un incremento de 0.09 pmol en los dienos conjugados entre niños asmáticos de Salamanca (p

The benefits of improved biomass cookstoves (ICS) depends on their adoption and sustained use. Few studies have documented if and how they are used more than five years after being introduced.We conducted a 9-year prospective cohort study among young rural women in the highlands of Michoacan, Mexico. Participants had received a Patsari ICS during a community trial either in 2005 or 2006. With retrospective information collected in 2012–13, we studied the households' energy use, ICS survival, and cooking practices during the follow-up period. Using an exposure model constructed with personal PM2.5 measurements in a subsample of homes at the time of the initial trial in 2005, we estimated the exposure associated with different energy use patterns during the follow-up period.The ICS had a mean lifespan of 4 years, after which more than half of the stoves were not in use; therefore, the use of open fire increased, particularly among the indigenous communities. ICS use peak was achieved two years after the initial trial, either exclusively or combined with open fire. Yearly household energy use and other variables were used to estimate chronic air pollution exposure. Mean PM2.5 exposure during the follow-up period ranged from 51 to 319 μg/m3; the median was 102 and 146 μg/m3 for mainly ICS and mainly open fire use, respectively.The ICS has a useful period after which it needs maintenance, repair, or replacement. Unfortunately, many programs have not afforded a follow-up component. Exposure to biomass smoke air pollutants can be reduced by using an ICS instead of the traditional open fire. Household energy strategies should ensure equitable access to clean energy options adapted to local needs and preferences with culturally appropriate technology implemented on a sustainable perspective. Keywords: Household air pollution, Household energy use, Chronic exposure assessment, Particulate matter, Improved cookstove

Objective. To assess links between the social variables and longer-term El Niño-Southern Oscillation (ENSO) related weather conditions as they relate to the week-to-week changes in dengue incidence at a regional level. Materials and methods. We collected data from 10 municipalities of the Olmeca region in México, over a 10 year period (January 1995 to December 2005). Negative binomial models with distributed lags were adjusted to look for associations between changes in the weekly incidence rate of dengue fever and climate variability. Results. Our results show that it takes approximately six weeks for sea surface temperatures (SST -34) to affect dengue incidence adjusted by weather and social variables. Conclusion. Such models could be used as early as two months in advance to provide information to decision makers about potential epidemics. Elucidating the effect of climatic variability and social variables, could assist in the development of accurate early warning systems for epidemics like dengue, Chikungunya and Zika.

In this paper we conduct a scoping review of current household energy use patterns and trends in rural Latin America (LA), with the objective of identifying strategies that help promote just and fair transitions in the region. We reviewed a total of 143 publications covering 13 countries within the period from 1996 to 2021. The review shows: (a) fuelwood (FW) continues to be a very important, resilient—and in many countries—the dominant cooking fuel for rural LA households, both exclusively and increasingly stacked (combined) with liquefied petroleum gas (LPG); (b) FW is mostly used in open fires and rustic stoves, with a total toll of 59 000 premature deaths. Interventions have centered on the dissemination of improved woodburning chimney cookstoves and increasing access to LPG through top-down government programs. These programs have focused mostly on single-fuel and stove combinations, and on the number of devices installed with little or no follow-up with local users. As a result, success has been limited and open fires have not been fully displaced in most programs. We conclude that renewed efforts are needed to ensure a sustainable and just household energy transition in the LA region. These efforts should promote integrated portfolios of options including improved practices (drying wood, use of pressure cooker), and the stacking of devices (stoves, water heaters, space heating) and fuels (biomass, other). Specifically, improved chimney woodburning stoves need to be integrated with and be an important component of these programs. Programs should adopt a user-centered perspective, beginning with the understanding of users’ needs and priorities and tailoring solutions to their socio-environmental context. Innovation should be fostered through participatory methods, developing tests adapted to local circumstances and enforcing national standards. Implementation programs should focus on the adoption and sustained use of clean(er) devices and the displacement of traditional fires. Public policies should be more integrated and intersectoral seeking synergies between health, environmental, social development, and economic objectives.

México y la región de Latinoamérica enfrentan enormes retos relacionados con la degradación y contaminación ambiental y su impacto en la salud humana y en los ecosistemas, por lo que es necesario formar profesionales con visión multidisciplinaria. El Instituto Nacional de Salud Pública ha acumulado desde 1990 experiencia en la enseñanza de la salud ambiental. Originalmente, con un enfoque epidemiológico e incorporando progresivamente perspectivas más integradoras. Por su parte la Universidad Autónoma de San Luis Potosí a partir del año 2002 con el Programa Multidisciplinario de Posgrado en Ciencias Ambientales ha contribuido en la formación de recursos humanos altamente especializados en el área de las ciencias ambientales. Ambas instituciones son líderes en el estudio de la Salud Ambiental y han generado información científica sobre diversas problemáticas en zonas mineras, agrícolas, metropolitanas, indígenas, entre otras. Sin duda, se han obtenido avances significativos en la formación de recursos humanos en el área de salud ambiental, pero aún falta mucho por hacer para alcanzar el bienestar de las comunidades y los ecosistemas y consolidar un sistema salud pública ambiental completo. Se deben articular mecanismos para trasladar la evidencia científica en políticas públicas que impacten positivamente en la salud ambiental.

El uso doméstico de leña representa una condición socioecológica con importantes efectos sobre la salud, principalmente en las zonas rurales de los países en desarrollo. El objetivo del estudio fue evaluar la exposición a hidrocarburos aromáticos policíclicos (HAP) en mujeres y niños, así como la concentración de PM2,5 en interiores de viviendas indígenas de Tocoy, San Antonio, San Luis Potosí, México. Con los resultados, se analizó la perspectiva de los padres para la toma de decisiones en la atención a la salud ambiental infantil por riesgos de exposición a tóxicos. Utilizamos el 1-hidroxipireno como un biomarcador de exposición a HAP y se evaluaron las PM2,5 de 24 horas en interiores de viviendas indígenas mediante equipos Minivol®. El 100 % de las viviendas estudiadas utilizaban biomasa para la cocción de sus alimentos y el 70 % quemaban basura en sus hogares. Se encontraron niveles de 1-OHP en mujeres y niños de 1,15 (0,28-2,1) y 1,04 (0,28-3,62) μmol/mol creatinina respectivamente. Además, se detectaron concentraciones medias de PM2,5 de 93,3 ± 3,6 μg/m3. Finalmente se mostró que el 90 % de los cuidadores indican que el niño se concentra en el área de la cocina y traspatio, existiendo poca o nula adaptación para la seguridad del niño. Esta comunidad indígena es un ejemplo de los riesgos en salud asociados a contaminación de aire de interiores en México; por consiguiente se requiere de programas de intervención dirigidos a reducir la exposición a estos tóxicos en poblaciones vulnerables, iniciando por la educación de los cuidadores.

The aim of this study was to analyze the factors enabling/limiting the use of improved cookstoves among rural fuel wood users from one mestizo and two indigenous communities eight years after an intervention in the state of Michoacan, in Mexico.A qualitative study with an ethnographic perspective was conducted in 2013/2014 based on 62 interviews with women who had participated in an improved firewood cookstove program in 2005. Thematic qualitative content analysis was performed.Very few women from the indigenous communities were using the improved cookstove at the time of the study; the majority had dismantled or had ceased using it; whereas most of those from the mestizo community were using it for all of their cooking activities. In the indigenous communities, characterized by extended families, uptake of new technology was limited by traditional routine practices, rearrangement of rooms in the house, attachment to the traditional stove, a low- or non-risk perception of woodsmoke; gender relations, insufficient training, non-compliance with program recommendations and design-related aspects. Conversely, in the mestizo community, the uptake of the improved cookstove was favored by routine cooking practices in a nuclear family, a previous use of a raised cookstove and social representations on the health-disease-death effects of woodsmoke vs. the health benefits of cooking with improved stoves. The sociocultural dimension of communities and the cookstove design are aspects that either favor or limit the use of improved cookstoves in indigenous and mestizo populations.Effective cookstove programs must take these elements into account from their early planning stages, and blend them into implementation and follow-up. Project communication, training and differentiated follow-up activities ensuring the operation and maintenance of the cookstove, should be designed according to the specific needs and traditions of each community; they should be based on the preferences and needs of the users.

Objective. To conduct a health impact assessment (HIA) to quantify health benefits for several PM and O3 air pollution reduction scenarios in the Mexico City Metropolitan Area (MCMA). Results from this HIA will contribute to the scientific support of the MCMA air quality management plan (PROAIRE) for the period 2011-2020. Materials and methods. The HIA methodology consisted of four steps: 1) selection of the air pollution reduction scenarios, 2) identification of the at-risk population and health outcomes for the 2005 baseline scenario, 3) selection of concentration-response functions and 4) estimation of health impacts. Results. Reductions of PM10 levels to 20 μg/m3 and O3 levels to 0.050ppm (98 µg/m3) would prevent 2300 and 400 annual deaths respectively. The greatest health impact was seen in the over-65 age group and in mortality due to cardiopulmonary and cardiovascular disease. Conclusion. Improved air quality in the MCMA could provide significant health benefits through focusing interventions by exposure zones.

Environmental health has been established in Mexico as a discipline since the early nineties resuming the sanitarian tradition developed over the past century and incorporating new knowledge generated by environmental toxicology and epidemiology. During the last decade there has been some progress in reviewing and updating the regulations, designing programs and policies to reduce exposure to pollutants and consolidating research groups and teaching in the area. However, the most prevalent problems previously diagnosed still remain and new risks have emerged due to environmental degradation (air pollution, toxics exposure and climate change among others) have been incorporated. If this trend persists, the environmental risks will continue to increase and multiply. The environmental health governance in Mexico has to be redesigned involving a transectoral approach. Future proposals might include: establishment of a National Environmental Health Program, update the situational diagnosis at national and regional level, strengthening teaching and graduate programs in environmental health as well as increase support for research in the area and development of an integrated environmental health surveillance system.

OBJETIVO: Evaluar las condiciones de vulnerabilidad asociadas con la ocurrencia de dengue en dos localidades de Morelos en los años 2006 a 2009. MATERIAL Y MÉTODOS: se aplicó una encuesta sobre conocimientos, percepción de riesgo, prácticas de prevención y uso del agua en dos localidades de Morelos. Mediante un análisis de componentes principales, se construyó un índice de vulnerabilidad local al dengue (IVL). La asociación del IVL con la enfermedad en la vivienda se evaluó mediante una prueba de ji cuadrada. RESULTADOS: El IVL incluyó cinco componentes explicando el 63% de la varianza y fue clasificado en tres categorías: baja, media y alta. Se observó una asociación significativa entre el aumento de la vulnerabilidad y la prevalencia del reporte de casos de dengue en las localidades. CONCLUSIÓN: El estudio de la vulnerabilidad al dengue permite identificar necesidades locales específicas en materia de promoción de la salud.OBJECTIVE: To evaluate the vulnerability associated with the occurrence of dengue in two villages of Morelos, Mexico from 2006 to 2009. MATERIALS AND METHODS. A survey on knowledge, risk perception, prevention practices and water use was applied in two villages of Morelos. Using a principal component analysis, an index of local vulnerability to dengue (IVL) was constructed. The association of IVL with the disease at home was assessed using a Chi-square test. RESULTS: The IVL included five components explaining 63% of the variance and was classified in three categories: low, medium and high. There was a significant association between increased vulnerability and prevalence of reported cases of dengue in Temixco and Tlaquiltenango. CONCLUSION: The study of vulnerability to dengue allows us to identify local needs in the field of health promotion.

OBJETIVO: Analizar las relaciones que se establecen entre contaminación del aire y salud-enfermedad-muerte en una muestra de estudiantes de la Ciudad de México. MATERIAL Y MÉTODOS: Se realizó una encuesta a 1 274 alumnos de secundaria de 14 escuelas en cinco zonas del Distrito Federal, entre marzo y abril de 2003. Muestreo polietápico de áreas geoestadísticas básicas (AGEB). RESULTADOS: El 84.4% considera alta o muy alta la contaminación del aire en la Ciudad de México, que disminuye al aproximarse al espacio más inmediato del alumno. Los riesgos a la salud van desde efectos en la salud respiratoria, 66.9%, a otras consecuencias en la vida diaria, 2.2%. Los predictores de percibir la contaminación como grave/muy grave son: a) que la asocien con la posibilidad de causar la muerte (RM= 1.35, IC 95%= 1.02-1.77), y b) asistencia a escuelas en la zona de La Merced (RM= 2.23, IC 95%= 1.56-3.21). CONCLUSIONES: Los determinantes de la percepción para esta población de adolescentes son: género, zona de ubicación de la escuela y las diferencias en la calidad del aire percibidas en la ciudad/colonia/plantel educativo. Lo anterior permite sugerir que en la política ambiental debe incorporarse el componente de la focalización, de tal manera que los programas ambientales sean más eficientes en el ámbito local.OBJECTIVE: Analyze the relations established between air pollution and health-disease-death in a sample of students in Mexico City. MATERIAL AND METHODS: Survey of 1274 students from 14 secondary schools in five areas in Mexico City was conducted between March and April of 2003. We used a multi-stage sampling, based in a basic geostatistical areas (AGEB). RESULTS: A total of 84.4% believed that Mexico City has a high, or very high air pollution; that valuation decreases as it approaches the most immediate place in which the students live. The health risks range from effects on respiratory health, 66.9%, to other effects on daily life, 2.2%. The predictors that air pollution is perceived as serious/very serious are: 1) that they associate it with the possibility of causing death (OR= 1.35, 95% CI=1.02-1.77), and 2) that they attend schools located in the La Merced zone, (OR= 2.23, 95% CI= 1.56-3.21). CONCLUSIONS: Determinants of perception, such as gender, zone where the school is located and the differences in air quality perceived in the city/area/schools, suggest that focalizing components must be involved in environmental policies, in order to make environmental programs more effective at the local level.

Estudios epidemiológicos han demostrado la relación entre los contaminantes atmosféricos y el incremento en la mortalidad por causas cardiovasculares, en especial en personas con enfermedad cardiopulmonar previa. Sin embargo, los mecanismos fisiopatológicos mediante los cuales estos padecimientos ocurren no son bien conocidos. Se ha sugerido que una de las vías mediante las cuales las partículas suspendidas respirables y otros contaminantes producen su efecto es alterar la regulación del corazón por el sistema nervioso autónomo. El análisis de los cambios en la variabilidad de la frecuencia cardiaca (VFC) es un indicador de efecto sobre este mecanismo. En este trabajo se realiza una revisión de las bases fisiológicas de este método, de sus ventajas y limitaciones y de los resultados que se obtienen al relacionarlo con la exposición a contaminantes atmosféricos. A partir del análisis de la literatura disponible, se sugieren alternativas relacionadas con el diseño de los estudios, la selección de poblaciones en riesgo, los métodos para evaluar la exposición y los métodos de análisis estadístico que pueden servir para utilizar mejor el análisis del registro electrocardiográfico ambulatorio en relación con los riesgos cardiacos por exposición a contaminantes atmosféricos.Epidemiological studies have shown the association between atmospheric pollutants and increase in mortality due to cardiovascular causes, especially in patients with previous cardio-respiratory diseases. However, the pathophysiological mechanisms by which these events take place have not been elucidated. One of the proposed mechanisms by which suspended respirable particles and other pollutants produce their effect is that they modify autonomic heart control. The analysis of changes in heart rate variability (HRV) is an indicator of pollutant effect on this mechanism. The article reviews the physiologic basis of this non-invasive method, its advantages and disadvantages, and the results obtained to date through HRV analysis associated with air pollution. After reviewing the available literature, we suggest alternatives for study design, selection of risk population, exposure assessment methods, and statistical analysis methods that may be used to improve the analysis of the ambulatory ECG record to assess the cardiac risk related to exposure to air pollution.

ABSTRACT Objective To assess the status of the legal framework for air quality control in all countries of Latin America and Caribbean (LAC); to determine the current distribution of air monitoring stations and mean levels of air pollutants in all capital and large cities (more than 100 000 inhabitants); and to discuss the implications for climate change and public policymaking. Methods From January 2015–February 2016, searches were conducted of online databases for legislation, regulations, policies, and air pollution programs, as well as for the distribution of monitoring stations and the mean annual levels of air pollution in all LAC countries. Results Only 117 cities distributed among 17 of 33 LAC countries had official information on ground level air pollutants, covering approximately 146 million inhabitants. The annual mean of inhalable particles concentration in most of the cities were over the World Health Organization Air Quality Guidelines; notably, only Bolivia, Peru, and Guatemala have actually adopted the guidelines. Most of the cities did not have information on particulate matter of 2.5 microns or less, and only a few measured black carbon. Conclusions The air quality regulatory framework should be updated to reflect current knowledge on health effects. Monitoring and control of ground level pollutants should be extended and strengthened to increase awareness and protect public health. Using the co-benefits of air pollution control for health and climate as a framework for policy and decision-making in LAC is recommended.