Salud Ambiental Modulo de Capacitacion

Presentación del tema: "Salud Ambiental Modulo de Capacitacion"— Transcripción de la presentación:

1 Salud Ambiental Modulo de Capacitacion
Aire Interior Salud Ambiental Modulo de Capacitacion

2 Nuevas preocupaciones EN PAISES INDUSTRIALIZADOS
El AMBIENTE Y LA SALUD Nuevas preocupaciones EN PAISES INDUSTRIALIZADOS Enfermedades respiratorias y calidad del aire Obesidad / nutrición / diabetes Ambiente "construido" Daño neurológico Defectos de nacimiento Autismo Cáncer infanto-juvenil Disrupción endócrina Origen fetal de la enfermedad adulta ? PRINCIPALES FACTORES RIEGOS GLOBALES (OMS) Agua insegura Higiene y saneamiento Contaminación del aire Enfermedades transmitidas por vectores Peligros químicos Lesiones no intencionales y accidentes Esta diapositiva compara los temas que representan las principales preocupaciones "globales" con aquellos informes realizados en países industrializados. Los niños de TODOS los países se encuentran expuestos a factores de riesgo ambiental. Entonces, el riesgo varía de país en país, a veces dentro del mismo país y en las diferentes comunidades (Ej.: urbana y rural). Es útil comparar los temas preocupantes en países en desarrollo y países industrializados: Principales factores de riesgos globales – determinados por OMS- que han sido descriptos, los factores de riesgo “básico” que resultan en una alta morbilidad y mortalidad; y preocupaciones específicas tanto de la comunidad científica como del público en los países más industrializados - que se refieren más a los resultados que pueden ser atribuibles a factores de riesgo ambientales. Esto es una lista de enfermedades y efectos sobre el desarrollo que son relacionados a causas ambientales observados en niños - incluso si en algunos casos no hay prueba científica de los procesos. <<LEA LA DIAPOSITIVA.>>

3 World Health Report, 2002, www.who.int/whr/2002/en/
Every year, almost 11 million children die before the age of % of pneumonia deaths are preventable. This slide helps us to view the air pollution problem in context. There are many problems facing children, and this slide shows that environmental health problems contribute to the “burden of disease” in children from birth to 4 years of age. DALY stands for “disability adjusted life years” and is a common measurement unit for morbidity and mortality. DALYs reflect the total amount of healthy life lost, to all causes, whether from premature mortality or from some degree of disability during a period of time. The attractiveness of this measurement lies in the fact that it combines information about morbidity and mortality in a single number. DALYs allow the losses due to disability and the losses due to premature death to be expressed in the same unit. According to the World Health Report (2002), the biggest contributor to poor health in the world’s children is underweight. The second most important contributor is unsafe water, sanitation and hygiene, and the third most important contributor is indoor smoke from solid fuels. As you can see, in 2002 ambient (outdoor) air pollution contributed far less to poor health in young children. This is not to say that it is not important. But its influence on young children’s health is comparatively less than that of indoor air pollution because young children spend most of their time indoors where levels of air pollution can be much higher that levels outdoors. Ref: World Health Report, 2002, World Health Report, 2002,

4 Links between exposure and health
Housing and shelter Water supply Food Sanitation and hygiene Solid waste Air pollution Hazardous chemicals Radiation Noise Road traffic Social environment Vector-borne diseases Natural hazards All-cause and infant mortality Nutritional diseases Diarrhoeal diseases Other infectious parasitic diseases Respiratory diseases Cancers and tumours Circulatory diseases Birth defects and perinatal conditions Eye and ear diseases Accidents and injuries Poisonings Mental/behavioural disorders As we consider interconnections between environmental exposures and health status in children, we need to stress the many-to-many links that exist between environment and health. These links are not set in stone. Additional evidence adds to the body of knowledge regarding the level of evidence between the environmental exposure and the health effect. They are open to debate and challenge – and will certainly vary geographically. Each of the red boxes, however, represents point at which environment might affect health – and therefore where indicators have a role. This matrix already begins to illustrate some of complexities of environmental health indicators, for it shows that we cannot design indicators to be read as simple expression of a single environmental risk factor causing a single health effect. This diagram, however, is itself a major simplification of the reality underneath. For each of these boxes represents a linkage between environment and health; and each link between environment and health represents a process or a system. Within each of these boxes, therefore, we need not one indicator, but many if we are to capture the issue in full, and know how and where to act. Ref: Briggs D. Making a Difference: Indicators to Improve Children's Environmental Health. Geneva, World Health Organization, 2003. Briggs 2003

5 Los 10 Contaminantes ( o Grupos) de Interés global para la OMS
Plaguicidas altamente Peligrosos Contaminantes del aire interior Partículas , Monóxido de carbono, Vapores Orgánicos, Plomo, Mercurio Benceno (COV) Arsénico Fluor COPs: contaminantes orgánicos persistentes Asbestos

6 Poblaciones vulnerables niños
Ingieren mas agua, mas comida y respiran mayor volumen de aire que los adultos en relación a su peso Comportamiento mano-boca/juegos en el piso mayor absorción digestiva metabolismo inmaduro en los primeros meses ( protección? en algunos casos) tejidos en crecimiento rápido años para desarrollar efectos a largo plazo diferencias en la expresión clínica retardan el diagnóstico

7 A MÁS PEQUEÑAS LAS VÍAS RESPIRATORIAS, MAYOR VULNERABILIDAD
Diagrama del efecto del edema en el diámetro transversal de las vías aéreas (R = radio) Adulto Recién nacido de término Si tiene 1 mm de edema Si tiene 1mm de edema The effect of oedema on the adult airway is much less dramatic that it is on the newborn’s airway. One millimetre of oedema reduces the diameter of the adult airway by about 19% while it reduces the diameter of the infant airway by 56%. Compared to that of adults, the peripheral airway (bronchioles) is both relatively and absolutely smaller in infancy allowing intralumenal debris to cause proportionately greater obstruction. In addition, infants have relatively larger mucous glands, with a concomitant increase in secretions. They also have the potential for increased oedema because their airway mucosa is less tightly adherent. Lastly, there are fewer interalveolar pores (Kohn’s pores) in the infant, producing a negative effect on collateral ventilation and increasing the likelihood of hyperinflation or atelectasis. The resting minute ventilation normalized for body weight in a newborn infant (400 cc/min/kg) is more than double that of an adult (150 cc/min/kg). Ref: Bar-on. Bronchiolitis. Prim Care, 1996, 23:805. Picture: - Copyright protected material used with permission of the authors: Drs. Michael and Donna D'Alessandro - and the University of Iowa's Virtual Hospital,

8 CALIDAD DEL AIRE INTERIOR
INFLUENCIADA POR: Contaminación del aire exterior: vehículos y plantas industriales. Humo de tabaco de segunda mano Combustibles utilizados para calentar y cocinar. Materiales de construcción Costumbres, hábitos o tradiciones Espacio, cohabitantes y ventilación In summary, indoor air quality is influenced by concentrations of outdoor air pollutants, indoor sources of pollution, characteristics of the building and the habits of the residents. Indoor air pollution may arise from the use of open fires, unsafe fuels or combustion of biomass fuels, coal and kerosene. Gas stoves or badly installed wood-burning units with poor ventilation and maintenance can increase the indoor levels of carbon monoxide, nitrogen dioxide and particles. Other pollutants not associated with fuel combustion include building materials such as asbestos and cement, wood preservatives and others. Volatile organic compounds may be released by various sources including paints, glues, resins, polishing materials, perfumes, spray propellants and cleaning agents. Formaldehyde is a component of some household products and can irritate the eyes, nose and airways.

9 PRODUCTOS DE COMBUSTIÓN
Recursos Cocinas a gas Estufas de leña y carbón Gas y motores de propano Chimeneas Humo de cigarrillo Velas e incienso Espirales mata mosquitos Productos de combustión Monóxido de Carbono (CO) Dióxido de Nitrógeno (NO2) Dióxido de Sulfuro (SO2) Compuestos nitrogenados (Nx) Material particulado (MP) A large number of combustion products originate from various different sources. The main ones are listed here. <<READ SLIDE>>

10 Combustion dentro del Hogar
muertes por IRA en < 5 años ( ½ debido al uso de combustibles fósiles) Tendencia creciente de “sibilantes” % de Individuos 10 20 30 40 50 60 70 80 % 4 - 10% > 10% % Carboxihemoglobina en Tancuime Junio 2005 Cotinina (-) OMS Fuente : Carbón y biomasa: The home is the first indoor environment a child will know. It should be a safe and healthy place. <<READ SLIDE>> Picture: WHO, C. Gaggero. Child housework, Costa Rica. IRA: Infección respiratoria aguda

11 COMBUSTION PARA COCINAR O CALEFACCIONAR PRODUCE HUMO
Madera Residuos de la agricultura Carbón vegetal Carbón Estiercol que contiene como mínimo : Partículas finas Monóxido de Carbono (CO) Hidrocarburos aromáticos policíclicos (HAP) <<READ SLIDE>> Girls are at most risk as they are often requested to help their mothers with household chores. Infants are exposed to pollutants when carried on the backs of their mothers as they tend fires. Irritation that would not affect adults may result in severe obstruction or damage to children’s lungs because they are more vulnerable. Ref: Environmental Threats to Children, in: Children in the New Millennium, Environmental Impact on Health. UNEP, UNICEF & WHO, 2002. OMS

12 NIVELES DE PARTICULAS DEL AIRE INTERIOR
En 24 hs de uso de biomasa en el hogar se acumulan: 1000 µg/m3 Puede alcanzar hasta µg/m3 PM10 (si el fuego es abierto) Según EPA *: la media anual es 50 µg/m3 PM10 Las mujeres y niños pequeños ESTAN MAS TIEMPO EN EL HOGAR Standards and guidelines EPA standards are illustrated here. 150 µg/m3 PM10 is the 24-hour 99% percentile value, thus only to be exceeded on 1% of occasions. The recommended annual mean limit is 50 µg/m3 PM10 (PM10 are respirable particles ≤ 10 µ in diameter). Levels of pollution in homes using biomass fuel Numerous studies have shown that the levels of particulates are very high, with 24-hour means of around 1000 µg/m3 PM10, and even exceeding µg/m3 PM10 when sampling is carried out during use of an open fire. It is reasonable to compare the EPA recommended annual mean limit of 50 µg/m3 PM10 with the typical 24-hour mean for a home in which biomass fuel is used, of 1000 µg/m3 PM10 quoted, as this latter value is typical of the level every day (thus, annual mean levels can be expected to be around 1000 µg/m3 PM10). This comparison shows that average pollution levels are around 20 times the EPA recommended limit. Ambient pollution and personal exposure Two important components are (a) the level in the home, and (b) the length of time for which each person in the home is exposed to that level. We know that typically women and young children (until they can walk), and girls (as they learn kitchen skills) are often exposed for at least 3-5 hours a day, often more. In some communities, and where it is cold, exposure will be for a much longer period each day. Ref: Addressing the links between indoor air pollution, household energy and human health. Based on the WHO-USAID Consultation on the Health Impact of Household Energy in Developing Countries (Meeting report)..World Health Organization, 2002. Additional information on these references can be found at: Picture: Nigel Bruce/ITDG. Used with permission. Nigel Bruce/ITDG * EPA : Agencia de Protección Ambiental de EEUU)

13 EFECTOS ADVERSOS DE LA CONTAMINACION DEL AIRE
<<READ SLIDE>>

14 EXPOSICIÓN A MONÓXIDO DE CARBONO
POST PRE EXPOSICIÓN A MONÓXIDO DE CARBONO Estufas Ecologicas Dr. Díaz Barriga UASLP. México Curso Sitios Contaminados 14

15 El ambiente interior también refleja la calidad del aire exterior.
Actividades industriales o agrícolas Partículas del suelo contaminado Aerosoles, gases y Vapores Tránsito Manejo de desechos sólidos Accidentes y derrames químicos Indoor environment also reflects outdoor air quality and pollution. Outdoor pollution primarily results from the combustion of fossil fuels by industrial plants and vehicles. This releases carbon monoxide, sulfur dioxide, particulate matter, nitrogen oxides, hydrocarbons and other pollutants. The characteristics of emissions and solid waste disposal may vary for each specific industry (e.g. smelting, paper production, refining and other). Picture: WHO, J. Vizcarra. Environmental Air Pollution OMS

16 MONÓXIDO DE CARBONO Intoxicacion potencialmente MORTAL
Síntomas: Niveles de CoHb Dolor de cabeza, vértigo, fatiga, disnea 10% Náuseas, vómitos Irritabilidad % Somnolencia, confusión, desorientación 40% Inconciencia, coma 60% Muerte % Retraso neuro-psicológico, secuelas Incremento COHb The route of exposure is through inhalation. Unintentional exposure to CO can be attributed to smoke inhalation from inadequately vented combustion appliances, and from vehicles and tobacco smoke. The clinical features of CO poisoning are highly variable and symptoms vary from mild to very severe. Acute effects are due to the formation of carboxyhaemoglobin in the blood, which inhibits oxygen intake. At moderate concentrations, angina, impaired vision, and reduced brain function may result. At higher concentrations, exposure to CO can be fatal. Delayed neuropsychological sequelae have been reported in adults and children; these usually occur 3 to 240 days following exposure and are estimated to occur in 10 to 30% of victims. Ref: California Poison Control System. Poisoning and drug overdose. Ed: Olson. Appleton and Lange, 1999. <<READ SLIDE>>

17 HUMO DE TABACO DE SEGUNDA MANO ALCANCE DEL PROBLEMA
Niños cuyas madres fuman: 70% más problemas respiratorios 38% más frecuencia de neumonía y la hospitalización en el primer año de vida La mortalidad infantil es 80% mayor 20% de todas las muertes infantiles podrían ser evitadas si las madres embarazadas fumadoras dejaran de fumar en la 16a semana de gestación Riesgo 5 veces mayor de presentar Síndrome de Muerte Infantil Súbita Children whose mothers smoke have an estimated 70% more respiratory problems than children whose mothers do not smoke. Pneumonia and hospitalization in the first year of life is 38% more frequent in children whose mothers smokes. Infant mortality was 80% higher in children born to women who smoked during pregnancy than in children of nonsmokers. An estimated 20% of all infant deaths could be avoided if all pregnant smokers stopped by the 16th week of gestation. Infants of mothers who smoke have almost 5 times the risk of sudden infant death syndrome (SIDS) than infants of mothers who do not smoke. Smoke released from cigarettes, cigars and pipes is composed of more than 3800 different substances. Air-borne particulate matter is 2–3 times higher in homes of smokers. Exposure may occur at home, school, in child care settings, in relatives´ homes and other places. The importance of the need to reduce exposure to second-hand smoke justifies prohibiting smoking at home, in schools and in child care facilities. SHTS is covered extensively in a separate module. Refs: Etzel, Indoor Air Pollutants in Homes and Schools, Pediatric Clinics of North America (2001) 48 (5): 1153 Wisborg, Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life,Am J Epidemiol. (2001)154(4):322 The authors examined the association between exposure to tobacco smoke in utero and the risk of stillbirth and infant death in a cohort of 25,102 singleton children of pregnant women scheduled to deliver at Aarhus University Hospital, Aarhus, Denmark, from September 1989 to August Exposure to tobacco smoke in utero was associated with an increased risk of stillbirth (odds ratio = 2.0, 95% confidence interval: 1.4, 2.9), and infant mortality was almost doubled in children born to women who had smoked during pregnancy compared with children of nonsmokers (odds ratio = 1.8, 95% confidence interval: 1.3, 2.6). Among children of women who stopped smoking during the first trimester, stillbirth and infant mortality was comparable with that in children of women who had been nonsmokers from the beginning of pregnancy. Conclusions were not changed after adjustment in a logistic regression model for the sex of the child; parity; or maternal age, height, weight, marital status, years of education, occupational status, and alcohol and caffeine intake during pregnancy. Approximately 25% of all stillbirths and 20% of all infant deaths in a population with 30% pregnant smokers could be avoided if all pregnant smokers stopped smoking by the sixteenth week of gestation.

18 FUENTES DE EXPOSICIÓN AL PLOMO
Principales Fuentes: Pinturas viejas en los hogares : pica y contaminación del aire con partículas Transito : Aditivo a las naftas( controlado en 2004) Cañerías viejas: agua Suelos contaminados por industrias , fundiciones, reciclado de baterías... Utensilios de cocina : Cerámica vidriada OMS Condiciones de alto riesgo: renovaciones, rasqueteado de punturas , remoción de tierra

19 PLOMO : impacto sobre el NEURODESARROLLO segun OMS
12 millones de niños en los países en desarrollo sufren de alguna forma de daño permanente debido al envenenamiento por plomo Cientos de millones de niños y mujeres embarazadas están expuestos a diferentes fuentes de plomo Cerca de 3.5% de los retardos mentales en todo el mundo son atribuídos al envenenamiento por plomo El impacto es observable mas como efecto sobre la salud publica que en lo individual Children are the major victims of lead poisoning. Current estimates from WHO are that about 15 to 18 million children in developing countries may suffer permanent brain damage due to lead poisoning. Ref: Prüss-Üstün. Lead exposure. In: Ezzati eds. Comparative quantification of health risks. Geneva, World Health Organization, 2004. <<READ SLIDE.>>

20 PLOMO : PRINCIPAL IMPACTO EL NEURODESARROLLO INFANTIL Significancia de 5 puntos de reduccion del CI El “ Effecto Weiss" A 5-point loss in IQ might not affect the ability of an individual to live a productive life. But if that loss is experienced by an entire population, the implications for that society could be profound. Bernard Weiss, a behavioural toxicologist at the University of Rochester, USA, examined the societal impact of seemingly small losses of intelligence. Imagine an unaffected population numbering 260 million people (such as that of the USA) with an average IQ of 100 and a standard deviation of 15 (left-hand graph). In that population there would be 6 million people with IQs above 130 and 6 million below 70. A decrease in average IQ of 5 points would shift the distribution to the left (right-hand graph). The number of people scoring above 130 would decline by 3.6 million while the number below 70 would increase by 3.4 million. Picture adapted from Schettler. In harm' s way. GBPSR, Used with permission. Schettler, GBPSR, 2000

21 Plaguicidas: FUENTES Y LUGARES DE EXPOSICION...
Aplicación dentro y fuera del hogar Control de mosquitos Aplicación Profesional/domestica Pediculosis / scabiosis Pulgas y Garrapatas en mascotas Residuos detectados Polvo, suelo,mobiliario,alfombras,juguetes, alimentos... Patio de recreo, canchas, plazas de juego, jardines, parques Preservantes de madera en estructuras de juego Pesticide application Professional application of pesticides both indoors and outdoors is used increasingly commonly for the control of rodents, cockroaches, ants, termites, earwigs and other pests. Signs and symptoms of pesticide-related-illnesses have been described after indoor and outdoor spraying. Domestic use of insecticides is also a source of exposure. Insecticides formulated as sprays, strips and baits are widely available. Certain topical pharmaceuticals for direct application on children’s skin or scalp contain insecticides to control lice or scabies. Their use carries a risk of acute (chronic if repeated) overexposure. High doses or applications lasting a long time have caused acute poisoning. There are many pharmaceuticals described in the International pharmacopoeia that contain organophosphorus (malathion) and organochlorine (lindane) pesticides still being used to treat head lice. Such products may contains up to 2% of pesticide. Dogs and cats are often treated with insecticides to control fleas or ticks. Veterinary products can be as concentrated as agricultural ones. Pet dips for treatment of flea infestations usually contain organophosphate and pyrethroid pesticides. Children are often involved in pet care. Pesticide residues Insecticides may persist in house dust, in soil tracked in from outdoors, in carpets, toys, food and furniture. High levels of insecticides have been measured for weeks after professional application. Residues of organophosphorus insecticides sprayed in indoor environments have been reported to occur on floors, carpets, children’s toys, furniture, bed covers and in dust. Poor hygiene habits or houses that are difficult to clean increase the risk of exposure. Playgrounds, playing fields, lawns and gardens may be routinely sprayed in order to keep insects away. Pesticides are found in recreational waters (lakes, rivers and in pools (algaecides)). Persistent wood preservatives such as arsenic/ copper/chromium mixtures have been used on play structures. The persistent organic pollutants (POPs) include nine pesticides. Refs: Bass. What is been used at home: a household pesticide survey. Rev Panam Salud Publica, 2001, 9:138. CDC Surveillance for acute insecticide related illness associated with mosquito control efforts Nine States 1999–2002 ( Fields. Caution – children at play: How dangerous is CCA? EHP, 2001, 109 A262 (ehp.niehs.nih.gov/docs/2001/109-6/focus.html) Forrester. Epidemiology of lindane exposures for pediculosis reported to poison centers in Texas, 1998–2002. J Toxicol - Clin Toxicol, 2004, 42:55. Lemus. Chlorpyrifos: an unwelcome pesticide in our homes. Rev Environ Health, 2000, 15:421. WHO. The physical school environment, information series on school health, Document 2. Geneva, World Health Organization, 2003. Picture: WHO WHO

22 FUENTES Y LUGARES DE EXPOSICION
Niños que viven en granjas o areas agricolas estan expuestos : a la deriva de plaguicidas desde los campos tratados al suelo contaminado en su entorno a equipos y ropas contaminadas cuando juega alrededor del los campos tratados cuando ayuda a sus familiares con la aplicacion … o en baños de animales si es un niño que trabaja en el campo The rural setting is of particular importance for children and young adults. Children may be exposed to pesticide drift from fields that are being sprayed. Acute “unintentional" poisoning, is possible when small children play with pesticide bottles and colourful containers that have been discarded in their playing areas. Highly concentrated pesticides may be stored in rural homes. Parents who are farm-workers or applicators may bring pesticides into the home through contaminated clothes, shoes or equipment. Children may accompany their parents and help them with their tasks. Infants who are still being breastfed are often carried by their mothers in the fields. Children may help with agricultural tasks or may be allowed to play around the sprayed field. Re-entry intervals (the time required before it is safe to return to a treated area) are not always respected or may be established on the basis of criteria that ensure adult safety only. Concern is increasing about child labour and young workers. Although few data are available, it is generally assumed that children make up a substantial part of the agricultural workforce in developing countries. They could be at a higher risk because they are less experienced and assertive than adults; they may lack protective equipment and receive less training or none at all. Refs: Calvert. Acute pesticide-related illnesses among working youths, Am J. Public Health 2003, 93: 605. Quandt. Agricultural and residential pesticides in wipe samples from farmworker family residences in North Carolina and Virginia. Environ Health Perspect, 2004, 112:382. Picture: L. Corra. Child working with pesticides, Argentina. Used with permission. Corra

23 VIVIR EN EL AMBIENTE RURAL...
Aumento del nivle de metabolitos de organofosforados (DAF) paralelo a la aplicación de pesticidas en un area rural Numerous studies on children’s exposure have demonstrated the absorption of pesticides. Pesticide metabolites are used as biomarkers of exposure, and children often have higher levels than adults. Younger children may have higher levels than older ones. Levels of pesticides were associated with residence in rural areas AND with domestic use of pesticides. The figure shows levels of dialkylphosphates (DAP) in children living in agricultural areas. Levels were measured in many samples taken over 1 year and were found to increase in parallel with  periods of pesticide application. Refs: Aprea. Biologic monitoring of exposure to organophosphorus pesticides in 195 Italian children. Env Health Perspect , 2000, 108:521. Koch. Temporal association of children's pesticide exposure and agricultural spraying: report of a longitudinal biological monitoring study. Env Health Perspect, 2002, 110:829. We measured organophosphorus (OP) pesticide exposures of young children living in an agricultural community over an entire year and evaluated the impact of agricultural spraying on exposure. We also examined the roles of age, sex, parental occupation, and residential proximity to fields. We recruited 44 children (2–5 years old) through a Women, Infants, and Children clinic. We collected urine samples on a biweekly basis over a 21-month period. Each child provided at least 16 urine samples, and most provided 26. We analysed samples for the dialkylphosphate (DAP) metabolites common to the OP pesticides. DAP concentrations were elevated in months when OP pesticides were sprayed in the region's orchards. The geometric means of dimethyl and diethyl DAPs during spray months were higher than those during nonspray months (p = for dimethyl; p = for diethyl). Dimethyl DAP geometric means were 0.1 and 0.07 micro mol/L for spray months and nonspray months, respectively (57% difference); diethyl DAP geometric means were 0.49 and 0.35, respectively (40% difference). We also observed differences for sex of the child, with male levels higher than female levels (p = for dimethyl; p = for diethyl). We observed no differences due to age, parental occupation, or residential proximity to fields. This study reports for the first time the temporal pattern of pesticide exposures over the course of a full year and indicates that pesticide spraying in an agricultural region can increase children's exposure in the absence of parental work contact with pesticides or residential proximity to pesticide-treated farmland. Loewenherz. Biological monitoring of organophosphorus pesticide exposure among children of agricultural workers in Central Washington State. Environ Health Persp 1997, 105:1344. Figure: ehp.niehs.nih.gov/members/2002/110p koch/koch-full.html Reproduced with permission from Environmental Health Perspectives Koch EHP, 2002, 110 (8): 829

24 Plaguicidas Efectos asociados a la exposición ambiental
Efectos cutáneos y respiratorios Alteraciones del neurodesarrollo Cáncer inmuno supresión

25 SOLVENTES Y COMPUESTOS VOLÁTILES ORGÁNICOS
Álcalis, hidrocarburos aromáticos, alcoholes, aldehídos, cetonas Fuentes: Solventes, suavizantes, desodorantes y productos de limpieza. Pinturas, pegamento, resinas, ceras y materiales para pulir. Sprays propelentes, líquidos de limpieza en seco. Lápices y marcadores. Carpetas y plastificantes Cosméticos: sprays para el cabello, perfumes Organic chemicals are widely used as ingredients in household products including paints, varnishes, wax, cosmetics, degreasing agents, wood preservatives, aerosol sprays, cleansers, disinfectants, moth repellents, air fresheners and hobby products. Fuels are also made up of organic chemicals. All of these products can release organic compounds while they are being used, and, to some degree, when they are stored. The average levels of several organic compounds in indoor air are 2–5 times higher than in outdoor air. During certain activities, such as paint-stripping, and for several hours immediately afterwards, levels may be 1000 times higher than outdoor levels. These notes are taken from the US EPA Website

26 COVs típicos Alcohol isopropilico metil-etil-cetona cloruro de metileno eter metilico naftaleno estireno tolueno xileno Acetaldehido Acetona Benceno Tetracloruro de carbono Acetato de etilo Formaldehído etilenglicol Hexano Heptano

27 ESPIRALES MATA MOSQUITOS
Utilizados en hogares de África, Asia, América del Sur Componente principal activo – piretrina Productos de combustión : formaldehido! La exposición prolongada está relacionada al asma y sibilancias El humo contiene partículas, todas < 1 micrón Mosquito coils may represent a serious potential threat to children’s health. Prolonged use has been associated with increased incidences of asthma and persistent wheezing in children. Although the active ingredient is usually small amounts of pyrethrins (considered a low toxicity insecticide), over 99% of the mass of the coil is so-called “inert” ingredients. When analysed, the smoke from coils was found to be entirely composed of respirable-sized particles, some quite small. The particles contain numerous PAH and carbonyl compounds including formaldehyde. One recent analysis found that the burning of one mosquito coil for 2 hours allowed a steady state of particulate matter to develop, and that the PM2.5 produced was the equivalent of that from burning 75–137 cigarettes (the formaldehyde produced was the equivalent of 51 cigarettes). Ref: Liu, Mosquito Coil Emissions and Health Implications Environ Health Perspect (2003) 111:1454. Burning mosquito coils indoors generates smoke that can control mosquitoes effectively. This practice is currently used in numerous households in Asia, Africa, and South America. However, the smoke may contain pollutants of health concern. We conducted the present study to characterize the emissions from four common brands of mosquito coils from China and two common brands from Malaysia. We used mass balance equations to determine emission rates of fine particles (particulate matter < 2.5 µm in diameter; PM2.5), polycyclic aromatic hydrocarbons (PAHs), aldehydes, and ketones. Having applied these measured emission rates to predict indoor concentrations under realistic room conditions, we found that pollutant concentrations resulting from burning mosquito coils could substantially exceed health-based air quality standards or guidelines. Under the same combustion conditions, the tested Malaysian mosquito coils generated more measured pollutants than did the tested Chinese mosquito coils. We also identified a large suite of volatile organic compounds, including carcinogens and suspected carcinogens, in the coil smoke. In a set of experiments conducted in a room, we examined the size distribution of particulate matter contained in the coil smoke and found that the particles were ultrafine and fine. The findings from the present study suggest that exposure to the smoke of mosquito coils similar to the tested ones can pose significant acute and chronic health risks. For example, burning one mosquito coil would release the same amount of PM2.5 mass as burning cigarettes. The emission of formaldehyde from burning one coil can be as high as that released from burning 51 cigarettes. Inciensos?

28 Espirales mata mosquitos Limpiadores y desodorantes del hogar
FORMALDEHÍDO Fuentes: Espirales mata mosquitos Limpiadores y desodorantes del hogar Pegamentos y resinas Humo de tabaco Plastificante de Pisos Muebles y Maderas prensadas Espuma aislante Ref:

29 CONTAMINANTES OCUPACIONALES EN EL HOGAR INCLUYENDO AIRE
Exposición relacionada al trabajo paterno que se " lleva al hogar": Contaminación de la ropa, zapatos, piel Aire exhalado contaminado Envases vacíos de plaguicidas u otros químicos llevados al hogar Los niños están directamente expuestos cuando: Visitan a sus padres al lugar de trabajo Participan en el trabajo( tareas rurales) Prevención No llevar la ropa de trabajo y ducha final de jornada. Clothing contaminated with pesticides and other chemicals can be an important source of exposure for children and a source of indoor air contamination. Exposures of family members to pesticides have occurred from contact with contaminated skin, clothing or shoes, contamination of the family car, and during visits to the workplace. Parents should avoid hugging children or playing with them after coming home from work until they have showered and changed their clothes.

30 ACCIONES LOCALES PARA REDUCIR LA CONTAMINACIÓN DEL AIRE INTERIOR
No Fumar ( s/t en hogares con niños) Eliminar o controlar las fuentes de contaminación Extracción de humo ( mantenimiento ) Mantenimiento regular de las cocinas, sistemas de calefacción y asegurar ingreso de aire Preferir Combustibles limpios ( gas) o electricidad Preferir materiales y componentes de construcción no volátiles . Ventilación/ Diseño del edificio Ventilación de ambientes interiores : Diluir y remover Tiempos de espera para aplicaciones de plaguicidas o renovaciones contaminantes It is always best to prevent rather than treat illness. To avoid problems due to indoor air quality, the first approach is source reduction and elimination, and the second, proper ventilation and maintenance of gas, oil and solid fuel cooking, heating and cooling systems. Air cleaning is the least effective, and most expensive. Air fresheners, which contain untested potentially harmful VOCs, should not be used to cover up stale or unpleasant smells. Ref: For more information on indoor air pollution, you can have access to a guide (Indoor pollution: An introduction for health professionals) recently published by EPA at:

31 ACCIONES PARA REDUCIR LA CONTAMINACIÓN DEL AIRE INTERIOR
Los filtros de aire pueden quitar algunas partículas Evitar dispersión regular de aerosoles ( ej: desodorantes) en el aire interior Limpieza húmeda ( evitar levantar polvo) Evitar cocinar con agua caliente de la cañería ( si se sospecha plomo) Utilizar protección cuando se remueven suelos o pinturas sospechosas de tener plomo Retirar a los niños cuando se remueven esos materiales

32 OMS ESTANDAR DE CALIDAD DE AIRE EXTERIOR
Ozone 100 ug/m3 8 hours NO ug/m3 1 hour CO 30 mg/m3 1 hour SO ug/m minutes PM ug/m hours PM ug/m hours Lead 0.5 ug/m3 1 year In countries with strong air pollution laws and good enforcement, air quality has improved significantly in the latter half of the 20th century. WHO has generated air quality standards for the major “criteria” air pollutants. Reductions to these levels offers significant health benefits. The guidelines include different averaging times. For example: Carbon monoxide:100,000 ug/m3 with averaging time of 15 minutes 60,000 ug/m3 with averaging time of 30 minutes 30,000 ug/m3 with averaging time of 1 hour 10,000 ug/m3 with averaging time of 8 hours Ref: WHO Air Quality Guidelines. Global Update Available at: WHO Air Quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Available at:

33 Rol de los profesionales de la salud ( OMS)
Recognize environmental risk factors for children's health Understand how environment affects children's health outcomes Take exposure histories Contribute to knowledge on children's environmental health The health care providers – from the paediatrician to the nurse, from the primary health care worker to the family doctor, and other relevant providers – are in a privileged position and play a key role in detecting the environmental threats to children's health because they are in direct contact with the child, his or her family and community. "Front-line" health care providers – those dealing with children’s health issues on a regular basis – have specific roles and responsibilities in recording environmental and health data. They should be able to: Recognize clinical, subclinical and potential effects of environmental risk factors on children's health. This requires the capacity to identify potential exposure to chemical, physical and biological agents and determine their effects on children's health and development. Understand the mechanisms of action – learn how environmental risk factors cause or trigger different diseases (e.g. respiratory, gastrointestinal or neurological) or how they may be linked to developmental problems or potential reproductive, endocrine and neurobehavioural effects. Take a thorough exposure history – ask the right questions and record the information in an appropriate place (the clinical record!). Contribute to research and knowledge generation – the data on environment and health that have been collected, collated and analysed provides valuable information to fill knowledge gaps and contribute to research. All this knowledge will enable more effective assessment of children’s environmental health and help monitor the success or failure of interventions to address specific children’s environmental health problems at the local, national and international level. This is a critical step in the prevention of environment-related diseases. Ref: Guide and instructions for the implementation of the Green Page Environmental Health Diagnostics. Geneva, Switzerland. World Health Organization, Children's Environmental Health ( accessed 10 September 2007). WHO

34 Historia clínica ambiental
La Hoja Verde Describes a child's known or possible environmental exposures Builds capacity for healthcare professionals Provides a basis for alerting authorities to environmental problems that need to be corrected Provides information about positive effects of the environment The Green Page is a new tool that forms part of the clinical history and can be used in symptomatic and asymptomatic patients. It adds a new element to the medical record: a description of the environment that surrounds the child, exposure characteristics (real or potential) and its possible effects. In addition, it allows medical personnel to become aware of the environment that children live in, and that of the mothers, fathers, families and communities. This kind of information improves clinical service for the child. It also builds the capacity of healthcare professionals responsible for the well-being of children, and alerts the authorities about those environmental situations that need to be corrected or mediated. Ref: Guide and instructions for the implementation of the Green Page Environmental Health Diagnostics. Geneva, Switzerland. World Health Organization, Children's Environmental Health ( accessed 10 September 2007). Photo credit: WHO WHO

35 La Hoja Verde Instrument for recording a child's environmental conditions Aids the healthcare provider in assessing the underlying cause of disease Identifies the most vulnerable patients and groups Records a history of exposure The Green Page is an instrument for the harmonious recording of information about the child’s environmental conditions in all the places where the child's life develops. The Green Page allows the healthcare professional to engage in environmental diagnostics, to characterize positive or negative factors and to detect the most vulnerable individuals or groups (for example, children living in poverty; children living in marginalized zones or in settlements with no basic sanitation infrastructure, or children exposed to pesticides). In cases where a child is ill, documentation of the environmental conditions provides the elements to suggest or establish, if present, an environmental etiology. The periodical registry of the Green Page allows for a longitudinal view of the environment and the environmental history of an individual patient. These environmental diagnostic records will allow the identification of possible antecedents and emergent clinical causes that may be expressed later, during adolescence and adulthood. Finally the Green Page may be used to construct environmental health indicators. Detailed information on the green page, and how to use it, is available at WHO's website. Ref: Guide and instructions for the implementation of the Green Page Environmental Health Diagnostics. Geneva, Switzerland. World Health Organization, Children's Environmental Health ( accessed 10 September 2007). Photo credit: WHO WHO