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A preliminary study on aflatoxin exposure by urine biomonitoring in Chile
(2022) Foerster, Claudia; Monsalve, Liliam; Maldonado, Carlos; Cortés Arancibia, Sandra; Ferreccio, Catterina; CEDEUS (Chile)
We assessed the occurrence of aflatoxin M1 (AFM1) in urine in a sample of the MAUCO population-based cohort (n = 120) using an enzyme-linked immune sorbent assay (ELISA) kit specially designed for the analysis of AFM1 in urine. We found AFM1 in the urine of 59% of the participants (> limit of detection), with 12% of the samples being over the limit of quantification. The mean of the quantifiable samples was 0.66 (± 0.35) ng/mg adjusted creatinine, ranging from 0.31 to 1.39 ng/mg creatinine. The mean probable daily intake (PDI) of AFB1 was 0.23 (± 0.37) ng/kg bw according to the upper bound (UB), being significantly higher in women and 0.14 (± 0.23) ng/kg bw in the modified lower bound (mLB) approach, ranging from 0.01 to 1.98 ng/kg bw. The risk of AFB1 was assessed with the margin of exposure (MOE) approach estimated at 2800 in the mean mLB and 1733 in the mean UB. According to the MOE values obtained in this study, aflatoxin B1 exposure must be considered a public health concern and must be taken as a priority for food risk management.
Air pollution and environmental epidemiological evidence in Chile: alerts for decision-makers and citizens
(2023) Cortés Arancibia, Sandra; CEDEUS (Chile)
Air pollution in Chile presents unique challenges, exacerbated by inequalities and geographical and climatic diversity. Current policies have not succeeded in aligning air quality with international and national standards, nor have they significantly mitigated public health impacts, despite being more advanced than those in other Latin American countries. The evidence on the health damages caused by air pollution is compelling, showing harmful acute and chronic effects across various life stages. Yet, current measures do not effectively reduce exposure to pollutants. The monitoring network, which reports data from stationary and mobile sources, does not always detect early fugitive emissions and is limited to regulated pollutants, leaving areas without adequate monitoring coverage and without management plans for critical episodes outside of autumn and winter and for a reduced number of pollutants. In the context of climate change, which increases the frequency of forest fires, Chile is experiencing a deterioration of air quality, highlighting the need to expand critical episode management beyond the current Air Pollution Prevention and/or Atmospheric Decontamination Plans. Integrated intersectoral plans need to be improved and extended to address the high exposure to pollutants, due to the large number of people exposed, and a broad population health risks, including quality of life. Decarbonisation by 2040 based on the Sustainable Development Goals is an important pillar of the strategy, but a public debate is needed to establish additional actions for addressing environmental injustice, improving equity and reducing current exposure to air pollutants.
An integrated study of health, environmental and socioeconomic indicators in a mining-impacted community exposed to metal enrichment
(2019) Moya, Pablo M.; Arce, Guillermo J.; Leiva Cisternas, Cinthya Aracely; Vega, Alejandro S.; Gutierrez Muñoz, Santiago Yvan; Adaros, Héctor; Muñoz, Luis; Pastén González, Pablo Arturo; Cortés Arancibia, Sandra; CEDEUS (Chile)
The occurrence of toxic metals and metalloids associated with mine tailings is a serious public health concern for communities living in mining areas. This work explores the relationship between metal occurrence (e.g., spatial distribution in street dusts), human health indicators (e.g., metals in urine samples, lifestyle and self-reported diseases) and socioeconomic status (SES) using Chanaral city (in northern Chile) as study site, where a copper mine tailing was disposed in the periurban area. This study model may shed light on the development of environmental and health surveillance plans on arid cities where legacy mining is a sustainability challenge. High concentrations of metals were found in street dust, with arsenic and copper concentrations of 24 +/- 13 and 607 +/- 911 mg/kg, respectively. The arsenic concentration in street dust correlated with distance to the mine tailing (r = - 0.32, p-value = 0.009), suggesting that arsenic is dispersed from this source toward the city. Despite these high environmental concentrations, urinary levels of metals were low, while 90% of the population had concentrations of inorganic arsenic and its metabolites in urine below 33.2 mu g/L, copper was detected in few urine samples (< 6%). Our results detected statistically significant differences in environmental exposures across SES, but, surprisingly, there was no significant correlation between urinary levels of metals and SES. Despite this, future assessment and control strategies in follow-up research or surveillance programs should consider environmental and urinary concentrations and SES as indicators of environmental exposure to metals in mining communities.
Assessment of Mycotoxin Exposure in a Rural County of Chile by Urinary Biomarker Determination
(2021) Foerster, Claudia; Ríos-Gajardo, Gisela; Gómez, Patricia; Muñoz, Katherine; Cortés Arancibia, Sandra Isabel; Maldonado, Carlos; Ferreccio Readi, Fresia Catterina; CEDEUS (Chile)
Aflatoxin B1 (AFB1), ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are frequent mycotoxins that may cause carcinogenic, mutagenic, estrogenic, or gastrointestinal effects. The aim of this study was to assess the exposure to and risk from AFB1, OTA, ZEN, and DON in 172 participants of the Maule Cohort (MAUCO) by a biomarker analysis in urine and to associate their exposure with food consumption and occupation. Mycotoxins in the first morning urine were analyzed by solid-phase extraction and quantified by Ultra-High-Performance Liquid Chromatography with a mass–mass detector. Participants’ information regarding food consumption, occupation, and other characteristics was obtained from a baseline and 2-year follow-up survey of the cohort. The prevalence and mean levels of mycotoxins in the urine were as follows: DON 63%, 60.7 (±78.7) ng/mL; AFB1 8%, 0.3 (±0.3) ng/mL; α-zearalenol (α-ZEL) 4.1%, 41.8 (±115) ng/mL; β ZEL 3.5%, 17.4 (±16.1) ng/mL; AFM1 2%, 1.8 (±1.0) ng/mL; OTA 0.6% (1/172), 1.3 ng/mL; and ZEN 0.6%, 1.1 ng/mL. These results were translated into exposures of DON, ZEN, and aflatoxins of public health concern. Participants who consumed coffee and pepper the day before had a significantly greater presence of DON (OR: 2.3, CI95 1.17–4.96) and total ZEL (OR: 14.7, CI95 3.1–81.0), respectively, in their urine. Additionally, we observed associations between the habitual consumption of beer and DON (OR: 2.89, CI95 1.39– .42). Regarding the levels of mycotoxins and the amount of food consumed, we found correlations between DON and nuts (p = 0.003), total ZEL and cereals (p = 0.01), and aflatoxins with capsicum powder (p = 0.03) and walnuts (p = 0.03). Occupation did not show an association with the presence of mycotoxins in urine.
Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019
(2023) Ríos-Blancas, María Jesus; Pando-Robles, Victoria; Razo, Christian; Carcamo, César P.; Mendoza, Walter; Pacheco-Barríos, Kevin; Miranda, J. Jaime; Lansingh, Van Charles; Demie, Takele Gezahegn; Saha, Manika; Okonji, Osaretin Christabel; Yigit, Arzu; Cahuana-Hurtado, Lucero; Chacón-Uscamaita, Pamela R.; Bernabe, Eduardo; Culquichicon, Carlos; Chirinos-Caceres, Jesus Lorenzo; Cárdenas, Rosario; Alcalde-Rabanal, Jacqueline Elizabeth; Barrera, Francisco J.; Ayala Quintanilla, Beatriz Paulina; Shorofi, Seyed Afshin; Nuwan, Darshana Wickramasinghe; Nuno, Ferreira; Louay, Almidani; Vivek, Kumar Gupta; Hanie, Karimi; Alayu, Daniel Shewaye; Benziger, Catherine P.; Takeshi, Fukumoto; Ebrahim, Mostafavi; Elrashdy, Moustafa Mohamed Redwan; Mesfin, Gebrehiwot; Khaled, Khatab; Ai, Koyanagi; Krapp, Fiorella; Lee, Seung; Noori, Maryam; Qattea. Ibrahim; Rosenthal, Victor Daniel; Sakshaug, Joseph W.; Wagaye, Birhanu; Iman, Zare; Ortega-Altamirano, Doris V.; Murillo-Zamora, Efrén; Vervoort, Dominique; Santos Silva, Diego Augusto; Abderrahim, Oulhaj; Herrera-Serna, Brenda Yuliana; Mehra, Rahul; Mehrdad, Amir-Behghadami; Nasrin, Adib; Cortés Arancibia, Sandra; Anh, Kim Dang; Binh, Thanh Nguyen; Ali, H. Mokdad; Hay, Simon I.; Murray, Christopher J. L.; Lozano, Rafael; García, Patricia J.; CEDEUS (Chile)
Background Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance.MethodsUsing estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region.ResultsThe Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region.ConclusionIn the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.
La amenaza del cambio climático a la salud de la población y la necesidad urgente de actuar
(2020) Palmeiro Silva, Yasna Karina; Cifuentes, Luis A.; Cortés, Sandra; Olivares, Macarena; Silva, Ignacio; CEDEUS (Chile)
Climate change is associated with negative health outcomes, such as cardiovascular and respiratory diseases. This article analyses the threat of climate change on population health and the urgent need to implement measures to avoid this damage. Heat vulnerability, heatwave exposures, and wildfire exposure to forest fires have increased in Chile. In 2018, the annual mean concentration of fine particulate matter (PM2.5) exceeded the safe level proposed by the World Health Organization, increasing the risk of negative health outcomes. Thus, multidisciplinary and inter-sectoral mitigation and adaptation policies are needed. Among other elements, mental health impacts of climate change, health education provided by health workers to reduce negative health impacts of climate change, greater engagement of academia to generate evidence useful for policy-making processes and a better articulation between central and local governments should be considered. Finally, achieving a healthy population should be the aim of all these policies and efforts.
Local and regional sources of organochlorine pesticides in a rural zone in central Chile
(2022) Llanos Castillo, Yasna Jovita; Cortés Arancibia, Sandra; Martínez, Andrés; Pozo, Karla; Přibylová, Petra; Klánová, Jana; Jorquera, Héctor; Cortés Arancibia, Sandra; Hurtado-Epstein, Andrea; Buss, Daniel F.; Hartinger, Stella M.; CEDEUS (Chile)
There is a lack of knowledge about exposure to airborne organochlorinated pesticides (OCPs), especially for people living near agricultural zones in developing countries. This study is the first one to measure spatiotemporal variation of airborne OCPs within a major agriculture area in Central Chile. Polyurethane foam passive air samplers (PUF-PAS) were deployed in five sites in the town of Molina (35°7′S, 71°17′W) and another one in the nearby town of Lontué (35°3′S, 71°17′W). Samplers were deployed from August 2016 to January 2018, in 8 periods lasting 2–3 months each. The measured concentrations in air (pg m−3) as geometric mean were α-HCH: 0.59, γ-HCH: 3.8, o,p'-DDT: 1.3, p,p'-DDT: 2.0, o,p'-DDE: 0.52, p,p'-DDE: 5.5, o,p'-DDD: 0.26, p,p'-DDD: 0.64, PeCB: 29.1 and HCB: 14.5. The highest concentrations were measured in the warmer months and negative correlations (p < 0.05) between the log of the concentrations and the inverse of ambient temperature were found, suggesting soil volatilization as the main release process. The exceptions were o,p'-DDE, p,p'-DDE and HCB. In the case of HCB, waste burning was a likely source. Most OCP concentrations showed significant spatial heterogeneity (p < 0.05), suggesting local source contributions are dominant; the exceptions are α-HCH and PeCB (p > 0.05) whose concentrations depend on regional sources. Backward wind trajectories obtained using NOAA's HYSPLIT identified air masses coming from the south and southwest when ambient concentrations are highest; these regional sources contribute to all ambient OCP concentrations.
Relationship between Wildfire Smoke and Children’s Respiratory Health in the Metropolitan Cities of Central-Chile
(2022) Ciciretti, Rebecca; Barraza, Francisco; Barrera, Francisco de la; Urquieta, Lorna; Cortés, Sandra; CEDEUS (Chile)
Socio-spatial differentiation in a Latin American metropolis: urban structure, residential mobility, and real estate in the high-income cone of Santiago de Chile
(2023) Fuentes Arce, Luis; Ramírez Silva, María Inés; Rodríguez, Sebastián; Señoret, Andrés; CEDEUS (Chile)
The High-Income Cone (HIC) is characteristic of the urban structure of Latin-American metropolises, consisting of a delimited area of the city where inhabitants of high socioeconomic status are located, consolidating the patterns of social segregation and inequality that are typical of those societies. Despite the urban transformations experienced by the metropolises of the continent in the last decades, little study has been done to understand the internal dynamics of HICs, which are usually considered a socially homogeneous space. This article delves into the internal complexities of the HIC of Greater Santiago, investigating its residential mobility processes and distinguishing between traditional and recent inhabitants, or ‘inheritors’ and ‘achievers’. Our results indicate the presence of parallel processes of residential mobility, where ‘achievers’ are concentrated in the apartments located in the pericentral zone of the HIC, while ‘inheritors’ move to the houses located in the extreme east. This process of permeability and filtering is conditioned by the recent trends of neoliberal urban densification and expansion, where the construction of more accessible buildings allows the arrival of certain people to the pericentral areas of the HIC, while the more exclusive houses and gated-communities far east are more accessible for inheritors.

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