Strengthening National Public Health: first steps towards the Spanish Public Health Agency

Issue/Problem

The social, ecological, health and economic crisis exacerbated by COVID-19 is a challenge of extraordinary magnitude and complexity for global public health. Part of the response to these challenges requires strong public health institutions.

Description of the problem

Component 18 of the Government of Spain’s Recovery, Transformation and Resilience Plan proposes the creation of a Spanish Agency of Public Health (SAPH), a centre of excellence to perform surveillance and health system preparedness functions in the face of new or emerging public health threats. The government has opened the debate on what design and functions it should have.

Results

SESPAS, the Spanish Society of Public Health and Public Administration, set out a proposal for the design and organization of the future Spanish Agency for Public Health [SAPH]. A large working group, made up of experts from various fields of public health and from its ten federated scientific societies, has designed the SAPH proposal. The scope of the public health functions to be assumed include: the strategic planning of the State’s public health (including health security), the prioritisation of public health policies and communication strategies, the assessment of the population’s health status and social conditions, the guarantee of the transversality and horizontality of health policies (health and health equity in all State policies), as well as their verticality (serving as an enriching link between the European Union level and the administrations of the Autonomous Communities and local authorities). The proposal also include 11 recommendations on the main elements to be taken into account in the establishment of the future SAPH.

Lessons

COVID19 pandemic has highlighted the need of creating strong public health institutions. Spain is giving its first steps toward the creation of the SAPH, which constitute a key step in addressing the current and future challenges of public health in Spain.

Key messages

• Spanish Public Health Agency is an opportunity to transform health policies and to improve the health of the Spanish population.

• Strengthening public health starts with building national institutions that ensure comprehensive and integrated health policies.

Neurocognitive reorganization of emotional processing following a socio-cognitive intervention in Colombian ex-combatants

Ex-combatants often exhibit atypical Emotional Processing (EP) such as reduced emphatic levels and higher aggressive attitudes. Social Cognitive Training (SCT) addressing socio-emotional components powerfully improve social interaction among Colombian ex-combatants. However, with narrow neural evidence, this study offers a new testimony. A sample of 28 ex-combatants from Colombian illegal armed groups took part in this study, split into 15 for SCT and 13 for the conventional program offered by the Governmental Reintegration Route. All of them were assessed before and after the intervention with a protocol that included an EP task synchronized with electroencephalographic recordings. We drew behavioral scores and brain connectivity (Coherency) metrics from task performance. Behavioral scores yielded no significant effects. Increased post-intervention connectivity in the delta band was observed during negative emotional processing only SCT group. Positive emotions exposed distinctive gamma band connectivity that differentiate groups. These results suggest that SCT can trigger covert neurofunctional reorganization in ex-combatants embarked on the reintegration process even when overt behavioral improvements are not yet apparent. Such covert functional changes may be the neural signature of compensatory mechanisms necessary to reshape behaviors adaptively. This novel framework may inspire cutting-edge translational research at the crossing of neuroscience, sociology, and public policy-making.

Comparative removal of emerging contaminants from aqueous solution by adsorption on an activated carbon

Batch sorption experiments were performed to study the adsorption of six emerging pollutants from aqueous solutions using a commercial granular activated carbon as adsorbent. Caffeine, clofibric acid, diclofenac, gallic acid, ibuprofen and salicylic acid were selected as representative contaminants. The activated carbon was characterized by nitrogen adsorption at 77 K, and through the determination of point of zero charge. The effects of several operational parameters, such as pH, initial concentration of organic molecules, mass of adsorbent and contact time, on the sorption behaviour were evaluated. The contact time to attain equilibrium for maximum adsorption was found to be 40 min. The kinetic data were correlated to several adsorption models, and the adsorption mechanism found to follow pseudo-second-order and intraparticle-diffusion models with external mass transfer predominating in the first 15 min of the experiment. The equilibrium adsorption data were analysed using the Freundlich, Langmuir and Toth isotherm equation models. The similar chemical structure and molecular weight of the organic pollutants studied to make the adsorption capacity of the activated carbon used very similar for all the molecules.

[Proximal humeral resurfacing. Whats today indication?]

INTRODUCTION

Data published in the literature about humeral resurfacing prostheses are not conclusive with good functional results but with large differences in the revision rate. The aim of our study was to evaluate the clinical and functional outcomes in patients operated at our center.

MATERIAL AND METHODS

Retrospective study of 19 cases in 18 patients. Follow-up of 31 (12-61) months. Surgery was indicated in cases of primary or secondary osteoarthritis. Demographic data, Constant scale, DASH questionnaire, complications and satisfaction were analyzed. Three patients were lost to follow-up due to death unrelated to surgery.

RESULTS

Mean age of 56 (25-80) years. Constant normalized of 73 (23-104) points. DASH questionnaire of 31 (7-84) points. Ninety four percent of the patients resumed their recreational activities and 81% sports activities. In seven cases, inferior conflict in the glenoid with varus implant was observed radiologically. There were five complications; a conservatively resolved capsulitis, three reinterventions due to symptomatic inferior glenoid usury and another to uncontrollable pain in a conservative way. Patients without rotator cuff lesion presented better scores on the functional questionnaires. All patients were satisfied with the symptomatic improvement over the previous situation and would be operated again if necessary.

CONCLUSIONS

The functional outcomes reported are similar to those previously published and, based on them, we believe that the resurfacing prosthesis is an option to be considered in cases of primary or secondary osteoarthritis when there is no rotator cuff injury, regardless of age.

The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition.

METHOD

We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP).

RESULTS

Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills.

CONCLUSIONS

Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.

Phosphodiesterase 10 inhibitors: new disease modifying drugs for Parkinson's disease?

Phosphodiesterases (PDEs), as key regulators of cyclic nucleotides, and their inhibitors have been emerged as new pharmacological targets and promising drug candidates for many diseases, including central nervous system pathologies. The high level of PDE10A expression in the striatal medium spiny neurons suggests a prominent function role for the isoenzyme. Basal ganglia dysfunction is associated with neuropsychiatric disorders and until recently the development of PDE10A inhibitors has been focused on schizophrenia. Currently, the pharmaceutical research on PDE10A inhibitors is moving to show the modulation of other functions associated with the basal ganglia such the motor control. Thus, PDE10A inhibitors may be important pharmacological agents for neurodegenerative disorders such as Parkinson's and Huntington's diseases. Recent data supporting new clues for PDE10A as therapeutic target together with a concise review of the chemical structures of its inhibitors are provided here. The goal of this manuscript is to provide new ideas for assistant pharmacologist and medicinal chemists in the search for PDE10A inhibitors as new disease modifying drugs for Parkinson's disease.

Differential PbP27 expression in the yeast and mycelial forms of the Paracoccidioides brasiliensis species complex

p27 is an antigenic protein produced by Paracoccidioides brasiliensis, the etiologic agent of paracoccidioidomycosis (PCM). Despite its unknown function, it has been suggested as a putative virulence factor, proposed as a suitable target for the design of diagnostic tools and vaccines, and considered as an enhancer in antifungal treatment of PCM. We evaluated sequence polymorphisms of PbP27 gene sequence among isolates, finding some polymorphisms associated with the isolates' phylogenetic origin. In order to determine if there was a differential expression pattern between morphological states and among isolates, we also evaluated PbP27 expression, at transcriptional and translational levels, in mycelia and yeast cultures in 14 isolates belonging to the P. brasiliensis species complex (S1, PS2, PS3, and "Pb01-like", proposed to be named Paracoccidioides lutzii) by two techniques, real time RT-PCR (RT-qPCR) and protein dot blot. For the latter, four protein extracts from different cell localizations (SDS or β-mercaptoethanol, cytoplasmic and extracellular proteins) were analyzed for each isolate. p27 was present in the four extracts evaluated, mainly in the SDS extract, corresponding to an extract containing proteins loosely attached to the cell wall. This information correlates with immunohistochemical analysis, where positive staining of the yeasts' cell wall was observed. We found that p27 was present in all isolates, mainly in the yeast form. This pattern was corroborated by RT-qPCR results, with higher expression levels found in the yeast form for most of the isolates. The results provide new insights into the expression patterns of this protein, and further characterize it in view of potential uses as a diagnostic and/or therapeutic tool.

Heart rate variability in type 2 spinocerebellar ataxia

OBJECTIVES

To explore cardiovascular autonomic regulation in Spinocerebellar ataxia type 2 (SCA2) patients, using heart rate variability (HRV) analysis and neurophysiologic autonomic reflex tests, and determine relations and causal related factors of dysautonomia in SCA2.

MATERIALS AND METHODS

Heart rate variability indices for 5 min series of RR intervals were analyzed in 97 SCA2 patients, assessed quantitatively for somatic and autonomic nervous system complaints applying the International Cooperative Ataxia Rating Scale and Scales for Outcomes in Parkinson's disease (SCOPA-AUT), respectively. Autonomic testing included: resting control, standing, Valsalva maneuver and deep breathing.

RESULTS

Mean RR, long- and short-term variability indices and spectral density power (LF, HF) indices were lower in the patients group, whereas LF/HF ratio and LF (nu) were higher. Highly differences between groups were observed for seven diagnostic autonomic test indices. Significant correlations were found between different clinical and demographic indices and between clinical indices and some HRV indices.

CONCLUSIONS

We confirm the presence of cardiovascular autonomic dysfunction in a large group of SCA2 patients.

Glycoproteins histochemistry of the gills of Odontesthes bonariensis (Teleostei, Atherinopsidae)

The histochemistry of glycoproteins (GP) in the mucous cells of the gills of the silverside Odontesthes bonariensis was identified with: (1) oxidizable vicinal diols; (2) sialic acid and some of their chain variants, carbon 7 ((7) C), carbon 8 ((8) C) or carbon 9 ((9) C); (3) sialic acid residues without O-acyl substitution and with O-acyl substitution at (7) C, (8) C or (9) C; (4) carboxyl groups and (5) sulphate groups. A battery of seven biotinylated lectins allowed GPs sugar residues to be distinguished. Mucous cells showed the presence of neutral, sulphated and sialylated GPs. Dolichos biflorus agglutinin (DBA) and Glycine max agglutinin (SBA) showed strong positive staining; Arachis hypogaea agglutinin (PNA), Ricinus communis agglutinin-I (RCA-I) and Triticum vulgaris agglutinin (WGA) showed moderate staining, while Ulex europaeus agglutinin-I (UEA-I) was completely negative.

Presence and expression of the mating type locus in Paracoccidioides brasiliensis isolates

Paracoccidioides brasiliensis has been classified in the phylum Ascomycota, order Onygenales, family Ajellomycetaceae, even in the absence of a known sexual cycle or mating system. The objective of this work was to determine the presence of the mating type locus in 71 P. brasiliensis isolates from various sources. A PCR assay using specific primers for the MAT 1 gene was developed and applied for the detection of such genes. Two heterothallic groups (MAT1-1 or MAT1-2) were recognized and, in some isolates, gene expression was confirmed indicating the existence of a basal gene expression. The distribution of two mating type loci in the studied population suggested that sexual reproduction might occur in P. brasiliensis. This finding points towards the possibility of applying a more precise definition of the concept of biological species to P. brasiliensis. Further studies should be conducted to confirm the sexual capacity of this fungus and its implications among phylogenetic species and geographical distribution.

[Thrombolysis in Madrid: is there improvement in the 4 years temporal analysis?]

INTRODUCTION

Thrombolysis in acute ischemic stroke (IS) is limited by the short time window. However, this can be improved with adequate coordination of all the professionals and procedures involved in acute stroke treatment.

PATIENTS AND METHODS

A multicenter, observational, prospective study conducted in IS patients treated with intravenous recombinant tissue plasminogen activator between January 2003 and May 2007 was performed. A descriptive analysis of epidemiologic and clinical variables was conducted. Temporal analysis of safety, efficacy and quality parameters was carried out with the Auto-Regressive Integrated Moving Average (ARIMA) (p, d, q) models.

RESULTS

From January 2003 to 2007, 324 patients were included (56% males; median age: 65.6). A total of 53.6 % became independent at 3 months (score 0-2 on the Modified Rankin Scale). Mortality rate 3 months after treatment was 15.7% and 3.7% suffered symptomatic intracranial bleeding. The temporal analysis showed a significant increase of thrombolysis, from a mean of 2 procedures per month to 20 (p<0.0001). There was a significant increase in the percentage of 3-month independent patients (0.83% [ARIMA] (1, 0, 1) p<0.0001).

CONCLUSIONS

Intravenous thrombolysis is a safe and effective procedure for the treatment of IS in the clinical practice. As the experience of all the professionals involved in IS treatment increases, the number of patients who receive iv rtPA increases, with better outcome. Temporal analysis by ARIMA models is useful in planning health policies.

Parental occupational exposure to organic solvents and anencephaly in Mexico

OBJECTIVE

To assess the relationship between parental occupational exposure to organic solvents, and the risk of anencephaly in Mexico.

METHODS

A case-control study was conducted based on the registers of the Epidemiological Surveillance System for Neural Tube Defects in Mexico; 151 cases of anencephaly of > or =20 weeks' gestation were included. A control, born alive and without any apparent congenital malformations at birth, was selected for each case in the same maternity service in which the case was born. Information on occupational exposures, lifestyle habits, reproductive history, use of medicines, supplementation with multivitamins and folic acid, was obtained by a general questionnaire; a food frequency questionnaire was also applied to obtain information of daily intake of folate and other B vitamins. Occupational exposure to organic solvents was based on job title as a proxy for exposure and analysed considering two critical periods around conception.

RESULTS

In logistic regression analysis, the odds of having a child with anencephaly was higher if the mother or the father was occupationally exposed to organic solvents during the periconceptional period, or when both parents or at least one of them were occupationally exposed during this period with an adjusted odds ratio of 2.97 (95% CI 1.36 to 6.52).

CONCLUSIONS

The results support the hypothesis that both maternal and paternal occupational exposure to organic solvents can increase the probability of having a child with anencephaly.

Pectoral fins of Micropogonias furnieri: a histochemical and ultrastructural study

The myotomal fibres of the pectoral fins of white croaker (Micropogonias furnieri) have been studied using histochemical techniques and transmission electron microscopy (TEM). Succinic dehydrogenase (SDH) for mitochondria, periodic acid Schiff (PAS) for glycogen, Sudan Black for lipids and myosin-adenosintriphosphatase (mATPase) pre-incubated at alkaline and acid pHs were used to visualize the contraction velocity. Three zones were determined: superficial (SZ), medium (MZ) and deep (DZ). Staining for SDH, PAS and Sudan Black was positive only in the SZ. The level of alkaline mATPase was the highest in fibres from the DZ, intermediate in the MZ and low in the SZ; at an acid pH, the reverse was obtained. Fibres from the SZ were small with large quantities of subsarcolemmal mitochondria, scarce intermyofibrilar mitochondria and a well-developed sarcoplasmic reticulum; the myofibrils displayed a polygonal distribution along the entire length of the fibre. Fibres in the MZ were larger than those in the SZ, the myofibrils were densely packed, mitochondria prevailed under the sarcolemma and the sarcoplasmic reticulum was not abundant. Fibres from the DZ were the largest, with ribbon-shaped myofibrils and scarce mitochondria. The intercellular space was abundant and nervous endings were frequently observed.

Morphological and histochemical characteristics of the epithelium of ovarian lamellae of Genypterus blacodes (Schneider, 1801)

The physiological significance of the glycoproteins (GPs) secreted by the epithelium of ovarian lamellae is discussed in reference to the reproductive biology of G. blacodes. Histochemical procedures for localising and characterising GPs were used to determine the cytoplasmic components of cells of the epithelium that covers the ovarian lamellae of pink cuskeel, Genypterus blacodes (Schneider, 1801) (Pisces, Ophidiidae), during spawning. This species is one of the most valuable demersal fish resources in the Argentine Sea, mainly due its large size and flesh quality. GPs with oxidizable vicinal diol groups, sialic acid with or without O-acyl substituents, O-acyl sugars, neutral sugars and GPs with carboxyl and sulphate groups were detected. Light microscope examination showed morphological changes in the epithelium of ovarian lamellae during the spawning season, associated with a secretory activity of mucus. Optical density studies revealed the presence of polyploid cells encompassing those morphological changes. Results of the present study suggest that the epithelium of ovarian lamellae of G. blacodes performs a secretory role, which is intensified during ovarian maturity, suggesting that G. blacodes could release masses of eggs enveloped in mucus.

A qualitative study about immigrant workers' perceptions of their working conditions in Spain

BACKGROUND

Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions.

METHODS

Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain.

RESULTS

Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions.

CONCLUSIONS

The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Maternal and paternal occupational exposure to agricultural work and the risk of anencephaly

AIMS

To evaluate the association between parental occupational exposure to agricultural work and the risk of anencephaly in three Mexican states.

METHODS

A paired case control study (1:1) was done based on records of the Epidemiological Surveillance System of Neural Tube Defects in Mexico; 151 cases of anencephaly of more than 20 weeks' gestation were selected between March 2000 and February 2001. Controls were selected from the same maternity services as those of the cases and were born alive without congenital malformations. Information was obtained from both parents by means of a general questionnaire, a food frequency questionnaire, and a specific questionnaire on occupational exposure to pesticides. Exposures were analysed with emphasis on the three months before and one month after the last menstruation periods (acute risk period (ARP)), as well as exposure prior to the above mentioned period (non-acute risk period (NARP)).

RESULTS

The children of mothers who worked in agriculture in the ARP had a greater risk of anencephaly (OR = 4.57, 95% CI 1.05 to 19.96). The risk of fathers having a child with anencephaly was greater in those who applied pesticides irrespective of whether it was done in the ARP or the NARP (OR = 2.50, 95% CI 0.73 to 8.64; and OR = 2.03, 95% CI 0.58 to 7.08, respectively).

CONCLUSIONS

These results support the hypothesis of the effect of maternal exposure to agricultural work on anencephaly and suggest that exposure of the father to pesticides in the periconceptional period or prior to this can also increase the risk of having an anencephalic child.

[Pure alexia secondary to progressive multifocal leukoencephalopathy as first manifestation of HIV infection]

INTRODUCTION

Pure alexia, or alexia without agraphia, is usually caused by disconnection between the gyrus angularis and visual areas of both hemispheres. Cerebrovascular disease is the most frequent cause of this syndrome.

CLINICAL CASE

We report the first case of a patient with pure alexia secondary to progressive multifocal leukoencephalopathy (PML) as the first manifestation of Human Immunodeficiency Virus (HIV) infection. Polymerase chain reaction in cerebrospinal fluid was positive for JC virus. Despite favorable immunological and virological response to highly active antiretroviral therapy, neurological symptoms and demyelinating lesions progressed during the first months, and right homonyous hemianopsia, acalculia, and color anomia were noted. In magnetic resonance imaging (MRI) demyelinating lesions involved white matter of both occipital lobes, with left predominance, forceps major and splenium of the corpus callosum, together with white matter of the left temporal lobe and both hippocampal regions. During the following months, coinciding cidofovir treatment, the patient had partial clinical improvement, but neurological deficits persisted. The size of MRI lesions significantly improved.

CONCLUSIONS

PML is frequently the first manifestation of AIDS (acquired immunodeficiency syndrome). It should be considered as a possible diagnosis of pure alexia.

Histology and Histochemistry of the Pharyngeal Cavity and Oesophagus of the Silverside Odontesthes bonariensis (Cuvier and Valenciennes)

The histology of the pharyngeal cavity and oesophagus of the freshwater 'silverside'Odontesthes bonariensis (Cuvier and Valenciennes) and the characteristics of their mucous cells were investigated. The histological characterization of its digestive wall revealed that the mucosa is thrown with longitudinal folds. The epithelium covering the folds was stratified with abundant mucous cells and gustative corpuscles, which are lacking in the oesophagus. The muscularis mucosa was absent. The submucosa presented the compactum stratum. The muscularis was organized in longitudinal and circular layers of muscular striated fibres. The serosa with a flat epithelium was located only in the oesophagus. Using histochemical procedures including methods for localization and characterization of glycoproteins (GPs), no differences were detected between the mucous cells contents of the pharyngeal cavity and those of the oesophagus. The mucous cells showed a weak periodic acid-Schiff (PAS) positive reaction in their content. The reactions for the differential analysis of sialic acids from GPs are feeble for periodic acid-Schiff at low temperature and low pH (PA*S) and KOH/PA*S and strong for periodic acid/borohydride/KOH/PAS (PA/Bh/KOH/PAS) and KOH/PA*/Bh/PAS revealing the scarce presence of C7 or C9 substituted and non-substituted sialic acids and the abundance of C7, C8 substituted sialic acids, O-acyl sugars and neutral sugars respectively. The results suggest that the pharyngeal cavity with the gustative corpuscles would induce the gastric secretion whereas the oesophagus is mainly involved in the transport of the food bolus to the stomach with the aid of abundant secretion of mucus. GPs secreted on the surface of the mucous cells, likely related to environmental conditions, would be involved in the lubrication, protection against abrasion and inhibition of microorganism proliferation.

Histology and histochemistry of the pharyngeal cavity and oesophagus of the silverside Odontesthes bonariensis (Cuvier and Valenciennes)

The histology of the pharyngeal cavity and oesophagus of the freshwater 'silverside'Odontesthes bonariensis (Cuvier and Valenciennes) and the characteristics of their mucous cells were investigated. The histological characterization of its digestive wall revealed that the mucosa is thrown with longitudinal folds. The epithelium covering the folds was stratified with abundant mucous cells and gustative corpuscles, which are lacking in the oesophagus. The muscularis mucosa was absent. The submucosa presented the compactum stratum. The muscularis was organized in longitudinal and circular layers of muscular striated fibres. The serosa with a flat epithelium was located only in the oesophagus. Using histochemical procedures including methods for localization and characterization of glycoproteins (GPs), no differences were detected between the mucous cells contents of the pharyngeal cavity and those of the oesophagus. The mucous cells showed a weak periodic acid-Schiff (PAS) positive reaction in their content. The reactions for the differential analysis of sialic acids from GPs are feeble for periodic acid-Schiff at low temperature and low pH (PA*S) and KOH/PA*S and strong for periodic acid/borohydride/KOH/PAS (PA/Bh/KOH/PAS) and KOH/PA*/Bh/PAS revealing the scarce presence of C7 or C9 substituted and non-substituted sialic acids and the abundance of C7, C8 substituted sialic acids, O-acyl sugars and neutral sugars respectively. The results suggest that the pharyngeal cavity with the gustative corpuscles would induce the gastric secretion whereas the oesophagus is mainly involved in the transport of the food bolus to the stomach with the aid of abundant secretion of mucus. GPs secreted on the surface of the mucous cells, likely related to environmental conditions, would be involved in the lubrication, protection against abrasion and inhibition of microorganism proliferation.

Ultrastructure and Histochemical Study of Glycoconjugates in the Gills of the White Croaker (Micropogonias furnieri)

The ultrastructure of the primary and secondary lamellae of gills was investigated in a marine teleost, the white croaker. The following cells were identified and briefly described: pavement cells, mucous cells, mitochondria-rich cells and rodlet cells. These cell types are present throughout the length of the lamellae. They are studied by means of a series of carbohydrate histochemical methods, including lectin procedures. Neutral sugars and substituted sialic acid were detected by means of periodic acid-borohydride reduction-saponification-periodic acid Schiff reaction (PA/Bh/KOH/PAS), saponification-selective periodic acid Schiff reaction (KOH/PA*S) and saponification-selective periodic acid-borohydride reduction-periodic acid Schiff reaction (KOH/PA*/Bh/PAS) histochemical techniques. A battery of seven lectins was used to study binding on tissue sections at the light microscopic level to characterize glycoconjugates in gills. The reaction to Canavalia ensiformis agglutinin (Con-A), Triticum vulgaris agglutinin (WGA), and Ricinus cummunis agglutinin-1 (RCA-1) was weak in pavement cells; unlike Con-A, the reaction to WGA and RCA-1 was more intense in mucous cells. Arachis hypogaea agglutinin (PNA) lectin showed a strong reaction in mucous cells. Ulex europaens agglutinin-1 (UEA-1) lectin was negative in all cell types. The lectin pattern was similar for both primary and secondary lamellae, except for PNA reaction, which was weak in the pavement cells of the secondary lamella and negative in the pavement cells of the primary lamella.

Composition and antibacterial activity of essential oil of Lantana achyranthifolia Desf. (Verbenaceae)

The essential oil of the aerial parts of Lantana achyranthifolia Desf. (Verbenaceae) was examined by GC and GC-MS. Eighteen constituents were identified. Carvacrol, 1,8-cineole, isocaryophyllene, beta-bisabolene and alpha-bisabolol were found to be the major components. The oil exhibited antibacterial activity against fourteen Gram-positive and Gram-negative bacteria.

[Study of the pre and post-synaptic dopaminergic system by DaTSCAN/IBZM SPECT in the differential diagnosis of parkinsonism in 75 patients]

INTRODUCTION

Essential tremor (ET) may be misdiagnosed as idiopathic Parkinson's disease (PD). In neurodegenerative diseases, structural imaging, such as CT or MRI, is of limited value for differentiating parkinsonian syndromes since structural changes are often only evident by the time the disease is far advanced. Most cases of symptomatic parkinsonism are vascular parkinsonism, but PD may coexist. The differential diagnosis between Alzheimer's disease (AD) and dementia with Lewy bodies (LBD) is often difficult.

OBJECTIVE

To define the utility of functional neuroimaging test to establish differential diagnosis between PD and ET, drug induced parkinsonism, multiple system atrophy and vascular parkinsonism, and between AD and LBD, when clinical presentation, evolution or treatment response are atypical.

PATIENTS AND METHODS

A group of 75 patients with parkinsonism was examined by clinical assessment and DaTSCAN (123I-FP-CTI, dopamine transporter protein marker) and/or IBZM SPECT (D2 receptor marker). The patients were recruited from our outpatient clinic.

RESULTS

Correlation between initial clinical diagnosis and functional imaging studies (DaTSCAN and/or IBZM SPECT) in our patients did not reach that described (more than 90 %) for these techniques in previously published studies. Conclusions. According to sensitivity and sensibility reported in previous imaging studies of the pre and/or postsynaptic dopaminergic system using DaTSCAN and/ or IBZM, SPECT may be a new tool in the diagnosis of parkinsonian patients with difficult clinical diagnosis.

Paternal exposure to agricultural pesticides and cause specific fetal death

AIMS

To study the association between fetal death and paternal agricultural occupation in areas and time periods with different levels of use of agricultural pesticides.

METHODS

A total of 1 473 146 stillbirths and births occurring in Spain between 1995 and 1999 were analysed.

RESULTS

The offspring of agricultural workers had the highest risk of fetal death from congenital anomalies in the southern and eastern area (where pesticide use is greatest) and the lowest risk in the rest of Spain. In both areas the offspring of agricultural workers had a similar excess risk of fetal death from the remaining causes of death. The relative risk of fetal death from congenital anomalies in infants conceived between April and September (the months of greater use of pesticides) in the southern and eastern area was 0.90 in manual workers and 1.62 in agricultural workers, compared to non-manual workers; in individuals who were conceived during the rest of the year, the relative risk was 0.87 and 0.85, respectively. In both periods the offspring of agricultural workers had an excess risk of fetal death from the remaining causes of death.

CONCLUSIONS

Paternal agricultural work in the areas where pesticides are massively used increases the risk of fetal death from congenital anomalies. The risk is also increased for fetuses conceived during the time periods of maximum use of pesticides The higher risk of fetal death from the remaining causes of death in the offspring of agricultural workers seems unrelated to pesticide exposure.

Morphological and Histochemical Characterization of the Mucosa of the Digestive Tract in Engraulis anchoita (Hubbs and Marini, 1935)

The histomorphological aspects as well as the histochemical content and distribution of glycoproteins (GPs) in the mucosa of the digestive tract of the anchovy Engraulis anchoita were studied. The buccopharyngeal cavity is lined by a squamous stratified epithelium with mucous superficial cells; the oesophagus shows two zones, cranial with a squamous stratified epithelium with mucous superficial cells and caudal with a columnar secretory epithelium. Finally, the stomach presents both the cranial and pyloric portion lined with a simple columnar epithelium. Tubular branched glands, formed by a single type of glandular cell, located along the stomach, are more numerous in the cranial portion. The GPs were identified with (1) oxidizable vicinal diols; (2) sialic acids and some of their chain variants, C7 or C9; (3) sialic acid residues with O-acyl substitution at C7 or C8; (4) carboxyl groups and (5) sulphate groups. Histochemical tests showed that the buccopharyngeal cavity presented the largest amount of the different types of mucosubstances. Epithelial secretory cells were found in the oesophagus, which synthesized a large quantity of sialosulphoglycoproteins likely to be related to a protective role. The surface epithelium of the stomach synthesizes and secretes acid and neutral GPs, probably related to the movement of fluids and to the absorption of easily digested substrates, respectively. Although great differences exist between different species, in E. anchoita as in other fish species, the wall of the digestive tract is composed of the four layers classically described for vertebrates. The GPs secreted by the epithelial cells are suggested to be important for the protection and inhibition of microorganisms. In addition, they are involved in enzymatic digestion of food, absorptive functions and lubrication of the alimentary tract.

Inhibition of growth and induction of apoptosis in human breast cancer by transfection of gef gene

The gef gene has cell-killing functions in Escherichia coli. To evaluate the feasibility of using this gene as a new strategy for cancer therapy, we transfected it in MCF-7 cells derived from breast cancer (MCF-7TG). The gef gene was cloned in a pMAMneo vector under the control of a mouse mammary tumour virus promoter, inducible by dexamethasone (Dex), and was transfected with liposomes. After selection and induction, expression of the gef gene was confirmed by reverse transcription-polymerase chain reactions (RT-PCR) and Western blot. Cell viability was determined with a haemocytometre and the sulphorodamine B colorimetric assay, and the cell cycle was studied by propidium iodide (PI) staining. Annexin V-FITC and PI assays were used to evaluate apoptosis, which was confirmed by electron microscopy. In comparison with MCF-7 parental cells and MCF-7 cells transfected with an empty vector, MCF-7TG cells induced with Dex showed a significant decrease in proliferation rate, which was associated with evidence of apoptosis. Morphological findings confirmed apoptosis and showed a typical pattern of mitochondrial dilation. Furthermore, the cell cycle was characterised by premature progression from G(1) to S phase and G(2) delay. Our results show that the gef gene was able to decrease proliferation in a breast cancer cell line, and induce apoptosis. These findings suggest that the gef gene is a potential candidate for tumour therapy.

A glossary for research in occupational health

This glossary includes a selection of terms pertaining to the field of research in occupational health. The glossary is mostly addressed to readers not familiarised with the more specific terms used in the study and protection of workers' health. The terms have been ordered according to their logical connections, so the glossary can be read from beginning to end giving the reader an overview on occupational health research main focuses, methods, and applications.

[Quality of manuscript evaluation in Gaceta Sanitaria]

OBJECTIVE

To describe strengths and weaknesses of peer reviews of manuscripts received in Gaceta Sanitaria in order to guide reviewers selection, to improve quality of peer reviews and to establish an internal system to be incorporated to the editorial process of handling manuscripts.

METHODS

100 peer reviews of 55 manuscripts received during 2000 and 2001 were included. A questionnaire containing closed questions assessing specific and general components of reviews' quality was applied (answers Yes/No or on a 5-points scale). Descriptive and correlation analyses were performed for the different items in the questionnaire. An Index of Quality was obtained by adding the ratings on the items in the questionnaire measuring specific quality components.

RESULTS

Peer reviews were rated high regarding completeness of the forms for reviewers (84%), constructiveness of the comments (reviews over 3: 63%), identification of the strengths and weaknesses of the method (reviews over 3: 59%) and substantiation of the reviewer comments (reviews over 3: 58%). Assessment of the manuscript's relevance (reviews over 3: 40%) or originality (reviews over 3: 35%) were less frequent.

CONCLUSIONS

Quality of peer reviews in Gaceta Sanitaria is good. Some weaknesses in the reviews have been pointed out. It is possible to establish a systematic process for assessing peer reviewers using simple indicators such as general utility of the review for the editorial decision and general quality of the review.

[Pesticide application practices in agricultural workers]

OBJECTIVE

We describe the sociodemographic characteristics and determinants of pesticide exposure in agricultural workers applying pesticides.

METHODS

The workers selected were included in a case-control study carried out in the Autonomous Community of Valencia in Spain. Contact was made by telephone and individuals who had been involved in agricultural work during the relevant period of exposure were interviewed face-to-face to gain information on the following determinants of pesticide exposure: crops and periods worked, mixing of products, treatment equipment, participation in the washing of equipment, use of personal protection during the treatments and knowledge of the risks of pesticide exposure.

RESULTS

Eighty-nine workers, aged between 16 and 46 years old, were included. Most of the interviewees had primary education or less. Pesticide treatments were mostly applied on high crops (82%), with manual equipment (61%) and throughout the year (45%). Workers frequently performed tasks involving additional exposure to pesticides (mixing chemicals, 66%, or washing equipment, 60%). Sixty-five percent of the workers used no personal protection or used it defectively. No differences were found in personal protection use according to age, family income or education. Most of the workers (90%) reported knowledge of the health risks of pesticide exposure and 21% of them rated the risk as null.

CONCLUSIONS

Workers involved in pesticide application use personal protection measures very defectively. There is a clear need to develop specific prevention programs for these workers. The determinants of pesticide exposure in agricultural workers described in this study should be properly assessed in epidemiological studies of the health effects of pesticides on agricultural workers.

Mucous cells in micropogonias furnieri gills: histochemistry and ultrastructure

The characteristics of the mucous cells located in the gills of the fish Micropogonias furnieri were investigated. Using histochemical procedures that included methods for localization and characterization of glycoproteins (GPs), no differences were detected between the mucous cell contents of the primary and secondary lamellae. The GPs were identified with (a) oxidizable vecinal diols; (b) sialic acids and some of their chain variants, C7 or C9; (c) carboxyl groups and (d) sulphate groups. The electron microscope showed large mucous globules of different electro densities from mucous cells located deep in the epithelium between the other epithelial cells; the release of mucus by exocytosis was observed. GPs secreted on the surface of the mucous cells was suggested to be important for the lubrication, protection and inhibition of microorganisms. It is possibility that GPs could have similar roles in Micropogonias furnieri gills.

Ameloblastic fibrosarcoma of the mandible: report of two cases and review of the literature

Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumour. To date, 60 well-documented cases have been published in the English-language literature. Two additional cases located in the posterior region of the mandible are reported. The relevant clinicopathological features of these cases, as well as those previously reported are discussed. Approximately two-thirds of AFS are malignant tumors de novo, with an average age of the affected patients being 22.9 years. This age is lower than the one observed in AFS developing from a pre-existent benign lesion (mean 33 years). Although regional and distant metastases are very infrequent, AFS is a locally aggressive lesion, with 23 (37%) of the reported cases having at least one recurrence; 12 patients (19.3%) died of the disease. Wide surgical excision with long-term follow-up remains the treatment of choice for this neoplasm.

Childhood cancer survival in Cuba

Reports dealing with childhood cancer population-based survival have not yet been published in Cuba. A survival study including cases reported to the National Cancer Registry in the period 1988-1989 have been accomplished in the National Cancer Registry of Cuba. A comprehensive view of its results in childhood cancer is intended to be shown in this paper. All sites childhood cancer cases aged below 15 years (400) and reported in this period were included derived from a total of 578 incident cases. Vital status of cases was checked-up to December of 1994 by a mixed follow-up. Survival analysis was achieved by the life-table method using the SPSS for Windows software. Relative survival rates were not included because no differences were appreciated with the observed ones. Cases between 0-4 years and females account for the highest frequencies. Leukaemia accounts for 27% of the cases, followed by lymphomas and tumours of the central nervous system. Lymphoid and non-lymphoid acute leukaemia had 41 and 9% 5-year survival rate respectively being the latter comparable with Bangalore, India (10%). For lymphomas, Hodgkin's disease present better prognosis compared with non-Hodgkin lymphoma with 73 and 35% 5-year survival rates, respectively. Figures are comparable to the corresponding to Bangalore, India (72 and 33%, respectively). For time trends survival distribution were compared by period of diagnosis (1982/1988-1989). In all cases differences resulted statistically non-significant with lower rates for 1988-1989 except for lymphomas. International reports show increasing time trends for childhood cancer. Nevertheless, these results may serve as a milestone for future comparisons, corresponding with the creation of the National Program for Childhood Cancer Control and future studies will confirm the success of its measures.

Experts' assessment of probability and level of pesticide exposure in agricultural workers

The occupational history of the parents of 261 infants with congenital malformations and 261 matched controls was collected. During the relevant time period before the birth of their child, 183 parents were involved in agricultural activities, 49% of them having directly applied pesticides. Two experts assessed the probability and the level of exposure to each quoted pesticide (582 observations) by using 4-point scales. Interrater agreement was estimated. Kappa-weighted values for probability and level of exposure were, respectively, kappa = 0.36 and kappa = 0.39. In the analysis of some categories of exposure (non-applicators, herbicides) very low interrater agreement was observed. In epidemiological studies, detailed assessment of pesticide exposure (product-by-product) is needed to investigate the effects of pesticides on health. But the application of experts' judgment in this area needs more research in assessing the validity of this approach.

Association between M467T and 114 C-->A variants within the SLC3A1 gene and some phenotypical traits in cystinuria patients from Spain

Cystinuria is an inherited metabolic disease characterized by an abnormal urinary excretion of cystine and dibasic amino acids. Formation of renal calculi, recurrent infections and renal failure are the main complications of this disease. The SLC3A1 gene, which codes for a dibasic amino acid transporter protein, is involved in the pathogenesis of cystinuria. We investigated the possible association between molecular variants (M467T, E483X, T216 M and 114 C-->A) within the SLC3A1 gene and some phenotypical traits in a Spanish area. The study population consisted of 45 cystinuria patients, 42 cystinuria relatives and 81 healthy control subjects. Only the M467T mutation was found in chromosomes of cystinuria patients and relatives. However, the 114 C-->A polymorphism was detected in cystinuria patients, in relatives and in control subjects but with different prevalences. Moreover, a statistically significant association between this polymorphism and urinary amino acid levels was found in cystinuria patients (P<0.05). Subjects with the C/C genotype showed significantly higher urinary levels of cystine, arginine and their sum as compared with carriers of the A allele (P<0.05). When multiple linear regression analysis was performed in cystinuria patients, the 114 C-->A polymorphism remained significantly associated (P=0.047) with cystine levels even after controlling for age, gender and the M467T mutation. Furthermore, we also found a statistically significant interaction term (P=0.028) between M467T and 114 C-->A in determining urinary cystine levels. According to our results, the 114 C-->A polymorphism might be a marker of a functional variant in the SLC3A1 gene or in other genes related to urinary amino acid excretion in cystinuria patients.

DNA ploidy status and proliferative activity as markers of malignant potential in Barrett's esophagus: flow cytometric study using routinely paraffin-embedded tissue

Regular endoscopic surveillance is recommended for patients with Barrett's esophagus to detect dysplasia and to diagnose carcinoma while it is in an early and possibly treatable stage. However, there are numerous unknown aspects regarding the natural history of dysplasia in this disease, and there is still a need for more accurate markers of risk of a malignant change. The aim of this study was to investigate the usefulness of DNA flow cytometry in Barrett's esophagus to define subgroups of patients showing similar histologic findings but with a different malignancy potential. Routinely formalin-fixed and paraffin-embedded tissues of 43 patients with Barrett's esophagus were processed for flow cytometric measurements (ploidy, proliferative index) and the results were compared with the histologic evolution observed in these patients. Only in the group of patients with "indefinite" dysplasia did we find statistically significant differences between the samples from patients with and without progression to more severe lesions (mean proliferative index of stable patients: 5.2% versus 8.3% in patients with progression, p = 0.001, Student's t-test). The presence in the flow cytometric analysis of a DNA aneuploid cell line is closely related to the presence of severe histologic alterations (i.e., high-grade dysplasia: p < 0.001, Fisher's exact test). Our results suggest that this procedure is at least capable of distinguishing between a real, although incipient, neoplastic process and morphologic changes of a reactive or reparative type. The increment in the tissue proliferative index could be an indicator of an early genomic instability which, with time, will develop into lesions with a more altered DNA content: aneuploidy.

[Genetic and molecular study of cystinuria in the Valencian community]

BACKGROUND

The aim of this study has been to know the prevalence of the four most common mutations reported in SLC3A1 gene involved in human cystinuria, and to estimate the association with different phenotypic manifestations of this disease in population of the Valencian Community, Spain.

PATIENTS AND METHODS

We have carried out a cross-sectional study with a control group in 16 families with one or more members diagnosed as cystinuric patients. 149 subjects (38 cystinuric patients, 39 relatives and 72 controls) were studied. Genetic analyses were carried out using PCR (polymerase chain reaction), RFLPs (restriction fragment length polymorphisms) and sequencing of PCR products. Parametric and non parametric tests were applied in the statistical analyses.

RESULTS

None of the four mutations studied were found in the control group. M467T mutation was the most prevalent in cystinuric patients as well as in relatives, showing and allelic frequency of 0.06 and 0.03 respectively. Regarding to the association analysis between genotype and phenotype, we found that, in cystinuric subjects, urinary excretion of some dibasic amino acid was higher in those who carried M467T mutation (p < 0.05). The formation of cystine crystals was also higher in cystinuric patients who carried this mutation (p < 0.05).

CONCLUSIONS

Prevalences of recurrent mutations reported up to now in SLC3A1 gene are very low in cystinuric subjects of the Valencian Community, Spain. Only mutation M467T has been found, without differences between cystinuric and their relatives, although in the first ones was associated with a more accurate phenotype manifestation of the disease.

Identification of peptides presented by HLA class I molecules on cervical cancer cells with HPV-18 infection

In this work we eluted peptides from purified class I MHC molecules, isolated from a novel human cervical carcinoma cell line (INBL), generated in our laboratory and positive for HPV-18 infection. A fraction of these peptides was capable of stimulating T lymphocytes obtained from a donor matched for HLA-Cw4 and who was also HPV-18+. Direct N-terminal Edman degradation of these peptides, revealed the sequence (XQFPIFLQF) that matched 85% with the sequence NVFPIFLQM localized in between the 54 and 62 residues of the HPV-18 L1 protein. After stimulation with the synthetic peptide NVFPIFLQM, T lymphocytes from the donor were capable to lyse INBL cells. Our results provide evidence of the existence of naturally occurring viral epitopes presented on cervical cancer cells by the HLA-Cw4 allele, that could be useful for immunotherapy on this type of patient.

Reference values of urinary excretion of cystine and dibasic aminoacids: classification of patients with cystinuria in the Valencian Community, Spain

OBJECTIVE

Cystinuria is an autosomal-recessive disorder of the kidneys and small intestine affecting a luminal transport mechanism shared by cystine, ornithine, arginine, and lysine. Three different types of cystinuria can be distinguished according to the excretion of these amino acids in urine samples. We propose cutoff values from our population as references and we present a classification of cystinuric patients using quantitative amino acid chromatography in first morning urine samples.

DESIGN AND METHODS

A random sample of forty healthy subjects belonging to general population of the Valencian Community were selected as control subjects. Cystine, lysine, arginine, and ornithine were quantified by reverse-phase HPLC. Seventy-two subjects, diagnosed previously as cystinuric by the cyanide-nitroprusside test were classified. Probands excreting more than 113.12 micromol cystine per mmol of creatinine (i.e., 1,000 micromol cystine per gram of creatinine) were classified as homozygotes. Parents of homozygotes in whom excretion of amino acids were normal were classified as heterozygotes type I. Those probands showing the excretion of at least one amino acid and the sum of urinary cystine plus the basic amino acids higher than the corresponding references ranges in our population were classified as heterozygotes type II or type III (heterozygotes non-type 1).

RESULTS

We identified 24 homozygotes, 39 non-type I heterozygotes and 3 type I heterozygotes. The remaining 6 probands could not be classified. Means for cystine, lysine, arginine ornithine and their sum in homozygotes and heterozygotes non-type I were significantly (p < 0.001) in excess of the respective reference ranges. Moreover, means values in homozygotes were statistically different (p < 0.001) from heterozygotes non-type I.

CONCLUSION

Urinary excretion of cystine per mmol creatinine allow us to distinguish heterozygotes from homozygotes. However, the best discriminator to distinguish non-type I heterozygotes from normal population might be the excretion of lysine per mmol creatinine. Additional studies including characterization of appropriate haplotypes should be carried out for a more precise identification of types of cystinuria.

Parental agricultural work and selected congenital malformations

The authors conducted a case-control study in Comunidad Valenciana, Spain, to assess the relation between occupational exposure to pesticides, mainly as a result of agricultural work, and the prevalence of congenital malformations. A total of 261 cases and 261 controls were selected from those infants born in eight public hospitals during 1993-1994. The cases were those who were diagnosed with selected defects (nervous system, cardiovascular, oral clefts, hypospadias/epispadias, musculoskeletal, and unspecified anomalies) during their first year of life. Information on occupational exposures and potential confounding variables was collected from the parents. For the mothers who were involved in agricultural activities during the month before conception and the first trimester of pregnancy, the adjusted odds ratio was 3.16 (95% confidence interval 1.11-9.01) primarily due to an increased risk for nervous system defects, oral clefts, and multiple anomalies. Paternal agricultural work did not increase the risk, although fathers who reported ever handling pesticides had an adjusted odds ratio of 1.49 (95% confidence interval 0.94-2.35) mainly related to an increased risk for nervous system and musculoskeletal defects. Although the power of this study regarding some associations is limited, the results justify further attention to maternal agricultural work and paternal pesticide exposure.

Paternal exposure to pesticides and congenital malformations

OBJECTIVES

A case-referent study with 261 matched pairs was carried out in 8 hospitals of Comunidad Valenciana, Spain, to assess the relation between occupational exposure to pesticides and selected congenital malformations. In this paper, the results concerning paternal exposure are presented.

METHODS

The parents of the case patients and the referents were interviewed to collect information about exposure to pesticides and potential confounding variables. Detailed information on direct involvement in the handling of pesticides was collected for the interviewees involved in agricultural activities during a previously defined period in relation to conception and pregnancy. Exposure data were reviewed by 2 experts who assigned ordinal scores for the probability and intensity of exposure to pesticide classes and active ingredients.

RESULTS

The dichotomous analysis of exposure (absent, present) yielded some increased risks, although not statistically significant, for aliphatic hydrocarbons [adjusted odds ratio (adjusted OR) 2.05, 95% confidence interval (95% CI) 0.62-6.80], inorganic compounds (adjusted OR 2.02, 95% CI 0.53-7.72), and glufosinate (adjusted OR 2.45, 95% CI 0.78-7.70), and a significant association for pyridil derivatives (adjusted OR 2.77, 95% CI 1.19-6.44). The analysis based on the experts' scores (2 levels of exposure) showed some consistent associations for these compounds.

CONCLUSIONS

This research indicates a possible risk of congenital malformations for paternal exposure to some pesticides, notably, pyridils, aliphatic hydrocarbons, inorganic compounds, and glufosinate. It did not find an increased risk for paternal exposure to pesticides in the classes of organophosphates, carbamates, organochlorines, chloroalkylthio fungicides and organosulfurs. These findings warrant further investigation.