Las escuelas de medicina desempeñan un papel central en la acumulación y desarrollo del conocimiento profesional, por lo cual poseen privilegios y recursos que se justifican solo en la medida en que los retribuyan a la comunidad, en particular a los más necesitados. La responsabilidad social de las escuelas de medicina se centra en los servicios formativos, asistenciales y de investigación que ofrecen. Los principios de la educación médica y la estructura propuesta por el Informe Flexner están en crisis debido a la pandemia de COVID-19 y se requiere la redefinición del contrato social. El presente documento ofrece una propuesta de responsabilidad social de las escuelas de medicina que incluye previsión de las necesidades de la comunidad, atención interprofesional centrada en el paciente, formación de profesionales en el área de salud y colaboración entre instituciones. Resalta la necesidad de una institución consciente que encuentre nuevos espacios de entrenamiento diferentes al hospitalario, donde se atienda a cada paciente de forma personalizada, con modelos formativos interprofesionales que consideren al alumno como persona que cuida de sí misma en colaboración abierta con las organizaciones. Los líderes deben actuar ya porque es su responsabilidad social y porque es lo correcto.

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Pesticides, which are widely used in tropical areas for controlling disease vectors, require the services of urban pest control operators (fumigators). Pesticide use and handling policies and regulations mostly relate to agricultural uses, not to urban pest control purposes. Our objectives included investigating use patterns, pesticide management practices, knowledge on related policies in urban pesticide applicators of southeastern Mexico, and comparing butyrylcholinesterase (BuChE) activity in this group with individuals non-occupationally exposed to pesticides. We conducted a cross-sectional study where all participants were males. The exposed group was integrated by 27 urban pest control operators and the non-exposed group by 26 non-sprayer subjects. A structured questionnaire was applied to participants and BuChE activity in serum was determined. Urban pest control operators had been working with pesticides for 1-17 years, mostly during summer; 67 % did not use personal protection equipment. Eighteen active ingredients were employed as pesticides; chemical groups included pyrethroids (PYR), organophosphates (OP), coumarins, phenylpyrazoles, carbamates (CAR), chloronicotinyls, and amides. Policy knowledge and application were reported in only 30 % of the fumigators. BuChE activity (U/L) was similar between groups: 9837.95 ± 1844.46 U/L in urban pest control vs. 10 414.81 ± 1558.42 U/L for the non-sprayer group. We suggest the inclusion of additional biomarkers in the evaluation of occupational exposure to pesticides, because currently only OPs and CARs are considered, while fumigators are exposed to many other pesticides. Urban pesticide applicators lacked knowledge regarding pesticide management and application policies, hence the need for educational courses for workers and updating regulations. Palabras clave: regulaciones, fumigadores urbanos, actividad de butirilcolinesterasa sugiere la inclusión de marcadores biológicos adicionales en la evaluación de la exposición ocupacional a plaguicidas, dado que los actuales sólo consideran la presencia de OP y CAR, pero los aplicadores están expuestos a otros tipos de plaguicidas. Se concluye que se requiere educar a los trabajadores y actualizar la regulación existente.

The adverse effects of pesticides on public health have been well documented in different populations across the world. Families of agricultural workers, particularly their wives, face pesticide exposures through a number of complex patterns even when they do not directly engage in agricultural work. Nonetheless, these patterns of exposure among women in agricultural communities remain understudied. Unfortunately, in Mexico there are no studies examining these patterns yet. In consequence, the main goals of this study were to: 1) evaluate pesticide exposure in a rural community of Southeast Mexico, 2) examine the patterns of environmental and para-occupational pesticide exposure, and 3) document the para-occupational and environmental pesticide exposure among women who are not agricultural workers but have an agricultural family or are wives of agricultural workers. We conducted a cross-sectional study of 78 women who did not themselves participate in any agricultural activity, but lived in an agricultural community. Questionnaires and interviews were used to construct a Pesticide Exposure Index (PEI) estimating the degree of pesticide exposure among women from agricultural families and wives of agricultural workers. Through the PEI we showed that women living in agricultural communities using pesticides are inherently exposed to a certain level of pesticides. With the PEI we showed that women from agricultural families, especially wives of agricultural workers, have a long-term para-occupational pesticide exposure that should not be underestimated because they are not agricultural workers.

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