ABSTRACT Background: The clinical teachers’ attributes can be grouped into physician competencies, teacher competencies, and personal characteristics. Global performance is considered the clinical teacher’s capacity to facilitate an active and stimulating learning process for medical students and a warm, supportive, and pleasant environment. Aim: To determine which attributes of the clinical teacher influence their global performance from the students’ point of view. Material and Methods: The Role Model Apperception Tool questionnaire (RoMAT) was answered by 133 second-year medical students at the University of Chile during 2018. Results: The students assessed 37 clinical teachers. Teaching competencies had the higher influence in global performance. Personal characteristics also had a significant influence. Physician competencies had an indirect influence on teaching competencies. The model obtained 88% of the explained variance of the teacher’s global performance. Conclusions: This study showed that teacher competencies, personal characteristics, and physician competencies are qualities that influence the perception of the global performance of clinical teachers.

Antecedentes: Los atributos de un tutor clínico pueden agruparse en competencias clínicas, competencias docentes y características personales. En el desempeño global del tutor se considera su capacidad de facilitar un proceso de aprendizaje activo y estimulante y generar un ambiente cálido y de soporte. Objetivo: Determinar qué atributos del tutor clínico, evaluados por los estudiantes, influyen sobre su desempeño global. Material y Método: La escala “Role Model Apperception Tool” fue contestada por 133 estudiantes de segundo año de medicina en la Universidad de Chile durante el 2018. Resultados: Los estudiantes evaluaron 37 tutores clínicos. Las competencias docentes tuvieron la mayor influencia sobre el desempeño global. Las características personales también mostraron influencia significativa. Las competencias clínicas influyeron indirectamente a través de las competencias docentes. El modelo logró explicar 88% de la varianza del desempeño global del tutor clínico. Conclusiones: El estudio muestra que las competencias docentes, características personales y competencias clínicas influyen sobre la evaluación de los estudiantes sobre el desempeño global del tutor.

Knowing what characterizes an excellent teacher is relevant to guide training, evaluation, and continuous improvement of the clinical teacher. We performed a systematic review using the PRISMA protocol, aiming to identify the attributes of an excellent clinical teacher. MEDLINE, ERIC, ScienceDirect, and Scopus databases were searched for articles published in English and Spanish, between 2007 and 2019. Two independent reviewers extracted and synthesized data from articles that met the PRISMA pre-established criteria. Twelve studies met the inclusion criteria. Of the 106 attributes reported by the studies, 49 (46,2%) were generic. The most frequently mentioned attribute was respectfulness. Forty-six attributes (43,3%) were pedagogical. Feedback and planning were those most frequently mentioned. Eleven attributes (10,3%) were disciplinary and clinical skills was the most mentioned. We conclude that generic and pedagogical dimensions had a greater representation in the literature, in comparison with the disciplinary dimension. This could be explained, considering that having adequate clinical skills is the minimal necessary requisite to become a clinical teacher, but does not make a difference in how their performance is perceived, contrary to the generic and pedagogical dimensions.

Cancer constitutes the second main mortality cause in the world, after cardiovascular diseases. In spite of the progresses in the chemotherapeutics treatments, many patients fail chemotherapy, mainly because of side effects or multi-drugs resistance, proving the need and importance of the research for new molecules with anticancer activity, more effective and with smaller adverse effects. Various compounds derived from plant secondary metabolites are commonly used in the chemotherapy against cancer and the natural products play an important role in the research for new molecules. Among several molecules of natural origin evaluated by MTT assay in murine tumor cell lines [breast (LM3) and lung (LP07)] the quinona-methide triterpenes tingenone and pristimerin showed marked cytotoxic activity presenting IC50 around 2 and 5 µM respectively. The structure-activity relationship suggests that rings A and B containing an α, ß-unsaturated carbonyl group are essential for the observed cytotoxic activity. The interaction between these positions and acetylcisteyne residues suggests a probable mechanism of action. The in vitro mutagenic activity was also evaluated by the Salmonella microsome assay (Ames test) for pristimerin and tingenone with and without metabolic activation (S9) in the strains TA98, TA97a, TA100 and TA102, none of which showed mutagenic potential in any strains. Estrogenic and anti-estrogenic activities were also studied by the e-screen assay in MCF-7 cells with negative results. The present data point to the importance of pristimerin and tingenone as representative of an emerging class of potential anticancer chemicals.

Background: To describe the overall and disease-free survival at five and ten years after breast cancer diagnosis in women from a previous case-control study, and establish related prognostic factors. Methods: We followed up 202 patients diagnosed between 1996 and 1998 in three public hospitals in Granada and Almeria provinces in Spain. Survival rates were calculated using the Kaplan and Meier method, and the Cox proportional hazards model was applied to identify the most significant variables contributing to survival. Results: Mean age at diagnosis was 54.27±10.4 years. Mean follow-up for overall survival was 119.91 months (95%CI 113.65-126.17); the five-year survival rate was 83.9% (95%CI: 78.13-89.66) and the ten-year rate was 71% (95%CI: 63.25-78.74). Mean follow-up for disease-free survival was 118.75 months (95%CI 111.86-125.65); the five-year disease-free survival rate was 81% (95%CI: 74.52-87.47) and the ten-year rate was 71.3% (95%CI: 63.33-79.26). The mortality rate of the study population was 33.17%. Conclusions: Disease characteristics are similar in our population to those in other Spanish and European regions, while the overall survival is higher than the mean rate during the same period in Europe (5-yr rate of 79%) and similar to that in Spain (83%).

Fundamento: Describir la supervivencia global y libre de enfermedad a los cinco y diez años del diagnóstico de cáncer de mama en mujeres participantes un estudio caso control previo, y establecer las variables pronóstico relacionadas. Métodos: Se realizó el seguimiento de 202 mujeres diagnosticadas en tres hospitales públicos de Granada y Almería entre 1996-1998. La supervivencia se evaluó mediante el método de Kaplan-Meier, y la identificación de factores relacionados mediante el análisis de regresión de Cox. Resultados: La edad media al diagnóstico fue de 54,27±10,4 años. La supervivencia global a los 5 años fue del 83,9% (IC 95%: 78,13-89,66) y a los 10 años del 71% (IC 95%: 63,25-78,74) con un tiempo medio de seguimiento de 119,91 meses (IC 95% 113,65-126,17). La supervivencia libre de enfermedad a los 5 años fue del 81% (IC 95%: 74,52-87,47) y a los 10 años del 71,3% (IC 95%: 63,33-79,26) con un tiempo medio de seguimiento de 118,75 meses (IC 95% 111,86-125,65). La mortalidad de la serie fue del 33'17%. Conclusiones: Las características de la enfermedad en las mujeres de la muestra estudiada son similares a las de otras regiones de España y Europa, con una supervivencia global superior a la descrita en Europa y y comparable a la de España amba referidas para el mismo periodo.

Background: To describe the overall and disease-free survival at five and ten years after breast cancer diagnosis in women from a previous case-control study, and establish related prognostic factors. Methods: We followed up 202 patients diagnosed between 1996 and 1998 in three public hospitals in Granada and Almeria provinces in Spain. Survival rates were calculated using the Kaplan and Meier method, and the Cox proportional hazards model was applied to identify the most significant variables contributing to survival. Results: Mean age at diagnosis was 54.27±10.4 years. Mean follow-up for overall survival was 119.91 months (95%CI 113.65-126.17); the five-year survival rate was 83.9% (95%CI: 78.13-89.66) and the ten-year rate was 71% (95%CI: 63.25-78.74). Mean follow-up for disease-free survival was 118.75 months (95%CI 111.86-125.65); the five-year disease-free survival rate was 81% (95%CI: 74.52-87.47) and the ten-year rate was 71.3% (95%CI: 63.33-79.26). The mortality rate of the study population was 33.17%. Conclusions: Disease characteristics are similar in our population to those in other Spanish and European regions, while the overall survival is higher than the mean rate during the same period in Europe (5-yr rate of 79%) and similar to that in Spain (83%).

Fundamento: Describir la supervivencia global y libre de enfermedad a los cinco y diez años del diagnóstico de cáncer de mama en mujeres participantes un estudio caso control previo, y establecer las variables pronóstico relacionadas. Métodos: Se realizó el seguimiento de 202 mujeres diagnosticadas en tres hospitales públicos de Granada y Almería entre 1996-1998. La supervivencia se evaluó mediante el método de Kaplan-Meier, y la identificación de factores relacionados mediante el análisis de regresión de Cox. Resultados: La edad media al diagnóstico fue de 54,27±10,4 años. La supervivencia global a los 5 años fue del 83,9% (IC 95%: 78,13-89,66) y a los 10 años del 71% (IC 95%: 63,25-78,74) con un tiempo medio de seguimiento de 119,91 meses (IC 95% 113,65-126,17). La supervivencia libre de enfermedad a los 5 años fue del 81% (IC 95%: 74,52-87,47) y a los 10 años del 71,3% (IC 95%: 63,33-79,26) con un tiempo medio de seguimiento de 118,75 meses (IC 95% 111,86-125,65). La mortalidad de la serie fue del 33'17%. Conclusiones: Las características de la enfermedad en las mujeres de la muestra estudiada son similares a las de otras regiones de España y Europa, con una supervivencia global superior a la descrita en Europa y y comparable a la de España amba referidas para el mismo periodo.

Objectives: Drinking water chlorination generates potentially harmful by-products, such as trihalomethanes. Trihalomethane levels are high in some parts of Spain. The aim of the present study was to investigate trihalomethane concentrations in drinking water from distinct water supplies in the province of Granada, within the framework of the Childhood and Environment (INMA) study. Methods: Eighty-two tap water samples were collected in two campaigns during the winter and summer of 2006. An optimized procedure based on gas chromatography and mass spectrometry was used to determine concentrations of chloroform, bromodichloromethane, dibromochloromethane, and bromoform in the samples. Results: Total trihalomethane concentrations ranged from 0.14 to 18.75 μg/l in winter samples and from 0.01 to 31.87 μg/l in summer samples. The most abundant compound was chloroform. Mean trihalomethane concentrations were 10.13 in surface waters and 1.41 μg/l in ground waters. Conclusions: The trihalomethane levels found were considerably below the maximum permitted level of 100 μg/l in the European Union. The values obtained varied widely according to the type of water source: the highest concentrations were found in urban and sub-urban areas, where the water is largely of surface origin. The presence of trihalomethanes was lower than that reported in other Spanish regions.

Objetivos: La cloración del agua da lugar a la formación de subproductos potencialmente dañinos para la salud, entre ellos los trihalometanos, que se han hallado elevados en algunas zonas de España. En este estudio se investigan los valores de trihalometanos en el agua de consumo suministrada por varios sistemas de abastecimiento de la provincia de Granada, en el área de actuación de la cohorte madres-hijos de la Red INMA (Infancia y Medio Ambiente). Métodos: Se analizaron 82 muestras de agua de consumo en dos campañas de muestreo en invierno y verano de 2006. Se determinó la concentración de cloroformo, bromodiclorometano, dibromoclorometano y bromoformo, siguiendo un procedimiento optimizado basado en cromatografía de gases y espectrometría de masas. Resultados: El rango de concentración de trihalometanos totales se situó entre 0,14 y 18,75 μg/l en la campaña de invierno y entre 0,01 y 31,87 μg/l en la de verano. El compuesto mayoritario fue cloroformo. La concentración media de trihalometanos en agua de origen superficial y subterráneo fue de 10,13 y 1,41 μg/l, respectivamente. Conclusiones: Los valores de trihalometanos encontrados son muy inferiores a la concentración máxima admisible (100 μg/l) establecida por la Uniσn Europea para estos compuestos. Estos valores varνan significativamente segϊn el origen del agua, con mayores concentraciones en αreas urbana y semiurbana, donde el agua es mayoritariamente de origen superficial. La presencia de trihalometanos en la zona es menor a la descrita en otras regiones espaρolas.

Objectives: Drinking water chlorination generates potentially harmful by-products, such as trihalomethanes. Trihalomethane levels are high in some parts of Spain. The aim of the present study was to investigate trihalomethane concentrations in drinking water from distinct water supplies in the province of Granada, within the framework of the Childhood and Environment (INMA) study. Methods: Eighty-two tap water samples were collected in two campaigns during the winter and summer of 2006. An optimized procedure based on gas chromatography and mass spectrometry was used to determine concentrations of chloroform, bromodichloromethane, dibromochloromethane, and bromoform in the samples. Results: Total trihalomethane concentrations ranged from 0.14 to 18.75 μg/l in winter samples and from 0.01 to 31.87 μg/l in summer samples. The most abundant compound was chloroform. Mean trihalomethane concentrations were 10.13 in surface waters and 1.41 μg/l in ground waters. Conclusions: The trihalomethane levels found were considerably below the maximum permitted level of 100 μg/l in the European Union. The values obtained varied widely according to the type of water source: the highest concentrations were found in urban and sub-urban areas, where the water is largely of surface origin. The presence of trihalomethanes was lower than that reported in other Spanish regions.

Objetivos: La cloración del agua da lugar a la formación de subproductos potencialmente dañinos para la salud, entre ellos los trihalometanos, que se han hallado elevados en algunas zonas de España. En este estudio se investigan los valores de trihalometanos en el agua de consumo suministrada por varios sistemas de abastecimiento de la provincia de Granada, en el área de actuación de la cohorte madres-hijos de la Red INMA (Infancia y Medio Ambiente). Métodos: Se analizaron 82 muestras de agua de consumo en dos campañas de muestreo en invierno y verano de 2006. Se determinó la concentración de cloroformo, bromodiclorometano, dibromoclorometano y bromoformo, siguiendo un procedimiento optimizado basado en cromatografía de gases y espectrometría de masas. Resultados: El rango de concentración de trihalometanos totales se situó entre 0,14 y 18,75 μg/l en la campaña de invierno y entre 0,01 y 31,87 μg/l en la de verano. El compuesto mayoritario fue cloroformo. La concentración media de trihalometanos en agua de origen superficial y subterráneo fue de 10,13 y 1,41 μg/l, respectivamente. Conclusiones: Los valores de trihalometanos encontrados son muy inferiores a la concentración máxima admisible (100 μg/l) establecida por la Uniσn Europea para estos compuestos. Estos valores varνan significativamente segϊn el origen del agua, con mayores concentraciones en αreas urbana y semiurbana, donde el agua es mayoritariamente de origen superficial. La presencia de trihalometanos en la zona es menor a la descrita en otras regiones espaρolas.

No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.

Aunque en España se han realizado estudios sobre concentraciones en medios biológicos humanos de compuestos tóxicos persistentes (CTP) desde hace varias décadas, no se ha llevado a cabo una revisión sistemática. Los objetivos fueron: a) identificar los estudios realizados en España en los últimos 30 años que hubiesen determinado concentraciones en humanos de diclorodifeniltricloroetano (DDT), diclorodifenildicloroeteno (DDE), hexaclorobenceno (HCB), hexaclorociclohexanos (HCH) y policlorobifenilos (PCB), y b) sintetizar las principales características y resultados de cada estudio. Los estudios son sumamente heterogéneos y la mayoría carece de representatividad poblacional. Las concentraciones de DDT y DDE parecen haber decrecido moderadamente en los últimos 20 años. Hay numerosas fluctuaciones en los valores de HCB, HCH y PCB, en algún caso compatibles con un estancamiento. Se observan grandes diferencias en los valores detectados en los distintos estudios y dentro de un mismo grupo: las concentraciones de CTP de algunos individuos pueden llegar a ser más de 200 veces superiores a los de otros. La magnitud real de la contaminación humana por CTP y sus tendencias a lo largo del territorio español, así como su diversidad geográfica y social, siguen siendo ampliamente desconocidas.

No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.

Aunque en España se han realizado estudios sobre concentraciones en medios biológicos humanos de compuestos tóxicos persistentes (CTP) desde hace varias décadas, no se ha llevado a cabo una revisión sistemática. Los objetivos fueron: a) identificar los estudios realizados en España en los últimos 30 años que hubiesen determinado concentraciones en humanos de diclorodifeniltricloroetano (DDT), diclorodifenildicloroeteno (DDE), hexaclorobenceno (HCB), hexaclorociclohexanos (HCH) y policlorobifenilos (PCB), y b) sintetizar las principales características y resultados de cada estudio. Los estudios son sumamente heterogéneos y la mayoría carece de representatividad poblacional. Las concentraciones de DDT y DDE parecen haber decrecido moderadamente en los últimos 20 años. Hay numerosas fluctuaciones en los valores de HCB, HCH y PCB, en algún caso compatibles con un estancamiento. Se observan grandes diferencias en los valores detectados en los distintos estudios y dentro de un mismo grupo: las concentraciones de CTP de algunos individuos pueden llegar a ser más de 200 veces superiores a los de otros. La magnitud real de la contaminación humana por CTP y sus tendencias a lo largo del territorio español, así como su diversidad geográfica y social, siguen siendo ampliamente desconocidas.

Background: It has been proposed that the intrauterine period of child-mother exposure to hormonally active compounds (endocrine disruptors) is of critical importance. Objective: We reviewed all Spanish and English-language epidemiological studies published between 1990 and the first trimester of 2006 that studied the possible association between human exposure to chemical compounds and the risk of cryptorchidism and/or hypospadias. Methods: The MEDLINE (PubMed) database was searched using the following key words: endocrine disruptors, organochlorine pesticides, xenoestrogens, cryptorchidism and hypospadias. Selection of the 16 studies included was based on the following criteria: study design and population, the measures of exposure used, inclusion and exclusion criteria, and the statistical analysis used. Results and conclusions: Although the studies reviewed do not conclusively confirm the association between exposure to endocrine disruptors and the risk of male genital malformation, this association cannot be ruled out. Further in-depth investigation of this association is required. Issues that remain to be resolved are the diagnostic classification to be used and appropriate measurement of exposure to multiple chemical compounds and environmental contaminants that act conjointly through mechanisms similar to endogenous hormones.

Antecedentes: Se ha sugerido que la exposición maternoinfantil a compuestos hormonalmente activos (disruptores endocrinos) tiene en la etapa intrauterina una de sus fases más comprometidas. Objetivo: Revisar los estudios epidemiológicos, nacionales e internacionales, publicados entre 1990 y el primer trimestre de 2006, que tuvieran como hipótesis la asociación entre la exposición humana a disruptores endocrinos y el riesgo de criptorquidia e hipospadias. Métodos: Se han buscado artículos en MEDLINE/PubMed mediante las palabras clave: disruptores endocrinos, xenoestrógenos, pesticidas organoclorados y criptorquidia e hipospadias. La selección de los 16 trabajos incluidos se hizo atendiendo al diseño y la población de estudio, las medidas de exposición empleadas, los criterios de exclusión e inclusión establecidos y el análisis estadístico utilizado. Resultados y conclusiones: Aunque los estudios aquí revisados no son concluyentes para confirmar la asociación entre disruptores endocrinos y riesgo de malformación del tracto genitourinario, tampoco demuestran la falta de tal asociación. Por este motivo parece razonable sugerir que este aspecto de la patología hormonal debería investigarse más en profundidad, resolviendo, al menos, el diagnóstico adecuado de los individuos y la estimación de la exposición a múltiples compuestos químicos, contaminantes ambientales, que actúan conjuntamente a través de mecanismos similares a las hormonas endógenas.

Background: It has been proposed that the intrauterine period of child-mother exposure to hormonally active compounds (endocrine disruptors) is of critical importance. Objective: We reviewed all Spanish and English-language epidemiological studies published between 1990 and the first trimester of 2006 that studied the possible association between human exposure to chemical compounds and the risk of cryptorchidism and/or hypospadias. Methods: The MEDLINE (PubMed) database was searched using the following key words: endocrine disruptors, organochlorine pesticides, xenoestrogens, cryptorchidism and hypospadias. Selection of the 16 studies included was based on the following criteria: study design and population, the measures of exposure used, inclusion and exclusion criteria, and the statistical analysis used. Results and conclusions: Although the studies reviewed do not conclusively confirm the association between exposure to endocrine disruptors and the risk of male genital malformation, this association cannot be ruled out. Further in-depth investigation of this association is required. Issues that remain to be resolved are the diagnostic classification to be used and appropriate measurement of exposure to multiple chemical compounds and environmental contaminants that act conjointly through mechanisms similar to endogenous hormones.

Antecedentes: Se ha sugerido que la exposición maternoinfantil a compuestos hormonalmente activos (disruptores endocrinos) tiene en la etapa intrauterina una de sus fases más comprometidas. Objetivo: Revisar los estudios epidemiológicos, nacionales e internacionales, publicados entre 1990 y el primer trimestre de 2006, que tuvieran como hipótesis la asociación entre la exposición humana a disruptores endocrinos y el riesgo de criptorquidia e hipospadias. Métodos: Se han buscado artículos en MEDLINE/PubMed mediante las palabras clave: disruptores endocrinos, xenoestrógenos, pesticidas organoclorados y criptorquidia e hipospadias. La selección de los 16 trabajos incluidos se hizo atendiendo al diseño y la población de estudio, las medidas de exposición empleadas, los criterios de exclusión e inclusión establecidos y el análisis estadístico utilizado. Resultados y conclusiones: Aunque los estudios aquí revisados no son concluyentes para confirmar la asociación entre disruptores endocrinos y riesgo de malformación del tracto genitourinario, tampoco demuestran la falta de tal asociación. Por este motivo parece razonable sugerir que este aspecto de la patología hormonal debería investigarse más en profundidad, resolviendo, al menos, el diagnóstico adecuado de los individuos y la estimación de la exposición a múltiples compuestos químicos, contaminantes ambientales, que actúan conjuntamente a través de mecanismos similares a las hormonas endógenas.

Este artigo apresenta uma análise das opiniões de diferentes grupos, inclusive de cientistas, agências regulatórias internacionais, organizações não-governamentais e indústrias, interessados na questão da identificação de substâncias químicas com atividade desreguladora endócrina. Os autores discutem também o impacto da exposição aos desreguladores endócrinos sobre a saúde humana, considerando as seguintes questões: estimativa de risco; testes utilizados para detectar distúrbios endócrinos; dificuldades na identificação de uma associação entre dose, tempo de exposição, suscetibilidade individual e efeito e tentativas no sentido de mapear os desreguladores endócrinos. Finalmente, os autores argumentam que nem todos os agonistas hormonais devem ser incluídos sob a denominação genérica de desreguladores endócrinos.

This paper presents an analysis of the opinions of different groups from: scientists, international regulatory bodies, non-governmental organizations and industry; with an interest in the problem of identifying chemical substances with endocrine disrupting activity. There is also discussion of the consequences that exposure to endocrine disruptors may have for human health, considering concrete issues related to: the estimation of risk; the tests that must be used to detect endocrine disruption; the difficulties to establish an association between dose, time of exposure, individual susceptibility, and effect; and the attempts to create a census of endocrine disruptors. Finally, it is proposed that not all hormonal mimics should be included under the single generic denomination of endocrine disruptors.

Este artigo apresenta uma análise das opiniões de diferentes grupos, inclusive de cientistas, agências regulatórias internacionais, organizações não-governamentais e indústrias, interessados na questão da identificação de substâncias químicas com atividade desreguladora endócrina. Os autores discutem também o impacto da exposição aos desreguladores endócrinos sobre a saúde humana, considerando as seguintes questões: estimativa de risco; testes utilizados para detectar distúrbios endócrinos; dificuldades na identificação de uma associação entre dose, tempo de exposição, suscetibilidade individual e efeito e tentativas no sentido de mapear os desreguladores endócrinos. Finalmente, os autores argumentam que nem todos os agonistas hormonais devem ser incluídos sob a denominação genérica de desreguladores endócrinos.

This paper presents an analysis of the opinions of different groups from: scientists, international regulatory bodies, non-governmental organizations and industry; with an interest in the problem of identifying chemical substances with endocrine disrupting activity. There is also discussion of the consequences that exposure to endocrine disruptors may have for human health, considering concrete issues related to: the estimation of risk; the tests that must be used to detect endocrine disruption; the difficulties to establish an association between dose, time of exposure, individual susceptibility, and effect; and the attempts to create a census of endocrine disruptors. Finally, it is proposed that not all hormonal mimics should be included under the single generic denomination of endocrine disruptors.