| 31. |
- Wesseling, Catharina
(författare)
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Health effects from pesticide use in Costa Rica : an epidemiologic approach
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The use of toxic pesticides is increasing in developing countries, often under unsafe conditions. Poisonings are a well-known but underreported public health problem, and studies on long-term effects are sparse. Therefore, a survey was carried out to determine the incidence and the risk factors for pesticide poisonings in Costa Rica, integrating data from national registries of occupational accidents, hospitalizations, and fatalities between 1980-1986. A case series further assessed the exposures that can lead to a fatal outcome in nonintentional paraquat poisonings. A cross-sectional study among 211 banana plantation workers tested the hypothesis that chronic neurobehavioral deficits occur as a consequence of previous intoxication with cholinesterase inhibiting pesticides. An ecologic study tested the hypothesis that geographical differences in cancer incidence are associated with pesticide use. A cohort of 34,457 banana plantation workers with more than 400,000 person years was established to assess the cancer pattern among workers with a high level of exposure to pesticides (in particular dibromochloropropane), and to examine the feasibility of computerized record linkage between various registries in Costa Rica. In addition, health hazards from pesticide use in the Third World were reviewed, and some possibilities and limitations for epidemiologic research in developing countries were assessed. Cholinesterase inhibitors and paraquat caused the vast majority of the poisonings. Young workers, female workers and banana plantation workers were the groups at highest risk for occupational poisonings. Suicide as a cause of severe poisonings was less frequent than expected. It was estimated that, yearly, 1.5% of the agricultural workers suffer a work-related pesticide poisoning requiring medical attention. The case series suggested that paraquat may be fatal by dermal absorption of diluted paraquat, by ingestion of very low doses, and possibly by inhalation of diluted spray. Mild neurobehavioral deficits were found among previously poisoned workers, both by organophosphates and carbamates; after a poisoning, the workers seemed to become more susceptible to subsequent low dose exposures to cholinesterase inhibitors. Pesticide use was associated with increased cancer incidence in the most rural areas of Costa Rica, including lung and female hormone related cancers. Male banana plantation workers were at increased risk of melanoma and penile cancer, and female workers of cervical cancer and leukemia. Pesticides appear to be a public health problem throughout the Third World. Epidemiologic research to assess these problems is difficult because of methodological and infrastructure restrictions. However, high exposures provide good opportunities to carry out etiologic research; another advantage is that participation rates are often very high. Registry based studies may be feasible, but sometimes after costly improvements of the registries. This thesis indicates that pesticide exposure in Costa Rica is associated with an increased risk of various health effects.
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| 32. |
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| 33. |
- Wesseling, Catharina, et al.
(författare)
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Resolving the enigma of the Mesoamerican nephropathy : a research workshop summary
- 2014
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Ingår i: American Journal of Kidney Diseases. - : Elsevier. - 0272-6386 .- 1523-6838. ; 63:3, s. 396-404
-
Tidskriftsartikel (refereegranskat)abstract
- The First International Research Workshop on Mesoamerican Nephropathy (MeN) met in Costa Rica in November 2012 to discuss how to establish the extent and degree of MeN, examine relevant causal hypotheses, and focus efforts to control or eliminate the disease burden. MeN describes a devastating epidemic of chronic kidney disease of unknown origin predominantly observed among young male sugarcane cutters. The cause of MeN remains uncertain; however, the strongest hypothesis pursued to date is repeated episodes of occupational heat stress and water and solute loss, probably in combination with other potential risk factor(s), such as nonsteroidal anti-inflammatory drug and other nephrotoxic medication use, inorganic arsenic, leptospirosis, or pesticides. At the research workshop, clinical and epidemiologic case definitions were proposed in order to facilitate both public health and research efforts. Recommendations emanating from the workshop included measuring workload, heat, and water and solute loss among workers; quantifying nephrotoxic agents in drinking water and food; using biomarkers of early kidney injury to explore potential causes of MeN; and characterizing social and working conditions together with methods for valid data collection of exposures and personal risk factors. Advantages and disadvantages of different population study designs were detailed. To elucidate the etiology of MeN, multicountry studies with prospective cohort design, preferably integrating an ecosystem health approach, were considered the most promising. In addition, genetic, experimental, and mechanistic methods and designs were addressed, specifically the need for kidney biopsy analysis, studies in animal models, advances in biomarkers, genetic and epigenetic studies, a common registry and repository of biological and demographic data and/or specimens, and other areas of potential chronic kidney disease experimental research. Finally, in order to improve international collaboration on MeN, workshop participants agreed to establish a research consortium to link these Mesoamerican efforts to other efforts worldwide.
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| 34. |
- Wesseling, Catharina, et al.
(författare)
-
SALTRA : A Regional Program for Workers' Health and Sustainable Development in Central America
- 2011
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Ingår i: International journal of occupational and environmental health. - : Maney Publishing. - 1077-3525 .- 2049-3967. ; 17:3, s. 223-229
-
Tidskriftsartikel (refereegranskat)abstract
- In 2003, the university-based Program on Work and Health in Central America, SALTRA, was launched to build national and regional capacities in occupational safety and health with the goal of preventing and reducing poverty in Central America. SALTRA has implemented 20 projects including action projects in priority sectors (e.g., construction, sugarcane, hospitals, migrant coffee workers); strengthening of surveillance (occupational health profiles, carcinogenic exposures, fatal injuries and pesticides); a participatory model for training and risk monitoring by workers; building occupational health capacity for professionals, employers, and workers, with collaborating networks between the countries; strengthening of universities in work, environment, and health; studies of serious occupational and environmental situations; communication channels; and continued efforts to raise political awareness. SALTRA has placed issues of workers' health on political, business, and academic agendas throughout the region and has laid the foundations for achieving substantial future improvements in health conditions of all workers in the region. External evaluators envisioned SALTRA as an innovative development model.
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| 35. |
- Wesseling, Catharina, et al.
(författare)
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The Epidemic of Chronic Kidney Disease of Unknown Etiology in Mesoamerica: A Call for Interdisciplinary Research and Action.
- 2013
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Ingår i: American Journal of Public Health. - 1541-0048 .- 0090-0036. ; 103:11, s. 1927-1930
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Tidskriftsartikel (refereegranskat)abstract
- During the last 20 years, several regions in Central America and Mexico have seen a dramatic increase of a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension.(1-3) This regional epidemic of chronic kidney disease of unknown origin (CKDu) is also being referred to as the Mesoamerican nephropathy or MeN.(4) It has been estimated that this largely unknown epidemic has caused the premature death of at least 20 000 men.(3) In MeN-affected areas in Nicaragua(3) and Costa Rica (C. W., unpublished data), chronic kidney disease mortality is up to five-fold the national rates. In El Salvador, kidney disease was the second most common cause of death among males in 2009.(5) MeN primarily, but not only, affects young and middle-aged male laborers in the agricultural sector, in particular sugarcane workers.(1-3) (Am J Public Health. Published online ahead of print September 12, 2013: e1-e4. doi:10.2105/AJPH.2013.301594).
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| 36. |
- Wesseling, Catharina, et al.
(författare)
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Wesseling et al. Respond.
- 2014
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Ingår i: American Journal of Public Health. - 1541-0048. ; 104:3, s. 1-2
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Tidskriftsartikel (refereegranskat)abstract
- We appreciate Ventres' observations and share his goal to reduce CKD incidence "by occupational, environmental, and health-related reforms that make this work [agricultural labor] more humane." In our summary of the workshop on the Mesoamerican nephropathy (MeN) in San José, Costa Rica, November 2012, we also noted the need for a broad understanding of the epidemic and we call readers' attention to the full report(1) that details the comprehensive discussion of the epidemic including the issues raised by Ventres. In the workshop, we took account of the several points raised in his letter, but in our editorial we wished to call special attention to the growing evidence of heat stress and dehydration as an essential cofactor in a likely multifactorial disease etiology. (Am J Public Health. Published online ahead of print January 16, 2014: e1. doi:10.2105/AJPH.2013.301803).
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| 37. |
- Wesseling, Catharina, et al.
(författare)
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Wesseling et al. Respond.
- 2014
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Ingår i: American Journal of Public Health. - 1541-0048. ; 104:7, s. 9-10
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Tidskriftsartikel (refereegranskat)abstract
- We thank Haynes et al. for expressing their concerns on behalf of the People's Health Movement (PHM) about our recent editorial on the Mesoamerican nephropathy (MeN). We wish to clarify for the readers that PHM is a growing international network of nongovernmental organizations, civil society, and academic organizations who work together toward "Equity, ecologically sustainable development and peace . . . a world in which a healthy life for all is a reality."(1) We share PHM's vision. In fact, SALTRA, the organizing entity of the workshop questioned in the Letter to the Editor, was recently approached by PHM to join its Fair and Healthy Work campaign circle. (Am J Public Health. Published online ahead of print May 15, 2014: e1-e2. doi:10.2105/AJPH.2014.302029).
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