| 1. |
- van Wendel de Joode, Berna, et al.
(författare)
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Pesticide exposure and neurodevelopment in children aged 6–9 years from Talamanca, Costa Rica
- 2016
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Ingår i: Cortex. - : Elsevier BV. - 0010-9452 .- 1973-8102. ; 85, s. 137-150
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Tidskriftsartikel (refereegranskat)abstract
- Certain pesticides may affect children's neurodevelopment. We assessed whether pesticide exposure was associated with impaired neurobehavioral outcomes in children aged 6–9 years. We conducted a cross-sectional study in 140 children living near banana plantations and plantain farms in the Talamanca County, Costa Rica and assessed their neurobehavioral performance. Exposure was determined by analyzing urinary metabolites of chlorpyrifos (3,5,6-trichloro-2-pyridinol, TCPy), mancozeb (ethylenethiourea, ETU), and pyrethroids (3-phenoxybenzoic acid, 3-PBA). Repeated urine samples were obtained for 36 children. We estimated associations of pesticide concentrations with neurobehavioral outcomes using multivariable linear and logistic regression models. Median (25th–75th percentiles) TCPy, ETU, and 3-PBA concentrations were 1.4 (.7–3.1), 1.2 (.7–3.0), and. 8 (.5–1.5) μg/L, respectively. Intraclass correlation coefficients (ICC) ranged between. 32 and. 67. After adjustment for potential confounders, higher urinary TCPy concentrations were associated with poorer working memory in boys (n = 59) (β per 10-fold increase in TCPy concentrations = −7.5, 95% CI: −14.4, −.7); poorer visual motor coordination (β = −1.4, 95% CI: −2.7, −.1); increased prevalence of parent-reported cognitive problems/inattention (adjusted OR per 10-fold increase in urinary concentrations = 5.8, 95% CI: 1.6, 22.9), oppositional disorders (aOR = 3.9, 95% CI: 1.0, 16.0), and ADHD (aOR = 6.8, 95% CI: 1.8, 28.6), and; decreased ability to discriminate colors (aOR = 6.6, 95% CI: 1.6, 30.3; the higher the score the worse). Higher ETU concentrations were associated with poorer verbal learning outcomes (β = −7.0, 95% CI: −12.7, −1.3). Higher 3-PBA concentrations were associated with poorer processing speed scores, particularly in girls (β = −8.8, 95% CI: −16.1, −1.4). Our findings indicate that children living near banana and plantain plantations are exposed to pesticides that may affect their neurodevelopment, which for certain domains may differ between boys and girls. We recommend the implementation of measures to reduce pesticide exposure in children living nearby banana plantations.
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| 2. |
- Hansson, Erik, et al.
(författare)
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Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort
- 2019
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Ingår i: Occupational and environmental medicine. - : BMJ. - 1470-7926 .- 1351-0711. ; 76:11, s. 818-826
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. METHODS: Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work. RESULTS: Mean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to -5 mL/min/1.73 m2 in the high and -9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury. CONCLUSIONS: Workers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.
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| 3. |
- Smpokou, Evangelia Theano, et al.
(författare)
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Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy
- 2019
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Ingår i: Occupational and environmental medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 76:12, s. 920-926
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Tidskriftsartikel (refereegranskat)abstract
- Objectives There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years. Methods Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined. Results Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. Conclusions The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.
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| 4. |
- 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
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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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| 5. |
- Hansson, Erik, 1987, et al.
(författare)
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Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation
- 2024
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Ingår i: WORKPLACE HEALTH & SAFETY. - 2165-0799 .- 2165-0969.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings.Method: We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare.Results: Each 1 degrees C WBGT was associated with an 18% (95% confidence interval [CI]: [4, 33%]) higher AKI-CD rate on the same day and a 14% (95% CI [-5, 37%]) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases.Discussion: Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.
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| 6. |
- Crowe, Jennifer, et al.
(författare)
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A pilot field evaluation on heat stress in sugarcane workers in Costa Rica : what to do next?
- 2009
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Ingår i: Global Health Action. - : Co-action publishing. - 1654-9716 .- 1654-9880. ; 2, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Climate change is producing major impacts including increasing temperatures in tropical countries, like Costa Rica, where the sugarcane industry employs thousands of workers who are exposed to extreme heat.OBJECTIVES: This article outlines a pilot qualitative evaluation of working conditions and heat in the sugarcane industry.DESIGN: A literature review, direct observations and exploratory interviews with workers were conducted to reach a preliminary understanding of the dimensions of heat-related health issues in the sugarcane industry, as a basis for the design of future studies.RESULTS: The industry employs temporary workers from Nicaragua and Costa Rica as well as year-round employees. Temporary employees work 12-hour shifts during the harvest and processing ('zafra') season. In many cases, sugarcane field workers are required to carry their own water and often have no access to shade. Sugar mill workers are exposed to different levels of heat stress depending upon their job tasks, with the most intense heat and workload experienced by the oven ('caldera') cleaners.CONCLUSIONS: Research is needed to achieve better understanding of the multiple factors driving and interacting with heat exposures in the sugarcane industry in order to improve the health and safety of workers while maintaining worker productivity.
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| 7. |
- Crowe, Jennifer, 1976-
(författare)
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Heat exposure and health outcomes in Costa Rican sugarcane harvesters
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background The remarkably efficient mechanisms of the human body to maintain its core temperature of 37°C can be inadequate when harsh climatic conditions and excessive muscle movement lead to heat stress, dehydration and potential heat illness, ranging from minor symptoms such as fatigue to a potentially fatal heat stroke. Agricultural workers in the tropics are at high risk, which is expected to increase with climate change. Sugarcane harvesting in Costa Rica is largely done by cutting the cane with a machete, by temporary, sub-contracted workers who are often migrants and living in poverty. Sugarcane harvesters are known to be affected by an epidemic of chronic kidney disease of non-traditional origin, currently hypothesized to be related to working conditions.Objectives This work aimed to better understand and document sugarcane harvester exposure to heat and the health consequences of working under such conditions. Specific objectives were to 1) Document working conditions and heat in the Costa Rican sugarcane industry (Paper I); 2) Quantify heat stress exposures faced by sugarcane harvesters in Costa Rica (Paper II); and 3) Quantify the occurrence of heat stress symptoms and abnormal urinary parameters in sugarcane workers in Costa Rica (Papers III and IV).Methods This study took place over three harvests following a pilot assessment prior to the first harvest. Methods included direct observation, semi-structured interviews with 24 individuals and a participatory workshop with 8 harvesters about heat-related perceptions, exposures and coping strategies during the harvest and non-harvest season (Pilot). Researchers accompanied workers in the field during all three harvests, measured wet bulb globe temperature (WBGT) and conducted direct observation. Heat exposure assessment was conducted by calculating metabolic load, WBGT and corresponding limit values based on international guidelines (NTP and OSHA) (Harvest 1). Self-reported symptom data were collected using orally-administered questionnaires from 106 sugarcane harvesters and 63 non-harvesters from the same company (Harvest 2). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. Finally, liquid consumption during the work shift was documented and urinalysis was conducted pre-and post-shift in 48 sugarcane harvesters on three days; differences were assessed with McNemar´s test on paired proportions (Harvest 3).Results Sugarcane workers in both the harvest and non-harvest seasons are exposed to heat, but particularly during the harvest season. Field workers have to carry their own water to the field and often have no access to shade. Some plantworkers are also exposed to intense heat. The metabolic load of sugarcane harvesting was determined to be 261 W/m2. The corresponding threshold value is 26 ◦C WBGT, above which workers should decrease work load or take breaks to avoid the risk of heat stress. Harvesters in this study were at risk of heat stress as early as 7:15 am on some mornings and by 9:00 am on all mornings. After 9:15 am, OSHA recommendations would require that harvesters only work at full effort 25% of each hour to avoid heat stress. Heat and dehydration symptoms at least once per week were experienced significantly more frequently among harvesters than non-harvesters (p<0.05): headache, tachycardia, fever, nausea, difficulty breathing, dizziness, and dysuria. Percentages of workers reporting heat and dehydration-related symptoms increased over increasing heat exposure categories. Total liquid consumed ranged from 1 to 9 L and differed over days (median 5.0, 4.0 and 3.25 on days 1, 2 and 3 respectively). On these same days, the two principle indicators of dehydration: high USG (≥1.025) and low pH (≤5), changed significantly from pre to post-shift (p=0.000 and p=0.012).Proportions of workers with proteinuria >30 mg/dL, and blood, leucocytes and casts in urine were also significantly different between pre and post-shift samples at the group level, but unlike USG and pH, these alterations were more frequent in the pre-shift sample. 85% of workers presented with proteinuria at least once and 52% had at least one post-shift USG indicative of dehydration.Conclusion Heat exposure is an important occupational health risk for sugarcane workers according to international standards. A large percentage of harvesters experience symptoms consistent with heat exhaustion throughout the harvest season. Pre and post-shift urine samples demonstrate dehydration and other abnormal findings. The results of this study demonstrate an urgent need to improve working conditions for sugarcane harvesters both under current conditions and in adaptation plans for future climate change.
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| 8. |
- Crowe, Jennifer, et al.
(författare)
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Heat exposure in sugarcane harvesters in Costa Rica
- 2013
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Ingår i: American Journal of Industrial Medicine. - : John Wiley & Sons. - 0271-3586 .- 1097-0274. ; 56:10, s. 1157-1164
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Occupational heat stress is a major concern in sugarcane production and has been hypothesized as a causal factor of a chronic kidney disease epidemic in Central America. This study described working conditions of sugarcane harvesters in Costa Rica and quantified their exposure to heat.METHODS: Non-participatory observation and Wet Bulb Globe Temperatures (WBGT) according to Spanish NTP (Technical Prevention Notes) guidelines were utilized to quantify the risk of heat stress. OSHA recommendations were used to identify corresponding exposure limit values.RESULTS: Sugarcane harvesters carried out labor-intensive work with a metabolic load of 261 W/m(2) (6.8 kcal/min), corresponding to a limit value of 26° WBGT which was reached by 7:30 am on most days. After 9:15 am, OSHA recommendations would require that workers only work 25% of each hour to avoid health risks from heat.CONCLUSIONS: Sugarcane harvesters are at risk for heat stress for the majority of the work shift. Immediate action is warranted to reduce such exposures.
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| 9. |
- Crowe, Jennifer, 1976-, et al.
(författare)
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Heat-Related symptoms in sugarcane harvesters
- 2015
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Ingår i: American Journal of Industrial Medicine. - : John Wiley & Sons. - 0271-3586 .- 1097-0274. ; 58:5, s. 541-548
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population.Methods: This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories.Results: Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories.Conclusions: A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population.
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| 10. |
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