| 1. |
- Aragón, Aurora
(författare)
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Dermal exposure to pesticides in Nicaragua : a qualitative and quantitative approach
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pesticide use continues to be a serious public health problem in developing countries, despite decades of safe pesticide use strategies. In Nicaragua, organophosphate insecticides, in particular chlorpyrifos and methamidophos are responsible for about half of the acute pesticide poisonings. Contamination of the skin occurs frequently in the occupational setting. There is extensive research to improve methods to assess dermal exposure. The applicability and feasibility of such methods in developing countries is uncertain. Aim: This thesis aims at increasing the understanding of risk factors underlying exposure, evaluating dermal exposure among Nicaraguan subsistence farmers, and proposing more suitable methods for developing country conditions. Methods: A group of 29 subsistence farmers were interviewed in four focus groups and their responses were analyzed using grounded theory. Field data for semi-quantitative and quantitative exposure measurements of 31 farmers were collected during 33 pesticide applications, using observation, supplementary video recording, a fluorescent tracer, and skin wiping. A visual scoring system developed in the US was modified into a Nicaraguan Visual Scoring System suitable for developing country conditions. Pesticides were traced during application. Skin fluorescence was videotaped in a foldaway darkened room which was later measured through Body Segment Scores (BSS), Contaminated Body Area (CBA) and Total Visual Score (TVS). TVS was used as a criterion indicator for the identification of main exposure determinants by observation. Univariate and multivariate analyses were performed. Hundred and ten potential exposure determinants were reduced to 27 variables grouped as worksite, spray equipment, work practices, clothing, and hygiene practices. Reliability of the visual score was tested with intraclass correlation coefficients, in a sub-sample of five farmers evaluated by five raters. Observations of hand exposure events (direct and indirect contacts) were summarized into a Concentrate Contamination Index (CCI) and a Solution Contamination Index (SCI). Chemical residues were quantified for the hands and selected body parts according to fluorescent intensities. Spearman rank correlation coefficients were computed to compare the observational indices (CCI+SCI), fluorescent visual scores and quantitative residues. Results: Reasons for unsafe practices were connected with poverty, inadequacy of personal protective equipment, climatic factors, and limited knowledge influenced by beliefs and traditions. Farmers felt affection towards their traditional crops and this relationship seemed to have strong meanings for pest removal and pesticide use, contributing to dangerous work practices. The observed fluorescent images on the skin of farmers reflected work practices and contamination mechanisms and pathways. Novel determinants included spraying on a muddy terrain, dew on plants, sealing of tank lids with a cloth, and wiping sweat from the face. The Visual Scoring System was highly consistent (Cronbach alpha = 0.96) and reasonably reliable (0.75; 95% CI: 0.62-0.83), with scoring of extent being more reliable than scoring of intensity. The highest CBA was 66% and the farmer with the highest TVS scored 60% of the maximum possible. Hands were most frequently contaminated and the back had the highest BSS. Hand contact was most frequently indirect, by touching contaminated surfaces. All farmers had quantifiable pesticide residues on their hands. Spearman correlation coefficients between the observational contamination scores, fluorescent visual scores and residues in relation to the hands ranged from 0.65 to 0.74 for chlorpyrifos and 0.62 to 0.87 for methamidophos. Differences in scores could be explained by limitations of the different methods. Conclusions: Poverty and cultural factors contribute to pesticide use and unsafe use conditions. Education programs should be culturally appropriate to achieve pesticide exposure reduction. Each method studied in this thesis can be used independently. However, they can also complement each other, providing a better understanding of the mechanisms of skin exposure. With further improvements, a combination of observation and fluorescent visual scoring techniques, both lowcost and practical, would become highly accessible methods for surveillance and for epidemiological studies in developing countries.
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| 2. |
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| 3. |
- Blanco, Luis E., et al.
(författare)
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The determinants of dermal exposure ranking method (DERM) : A pesticide exposure assessment approach for developing countries
- 2008
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Ingår i: Annals of Occupational Hygiene. - : Oxford University Press (OUP). - 0003-4878 .- 1475-3162. ; 52:6, s. 535-544
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Tidskriftsartikel (refereegranskat)abstract
- A new method for assessment of dermal exposure to pesticides in subsistence farmers by use of determinants of dermal exposure is described. The method, called the determinants of dermal exposure ranking method (DERM), is a combination of checklists and expert rating assessment. Thus, determinants are listed in a form, which is used to check their presence and to assess them using a simple algorithm based on two factors, the type of transport process (T value) and the area of body surface exposed (A value). In addition, the type of clothing worn during applications is included as a protection factor. We applied the DERM to real pesticide applications, characterizing dermal exposure and comparing DERM estimates with earlier developed semiquantitative visual scores based on fluorescent tracer, the total visual score (TVS) and contaminated body area (CBA). DERM showed a very good level of agreement with both the TVS (r = 0.69, P = 0.000) and the CBA (r = 0.67, P = 0.000). DERM allowed identification of the determinants that had the highest effect on exposure and the farmers with the highest exposure. In conclusion, DERM provided information on the determinants responsible for dermal exposure in a group of subsistence farmers. This can be useful to design monitoring and preventive programs, define priorities for intervention and prioritize and select most adequate measurement strategies. DERM promises to be a low-cost easy-to-use method to assess dermal exposure to pesticides in developing country conditions.
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| 4. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Laux, Timothy S, et al.
(författare)
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Nicaragua revisited : evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village
- 2012
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Ingår i: JN. Journal of Nephrology (Milano. 1992). - : SAGE Publications. - 1121-8428 .- 1724-6059. ; 25:4, s. 533-540
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes.METHODS: A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index.RESULTS: Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02).CONCLUSIONS: The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.
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| 6. |
- Laux, Timothy S., et al.
(författare)
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Revalence of hypertension and associated risk factors in six nicaraguan communities
- 2012
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Ingår i: Ethnicity & Disease. - 1049-510X. ; 22:2, s. 129-135
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Describe the prevalence of hypertension. Design: Population based cross-sectional survey. Setting: Six Nicaraguan communities with varying economies. Participants: 1,355 adults aged 20-60 years who completed both self-reported and quantitative measures of health. Main Outcome Measures: Prevalence of hypertension (systolic >= 140 mm Hg, diastolic >= 90 mm Hg, or self-reported medical history with diagnosis by a health care professional), uncontrolled hypertension (systolic >= 140 mm Hg or diastolic >= 90 mm Hg), diabetes (urinary glucose excretion >= 100 mg/dL or self-reported medical history diagnosed by a health care professional), and uncontrolled diabetes (urinary glucose excretion >= 100 mg/dL only). Results: The prevalence of hypertension was 22.0% (19.2% in men, 24.2% in women). Blood pressure was controlled in 31.0% of male hypertensives and 55.1% of female hypertensives (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.74-4.69). Older age and higher body mass index were strongly associated with hypertension. Women who completed primary school had a lower risk of hypertension (OR .40; 95% CI .19-.85) compared to those with no formal education. A history of living in both urban and rural settings was associated with lower prevalence of hypertension (OR .52; 95% CI .34-.79). Diabetes mellitus was found in 1.2% of men and 4.3% of women. Male sex was independently associated with decreased risk of diabetes (OR .31; 95% CI .11-.86). Conclusions: At least one cardiovascular risk factor was found in half of this Nicaraguan sample. Cardiovascular risk factors should be the target of educational efforts, screening, and treatment.
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| 7. |
- Peraza, Sandra, et al.
(författare)
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Decreased Kidney Function Among Agricultural Workers in El Salvador
- 2012
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Ingår i: American Journal of Kidney Diseases. - : Elsevier BV. - 1523-6838 .- 0272-6386. ; 59:4, s. 531-540
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Tidskriftsartikel (refereegranskat)abstract
- Background: An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design: Cross-sectional population-based survey. Setting & Participants: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor: Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD. Outcomes: Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), and proteinuria categorized as low (protein excretion >= 30-<300 mg/dL) and high grade (>= 300 mg/dL). Results: Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR <60 mL/min/1.73 m(2) compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR <60 mL/min/1.73 m(2) were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women. Limitations: The cross-sectional nature of the study limits etiologic interpretations. Conclusion: Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion. Am J Kidney Dis. 59(4): 531-540. (C) 2012 by the National Kidney Foundation, Inc.
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| 8. |
- 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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| 9. |
- Torres, Cecilia, et al.
(författare)
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Decreased Kidney Function of Unknown Cause in Nicaragua : A Community-Based Survey
- 2010
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Ingår i: American Journal of Kidney Diseases. - : Elsevier BV. - 0272-6386 .- 1523-6838. ; 55:3, s. 485-496
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Tidskriftsartikel (refereegranskat)abstract
- Background: End-stage kidney disease overwhelms health services in Central America. We determined prevalences of decreased kidney function in distinct populations in the most affected region of Nicaragua. Study Design: Cross-sectional survey. Setting & Participants: Total populations aged 20-60 years of 5 villages in Northwest Nicaragua: mining/subsistence farming (elevation, 100-300 m above sea level), banana/sugarcane (100-300 m), fishing (0-100 m), services (0-100 m), and coffee (200-675 m); 479 men and 617 women (83% response). Predictor or Factor: Village; participant sex, age, and occupation; conventional chronic kidney disease risk factors. Outcomes: Serum creatinine (SCr) values greater than laboratory reference range for sex, estimated glomerular filtration rate <60 mL/min/1.73 m(2), proteinuria stratified in the low (dipstick protein excretion, 30-300 mg/dL) and high (>300 mg/dL) range. Results: Prevalences of abnormal SCr levels: 18% (of all men) and 5% (of all women); in the mining/subsistence farming village, 26% and 7%; banana/sugarcane, 22% and 6%; fishing, 13% and 4%; services, 0% and 1%; and coffee, 7% and 0%. Prevalences of estimated glomerular filtration rate <60 mL/min/1.73 m2: 14% (of all men) and 3% (of all women); in the listed villages, 19% and 5%, 17% and 4%, 10% and 2%, 0% and 0%, and 7% and 0%, respectively. Proteinuria, predominantly in the low range, affected 14% and 11% of all men and women without marked differences between villages. By occupation, abnormal SCr levels occurred in 31% and 24% of male and female agricultural workers at 100-300 m above sea level, but not at higher altitudes, and also was high in male artisans (43%), construction workers (15%), and miners (14%). In logistic regression models, for the banana/sugarcane and mining/subsistence farming villages, high blood pressure and age were significant predictors of abnormal SCr levels in men, and for mining/subsistence farming, age in women. Limitations: Causality is not addressed. Conclusions: In some Nicaraguan villages and population segments, men in particular show a high prevalence of decreased kidney function of unknown origin, possibly environmental or occupational.
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| 10. |
- Wesseling, Catharina, et al.
(författare)
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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
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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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