Acute occupational pesticide-related illness in the US, 1998-1999: surveillance findings from the SENSOR-pesticides program

Toxicology of chemical biocides: Anticoagulant rodenticides - Beyond hemostasis disturbance

The use of anticoagulant rodenticides (ARs) is one of the most commonly employed management methods for pest rodents. ARs compete with vitamin K (VK) required for the synthesis of blood clotting factors in the liver, resulting in inhibition of blood coagulation and often animal death due to hemorrhage. Besides rodents (target species), ARs may affect non-target animal species and humans. Out of hemostasis disturbance, the effects of ARs may be related to the inhibition of proteins that require VK for their synthesis but are not involved in the coagulation process, to their direct cytotoxicity, and their pro-oxidant/proinflammatory activity. A survey of the cellular and molecular mechanisms of these sublethal/asymptomatic AR effects is given in this review. Data from field, clinical, and experimental studies are presented. Knowledge of these mechanisms might improve hazard characterization and identification of potential ecotoxicological risks associated with ARs, contributing to a safer use of these chemicals.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

BACKGROUND

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.

AIMS

Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.

METHOD

We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.

RESULTS

Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.

CONCLUSIONS

Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

Liquid chromatography tandem mass spectrometry for the determination of nine insecticides and fungicides in human postmortem blood and urine

Pesticide poisoning is a common occurrence due to their widespread use, easy access and high toxicity even in small concentrations. The most common poisoning fatalities have been observed due to exposure to organophosphates, carbamates and neonicotinoids, thus development of a method for the rapid determination of these compounds in blood and urine is of great importance for clinical and toxicology laboratories. A simple, fast and reliable method was developed for the determination of 9 pesticides in blood and urine using HPLC-MS/MS instrumentation. In order to find the most suitable sample pretreatment technique, three different sample preparation procedures: SPE, protein precipitation and QuEChERS were compared. The final optimized analytical method was fully validated with the values of parameters such as calibration linearity, accuracy, precision, recovery, matrix effect and stability being acceptable. The method proved reliable, accurate, robust and sensitive and was successfully applied for the quantitation of pesticides in three postmortem cases of pesticides poisoning.

A retrospective comparison of the burden of organophosphate poisoning to an Intensive Care Unit in Soweto over two separate periods

Introduction

Organophosphate poisoning (OPP) is a major health-care burden in South Africa. Recently, we have observed that patients admitted to our Intensive Care Unit (ICU) with OPP have followed a more complicated course in comparison to previous years.

Objectives

To describe the differences in the clinical course and costs of patients with OPP between two time periods, namely 2012 and 2017.

Methods

Retrospective comparison of patients admitted to the Intensive Care Unit (ICU) of Chris Hani Baragwanath Academic Hospital between January 2012 to December 2012 and January 2017 to December 2017.

Results

Forty-one patients were found in the database. Patients from our 2017 cohort showed a significantly longer total median (IQR) length of stay 8 (4–17) days vs. 2 (2–3) days, p = 0.000, duration of antidote therapy 5 (3−10) days vs. 2 (2–3) days, p = 0.004 and duration of ventilation 4 (2−11) days vs 1 (1–2) day, p = 0.003. Patients presenting in 2017 were more likely to be admitted to ICU, odds ratio 5.6 (CI 1.2–26). There was a 31- fold increase in ICU costs between 2012 and 2017.

Conclusion

Based on our experience, the clinical course of OPP requiring ICU admission has evolved into a condition with a longer length of stay, duration of antidote therapy, ventilatory support, increased risk of complications and additional costs.

Public Health Surveillance for the Prevention of Pesticide-Related Illness in Illinois

OBJECTIVES

There is no pesticide related illness (PRI) surveillance program in Illinois. This study examines the quality of state-based data sources for their ability to inform public health surveillance on PRI.

METHODS

We estimated the counts of PRI by probabilistic data linkage of hospital discharge, emergency department, and poison center databases from 2010 to 2015. We characterized identified PRI cases.

RESULTS

We identified 3867 unique cases of PRI and 6269 asymptomatic pesticide exposures. Out of the 3867 PRI cases, there were 1319 emergency department visits and 321 hospitalizations. We identified 13 deaths and 1640 major or moderate effects from PRI. Over half of ingestion related exposures occurred in children aged 0 to 4 years. Workers' compensation and Emergency Medical Service data were unusable.

CONCLUSION

An effective public health surveillance on PRI requires reliable state data sources and cost-effective methods of assembling data from multiple sources.

Cholinesterases and Engineered Mutants for the Detection of Organophosphorus Pesticide Residues

Nowadays, pesticide residues constitute an increasing public health concern. Cholinesterases, acetylcholinesterase, and butyrylcholinesterase, are reported to be involved in detoxification processes owing to their capability of scavenging organophosphates and carbamates. Thus, these enzymes are targeted for the discovery of sensors aiming at detecting pesticide residues. In recent years, cholinesterase-based biosensors have attracted more and more attention in the detection of pesticides. Herein, this review describes the recent progress on the engineering of cholinesterases and the development of the corresponding sensors that could be used for the detection of organophosphorus pesticide residues.

Aptasensor based on fluorophore-quencher nano-pair and smartphone spectrum reader for on-site quantification of multi-pesticides

Current techniques for the detection of multi-pesticides are limited by technical complexity, sensitivity and cost. There is an urgent demand of developing new specific recognition elements and sensitive signal readouts for on-site monitoring. In this work, we developed a fluorescent aptamer-based lateral flow biosensor (apta-LFB) integrated with fluorophore-quencher nano-pairs and a smartphone spectrum reader to accomplish triple-target detection of chlorpyrifos, diazinon, and malathion. Aptamers serve as alternative recognition elements instead of antibodies in LFB, offering better specificity and stability. A novel fluorophore-quencher nano-pair (quantum dots nanobeads and gold nanostars) was implemented to perform "signal-on" instead of "signal-off". After optimization, detection limit of chlorpyrifos, diazinon, and malathion were determined to be 0.73 ng/mL, 6.7 ng/mL, and 0.74 ng/mL, respectively. Greatly increased sensitivity may come from the combination of improved signal and zero background. This innovative cascade strategy allowed to lower the detection limit of pesticides residue level in food, which is largely considered satisfactory. The accuracy and practicality of this design for effective on-site quantification of multi-pesticides were further confirmed using 12 vegetable and fruit samples. The estimated recoveries were between 82.4% and 112.8% in spiked vegetable samples, which indicated that the developed method is capable for detecting multi-pesticides in food samples. This sensitive handheld-system is promising to become a powerful tool for practical on-site application of multi-pesticide quantification procedures.

Elemental Sulfur Use and Associations with Pediatric Lung Function and Respiratory Symptoms in an Agricultural Community (California, USA)

BACKGROUND

Elemental sulfur, "the oldest of all pesticides," is the most heavily used agricultural pesticide in California and Europe. Sulfur is considered relatively safe and is used in both conventional and organic farming systems. Adverse respiratory effects have been reported in applicators and animals, but the effect on residential populations, and especially on children living in proximity to fields treated with elemental sulfur, is not known.

OBJECTIVES

We evaluated associations between residential proximity to elemental sulfur applications and respiratory symptoms and spirometry of children living in an agricultural community.

METHODS

Participants were enrolled in the CHAMACOS longitudinal birth cohort. We collected respiratory symptomatology for 347 children at 7 y of age and measured spirometry on a subset of 279. Of these, estimations of proximity to sulfur application and relevant covariate data were available for 237 and 205 children for whom we had symptomatology information and FEV₁ measurements, respectively. Data from the California Pesticide Use Reporting System were used to estimate the amount of elemental sulfur applied within 0.5, 1, and 3km of a child's residence during the week, month, and 12 mo prior to pulmonary evaluation. Regression models controlled for maternal smoking during pregnancy; season of birth; PM_2.5 (particulate matter ≤2.5mm in aerodynamic diameter); breast feeding duration; child's sex, age, and height; technician; and other covariates.

RESULTS

Adverse associations with respiratory outcomes were found for sulfur applications within 0.5- and 1-km radii. Specifically, asthma medication usage and respiratory symptoms increased [OR=3.51; 95% confidence interval (CI): 1.50, 8.23, p=0.004; OR=2.09; 95% CI: 1.27, 3.46, p=0.004, respectively] and FEV₁ decreased (β=−0.143; 95% CI: −0.248, −0.039, p=0.008) per 10-fold increase in the estimated amount of sulfur used within 1 km of child residence during the year prior to pulmonary evaluation.

CONCLUSIONS

This study suggests that elemental sulfur use, allowed in both organic and conventional farming, in close proximity to residential areas, may adversely affect children's respiratory health. https://doi.org/10.1289/EHP528.

Molecular detection of M. tuberculosis and M. bovis and hematological and biochemical analyses in agricultural sprayers exposed to pesticides: A cross-sectional study in Punjab, Pakistan during 2014-2016

We determined the correlation between a pesticide exposure, physical health and susceptibility toward tuberculosis along with hematological indices and liver enzymes' alterations in sprayers exposed to pesticides. Molecular detection of Mycobacterium tuberculosis and Mycobacterium bovis was detected by targeting histone-like protein (hupB) gene. The WBC (white blood cells) and RBC (red blood cells) levels of male sprayers and non-sprayers were significantly different (P<0.05). In female spray workers, the WBC and neutrophils levels were significantly different as compared with non-sprayers. Overall, in both male and female pesticide-exposed sprayers, mean values of alanine amino transferase and aspartate amino transferase were higher as compared with unexposed workers. M. Tuberculosis were detected in 15% male sprayers and 36% female sprayers while, M. bovis was detected in 5% male sprayers and 10% female sprayers. A χ²-test indicated that there existed a significant different (P<0.05) between positive and negative M. tuberculosis and M. bovis in both male/female spray workers out of total. The susceptibility of pesticide-exposed sprayers to tuberculosis and alterations in hematology and liver enzymes is crucial for health. Toxic effects of pesticides may lead to a weak immune system and increased tuberculosis susceptibility.

Absence of t(14;18) chromosome translocation in agricultural workers after short-term exposure to pesticides

Exposure to pesticides represents a potential health risk for the general population and for agricultural workers in particular. Some researchers observed that occupational exposure to pesticides is associated with risk of non‑Hodgkin's lymphoma (NHL). The chromosomal translocation t(14;18)(q32;q21) is one of the most common chromosomal abnormalities in NHL. The aim of this study was to detect the effects of pesticides on t(14;18) chromosome translocation in agricultural workers after short-term exposure. Fifty-two workers occupationally exposed to pesticides (fungicides and insecticides) and 52 non-exposed were recruited. The farm workers were on average exposed to pesticides for ~3.7 h a day for 5 years. The frequency of BCL2-IGH t(14;18) translocation in workers occupationally exposed to pesticides was 10% (5 of 52) vs. 8% (4 of 52) in the control group. Overall, these data suggest that no significant association between occupational exposure to pesticides and an increased frequency of the chromosomal translocation BCL2-IGH t(14;18) in farmers was observed. However, further studies with a higher number of subjects exposed to pesticides are necessary to confirm this observation.

Aerial pesticide application causes DNA damage in pilots from Sinaloa, Mexico

The use of pesticides in agricultural production originates residues in the environment where they are applied. Pesticide aerial application is a frequent source of exposure to pesticides by persons dedicated to agricultural practices and those living in neighboring communities of sprayed fields. The aim of the study was to assess the genotoxic effects of pesticides in workers occupationally exposed to these chemicals during their aerial application to agricultural fields of Sinaloa, Mexico. The study involved 30 pilots of airplanes used to apply pesticides via aerial application and 30 unexposed controls. Damage was evaluated through the micronucleus assay and by other nuclear abnormalities in epithelial cells of oral mucosa. The highest frequency ratios (FR) equal to 269.5 corresponded to binucleated cells followed by 54.2, corresponding to cells with pyknotic nuclei, 45.2 of cells with chromatin condensation, 3.7 of cells with broken-egg, 3.6 of cells with micronucleus, and 2.0 of karyolytic cells. Age, worked time, smoking, and alcohol consumption did not have significant influence on nuclear abnormalities in the pilots studied. Pesticide exposure was the main factor for nuclear abnormality results and DNA damage. Marked genotoxic damage was developed even in younger pilots with 2 years of short working period, caused by their daily occupational exposure to pesticides.

Changes in Perceptions and Practices of Farmers and Pesticide Retailers on Safer Pesticide Use and Alternatives: Impacts of a Community Intervention in Chitwan, Nepal

Unsafe use of hazardous pesticides is a neglected public health problem in developing countries. This survey evaluates the effects of a training program to increase awareness on harmful effects of pesticides and to enhance capacity for safe handling involving 57 trained farmers, 98 neighboring farmers, 94 control farmers, and 23 pesticide retailers from villages in Chitwan, Nepal. Knowledge and attitude-related variables improved in all 3 farmer groups, with a significant trend of better knowledge and attitude from trained to neighboring to control farmers (in 14/16 [87.5%] variables). In practice, there were significant differences among the groups with a trend from trained to neighboring to control farmers (in 10/26 [38.5%] variables).The pesticide retailers also improved on knowledge and practice. In conclusion, training farmers and pesticide retailers improved their knowledge and practice, with possible positive effect on neighboring farmers and control villages as well. An improved extension service to farmers is recommended.

Ion mobility spectrometry evaluation of cocaine occupational exposure in forensic laboratories

An approach, based on ion mobility spectrometry (IMS) has been developed for the control of cocaine in air of the breathing zone of operators, in laboratory surfaces and in nasal mucus of employees to evaluate cocaine exposure in a forensic laboratory. The analytical methodology has been validated in terms of accuracy, precision and limits of detection and results obtained were statistically comparable with those obtained by liquid chromatography. Cocaine concentration in laboratory air increases from 100 ± 35 ng m(-3) of a normal day to 10,000 ng m(-3) during the manipulation of cocaine seizures. The occupational exposure limit (OEL) for cocaine has not been established which difficult the evaluation of the health effects of continuous exposition to very small doses of cocaine. Cocaine was also found in almost all the analyzed sample surfaces and also was found in nasal mucus of the police officers that were present during the manipulation of cocaine seizures without using a face mask. In summary, cocaine concentrations could present a health hazard to the employees and therefore warrants remediation and some modifications of the manipulation operations have been proposed.

Occupational pesticide exposures and respiratory health

Pesticides have been widely used to control pest and pest-related diseases in agriculture, fishery, forestry and the food industry. In this review, we identify a number of respiratory symptoms and diseases that have been associated with occupational pesticide exposures. Impaired lung function has also been observed among people occupationally exposed to pesticides. There was strong evidence for an association between occupational pesticide exposure and asthma, especially in agricultural occupations. In addition, we found suggestive evidence for a link between occupational pesticide exposure and chronic bronchitis or COPD. There was inconclusive evidence for the association between occupational pesticide exposure and lung cancer. Better control of pesticide uses and enforcement of safety behaviors, such as using personal protection equipment (PPE) in the workplace, are critical for reducing the risk of developing pesticide-related symptoms and diseases. Educational training programs focusing on basic safety precautions and proper uses of personal protection equipment (PPE) are possible interventions that could be used to control the respiratory diseases associated with pesticide exposure in occupational setting.

Occupational and Environmental Medicine in the United States: A Proposal to Abolish Workers' Compensation and Reestablish the Public Health Model

The workers' compensation model of occupational and environmental medicine should be converted to a public health model. Occupational and environmental medicine, as a part of the public health infrastructure,could play a much more substantive part in bringing about a national program to deal with occupational and environmental health. The workers' compensation insurance system could be discontinued at any time,but it will be vital to do so when national health insurance is adopted in the United States. Abolishing workers' compensation would remove the perverse incentives that currently undermine the practice of occupational medicine. Medical care for workers should be provided by health care professionals who are not subject to influence by employers or insurers. Eligibility for benefits should not be determined by health and safety professionals. Wage-replacement benefits for workers should be determined by guidelines established by government and industry that prevent manipulation of health and safety professionals by employers and insurers. A nationwide comprehensive system to track work-related injury and illness, superior to the current reliance on records provided by employers and collated by government agencies, should be adopted. When unusually high rates of injuries, illnesses,and fatalities occur, government inspectors ought to respond and regulate the industry accordingly. Occupational health and safety professional strained in public health can and should participate in these activities, but not when they are in the employ of industry or insurers.

Frequency, etiology and several sociodemographic characteristics of acute poisoning in children treated in the intensive care unit

AIM

The aim of this work has been to present the frequency, etiology and several other socio-demographic characteristics of acute poisoning in children. THE TREATED PATIENTS AND METHODS OF WORK: The treated patients were children of all age groups hospitalized in the Pediatric Clinic of Prishtina during year 2009. The study was done retrospectively. The diagnosis was done on the basis of heteroanamnesis and in several cases on the basis of the anamnesis data of a child, routine laboratory tests and toxicologic analysis.

RESULTS

66 (9.4%) poisoned children were treated in the Intensive Care Unit. The biggest number of patients, 37 (56.06%) of them, were male, and out of that number 36 (54.55%) cases were coming from rural areas. The biggest number of them 49 (74.98%) were over 2-6 years old. The poisoning was mostly caused through the digestive tract (ingestion), it happened with 55 cases (83.33%), 56 cases (84,80%) suffered from severe poisoning, whereas 59 cases (89,50%) suffered from accidental poisoning. Regarding the type of the substances that caused poisoning, the most frequent were drugs in 34 (51.50%) cases and pesticides in 20 (30.30%) cases. Among drugs, the most dominant were those belonging to a group of benzodiazepines (10 cases) and metoclopramide (4 cases). Among pesticides the most dominant one that caused poisoning was malation (5 cases), then paration and cipermetrina appeared in 3 cases each. The biggest number of cases, 64 (96.96%) of them, were treated, whereas 2 cases (3.40%) passed away.

CONCLUSION

The practice proved that that our people are not well informed about the poisoning in general, therefore it is necessary that they be educated by the use of all media, written and electronic, as well as other methods of medical education.

Acute pesticide illnesses associated with off-target pesticide drift from agricultural applications: 11 States, 1998-2006

BACKGROUND

Pesticides are widely used in agriculture, and off-target pesticide drift exposes workers and the public to harmful chemicals.

OBJECTIVE

We estimated the incidence of acute illnesses from pesticide drift from outdoor agricultural applications and characterized drift exposure and illnesses.

METHODS

Data were obtained from the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks-Pesticides program and the California Department of Pesticide Regulation. Drift included off-target movement of pesticide spray, volatiles, and contaminated dust. Acute illness cases were characterized by demographics, pesticide and application variables, health effects, and contributing factors.

RESULTS

From 1998 through 2006, we identified 2,945 cases associated with agricultural pesticide drift from 11 states. Our findings indicate that 47% were exposed at work, 92% experienced low-severity illness, and 14% were children (< 15 years). The annual incidence ranged from 1.39 to 5.32 per million persons over the 9-year period. The overall incidence (in million person-years) was 114.3 for agricultural workers, 0.79 for other workers, 1.56 for nonoccupational cases, and 42.2 for residents in five agriculture-intensive counties in California. Soil applications with fumigants were responsible for the largest percentage (45%) of cases. Aerial applications accounted for 24% of cases. Common factors contributing to drift cases included weather conditions, improper seal of the fumigation site, and applicator carelessness near nontarget areas.

CONCLUSIONS

Agricultural workers and residents in agricultural regions had the highest rate of pesticide poisoning from drift exposure, and soil fumigations were a major hazard, causing large drift incidents. Our findings highlight areas where interventions to reduce off-target drift could be focused.

Advances and current themes in occupational health and environmental public health surveillance

The essential purpose of public health surveillance is to monitor important health outcomes and risk factors and provide actionable information to practitioners, policy makers, researchers, and the public to prevent or ameliorate exposure, disease, and death. Although separate 1970s-era acts of Congress made possible the creation of modern occupational health and environmental public health surveillance, these acts also led to fragmented responsibilities and unconnected data across federal agencies. Having a well-defined purpose for systematically collecting relevant data is key, and state and local programs play a crucial role in conducting meaningful surveillance and connecting it with evidence-based outreach and interventions. Congress has directed monies to environmental public health surveillance and capacity has improved, yet no analagous funding has occurred to address the fragmentation found within occupational health surveillance. This article provides a review of the advances and important themes within occupational health and environmental public health surveillance over the past decade.

Activity-based protein profiling of organophosphorus and thiocarbamate pesticides reveals multiple serine hydrolase targets in mouse brain

Organophosphorus (OP) and thiocarbamate (TC) agrochemicals are used worldwide as insecticides, herbicides, and fungicides, but their safety assessment in terms of potential off-targets remains incomplete. In this study, a chemoproteomic platform, termed activity-based protein profiling, was used to broadly define serine hydrolase targets in mouse brain of a panel of 29 OP and TC pesticides. Among the secondary targets identified, enzymes involved in the degradation of endocannabinoid signaling lipids, monoacylglycerol lipase, and fatty acid amide hydrolase were inhibited by several OP and TC pesticides. Blockade of these two enzymes led to elevations in brain endocannabinoid levels and dysregulated brain arachidonate metabolism. Other secondary targets include enzymes thought to also play important roles in the nervous system and unannotated proteins. This study reveals a multitude of secondary targets for OP and TC pesticides and underscores the utility of chemoproteomic platforms in gaining insights into biochemical pathways that are perturbed by these toxicants.

The prognostic value of the Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus poisoning

BACKGROUND AND OBJECTIVES

Organophosphate poisoning (OP) is a serious clinical condition that may sometimes be fatal. The aim of this study was to determine whether the Glasgow coma scale (GCS), and serum acetylcholinesterase and leukocyte levels have prognostic value in acute OP poisoning.

DESIGN AND SETTING

Retrospective review of records of patients admitted to the intensive care unit of Selcuk University, Meram Medical Faculty, Emergency Department, Konya, Turkey, between January 2006 and January 2009.

METHODS

We studied acutely OP-poisoned patients admitted within 24 hours after OP exposure.

RESULTS

The mean age of the 25 patients was 37 years (range, 20-80 years). Three (12%) of the 25 patients (male-female ratio, 12:13) died. The mean GCS values of the patients who died were significantly lower compared to those of the group that survived (4 vs 11.7, respectively P<.05). While the mean serum acetylcholinesterase levels were lower in the patients who died, the difference in the mean serum acetylcholinesterase levels between the patients who died and the ones who survived was not statistically significant (3841 IU/L vs. 1768 IU/L, respectively).

CONCLUSION

Although serum cholinesterase values can be used in the quick diagnosis, their efficiency at predicting outcome in patients with OP poisoning has not been established. It has also been determined that serum leukocyte values have no prognostic value in OP poisoning, but GCS values have been found to be effective in predicting the outcome.

Impact of EMS outreach: successful developments in Latin America

This collection of articles was inspired by the long-standing relationship between the Environmental Mutagen Society and Latin American scientists, and by the program for the 39th Environmental Mutagen Society meeting in Puerto Rico in 2008, which included a symposium featuring "South of the border" scientists. This collection, compiled by Graciela Spivak and Ofelia Olivero, both originally from Argentina, highlights scientists who work in or were trained in Latin American countries and in Puerto Rico in a variety of scientific specialties related to DNA repair and cancer susceptibility, genomic organization and stability, genetic diversity, and environmental contaminants.

Overcoming language and literacy barriers in safety and health training of agricultural workers

The workforce in all areas of United States agriculture and forestry is becoming increasingly diverse in language, culture, and education. Many agricultural workers are immigrants who have limited English language skills and limited educational attainment. Providing safety and health training to this large, diverse, dispersed, and often transient population of workers is challenging. This review, prepared for the 2010 Agricultural Safety and Health Council of America/National Institute for Occupational Safety and Health conference, "Be Safe, Be Profitable: Protecting Workers in Agriculture," is divided into five sections. First, we describe the occupational and demographic characteristics of agricultural workers in the United States to highlight their safety and health training needs. Second, we summarize current research on the social and cultural attributes of agricultural workers and agricultural employers that affect the provision of safety and health training. Worker and employer attributes include language, literacy, financial limitations, work beliefs, and health beliefs. Third, we review current initiatives addressing safety and health training for agricultural workers that consider worker language and literacy. These initiatives are limited to a few specific topics (e.g., pesticides, heat stress); they do not provide general programs of safety training that would help establish a culture of workplace safety. However, several innovative approaches to health and safety training are being implemented, including the use of community-based participatory approaches and lay health promoter programs. Fourth, the limited industry response for safety training with this linguistically diverse and educationally limited workforce is summarized. Finally, gaps in knowledge and practice are summarized and recommendations to develop educationally, culturally, and linguistically appropriate safety and health training are presented.

Using surveillance data to promote occupational health and safety policies and practice at the state level: a case study

BACKGROUND

Following the investigation of a birth defects cluster involving migrant farmworkers employed in North Carolina and Florida, it became clear that greater efforts were needed to protect agricultural workers from pesticide exposure.

METHODS

Documentation is drawn from peer-reviewed published articles, government reports and news accounts.

RESULTS

The birth defects cluster was identified and investigated by state and federal pesticide poisoning surveillance system staff. Following the investigation, efforts were initiated to highlight pesticides as an important public health issue needing more attention. A series of subsequent events led to the creation and passage of important legislation recently enacted in North Carolina. The legislation resulted in funding to promote various activities to prevent harm from pesticides including strengthening surveillance, improving the quality of pesticide compliance inspections, and increasing and improving pesticide safety training. The legislation also broadened the coverage of anti-retaliation rules to include agricultural workers, and increased recordkeeping requirements pertaining to pesticide applications.

CONCLUSION

The important and positive impacts that can occur through surveillance activities are highlighted. As such, it is important to continue to support and improve occupational illness and injury surveillance programs.

A community-based participatory worksite intervention to reduce pesticide exposures to farmworkers and their families

We evaluated a community-based participatory research worksite intervention intended to improve farmworkers' behaviors at work and after work to reduce occupational and take-home pesticide exposures. The workers received warm water and soap for hand washing, gloves, coveralls, and education. Self-reported assessments before and after the intervention revealed that glove use, wearing clean work clothes, and hand washing at the midday break and before going home improved significantly. Some behaviors, such as hand washing before eating and many targeted after-work behaviors, did not improve, indicating a need for additional intervention.

Pesticide-related illness reported to and diagnosed in primary care: implications for surveillance of environmental causes of ill-health

Background

In Great Britain (GB), data collected on pesticide associated illness focuses on acute episodes such as poisonings caused by misuse or abuse. This study aimed to investigate the extent and nature of pesticide-related illness presented and diagnosed in Primary Care and the feasibility of establishing a routine monitoring system.

Methods

A checklist, completed by General Practitioners (GP) for all patients aged 18+ who attended surgery sessions, identified patients to be interviewed in detail on exposures and events that occurred in the week before their symptoms appeared.

Results

The study covered 59320 patients in 43 practices across GB and 1335 detailed interviews. The annual incidence of illness reported to GPs because of concern about pesticide exposure was estimated to be 0.04%, potentially 88400 consultations annually, approximately 1700 per week. The annual incidence of consultations where symptoms were diagnosed by GPs as likely to be related to pesticide exposure was 0.003%, an annual estimate of 6630 consultations i.e. about 128 per week. 41% of interviewees reported using at least one pesticide at home in the week before symptoms occurred. The risk of having symptoms possibly related to pesticide exposure compared to unlikely was associated with home use of pesticides after adjusting for age, gender and occupational pesticide exposure (OR = 1.88, 95% CI 1.51 – 2.35).

Conclusion

GP practices were diverse and well distributed throughout GB with similar symptom consulting patterns as in the Primary Care within the UK. Methods used in this study would not be feasible for a routine surveillance system for pesticide related illness. Incorporation of environmental health into Primary Care education and practice is needed.

Reducing farmworker residential pesticide exposure: evaluation of a lay health advisor intervention

The goal of this analysis is to evaluate the effectiveness of a promotora program for teaching women in Latino farmworker families about pesticide safety and increasing pesticide safety behaviors. Volunteer promotoras delivered a pesticide safety curriculum (intervention) and nutrition curriculum (control) to farmworker women residing in western North Carolina and Virginia. Pre-and postintervention interviews assessed differences in delivery of the intervention, recognition of the intervention, pesticide knowledge, pesticide exposures behaviors, and integrated pest management behaviors. Participants in the intervention group reported significantly more receipt of pesticide education and greater recognition of the key messages. However, their knowledge, pesticide exposure behaviors, and integrated pest management behaviors did not change. A more structured program is needed to be sure that the dose of interventions is large enough to overcome educational and cultural characteristics of immigrant communities. Policy changes are needed to address circumstances outside of farmworkers' control that affect pesticide exposure.

Pyrethrin and pyrethroid illnesses in the Pacific northwest: a five-year review

OBJECTIVE

Pyrethrin and pyrethroid insecticides are commonly applied in homes and businesses and on some agricultural crops. This research used a two-state regional approach to analyze reports of acute pesticide poisonings due to pyrethrin and pyrethroid insecticides.

METHODS

The Washington State Department of Health and the Oregon Public Health Division collected pesticide poisoning surveillance data from 2001 through 2005. Cases were included if they involved exposure to at least one pyrethrin or pyrethroid insecticide. Descriptive statistics were calculated; differences between categories were assessed using Chi-square analysis.

RESULTS

A total of 407 cases fit our definition. Overall, the rate of poisoning in Oregon was significantly higher than in Washington (incidence rate ratio 1.70, 95% confidence interval 1.40, 2.07), and rates for both states generally increased during the time period. For both states, most exposures resulted in low severity illnesses (92%), and most were classified as possible cases (73%). Only about one-fourth of cases were related to a person's work. The most common category of clinical signs and symptoms of illness was respiratory (52% of cases), followed by neurological (40% of cases). Exposure route was predominantly inhalation; there was no association between route and case severity. There was a significant association between illness severity and losing time from work or regular activities (p<0.0001).

CONCLUSIONS

Although the majority of pyrethrin and pyrethroid poisoning cases were low in severity, adverse reactions have occurred, as transpired in Oregon in 2005. Regional analysis has the potential to improve the surveillance system and provide unique opportunities for targeting preventive interventions.

Causes and types of health effects during the use of crop protection chemicals: data from a survey of over 6,300 smallholder applicators in 24 different countries

Purpose

The present investigation looks in detail at the causes and types of health incidents reported by 6,300 mainly smallholder agrochemical users in 24 countries during 2005 and 2006.

Methods

The investigation is based on a questionnaire survey of knowledge, attitude and practice that concentrated on the sequence of events from purchasing the pesticide to disposal. Information was also collected about health problems experienced while using agrochemicals. The survey targeted mainly smallholder knapsack spray operators who were expected to be at a highest risk of exposure.

Results

In the 12 months prior to interview, 1.2% of users reported an agrochemical-related incident that required hospital treatment, 5.8% reported an incident requiring at least trained medical treatment but not hospitalisation and 19.8% reported only a minor sign or symptom. Users who had experienced an incident involving agricultural equipment were 3.38 (95% CI 2.29–4.99) times more likely to experience an agrochemical-related health incident, but confident users who felt that their use of personal protective equipment while spraying was best practice were 0.60 (95% CI 0.44–0.84) times less likely to experience such an incident. Over 80% of product-related incidents were caused by insecticides and the incidence rate per spraying time for incidents linked to insecticides was significantly higher than that for fungicides or herbicides. Headache/dizziness and nausea/vomiting, often smell related, were the most common symptoms reported by users who listed agrochemical products that had caused them health problems (52 and 38% of product mentions, respectively).

Conclusions

In most countries, the incidence of serious health effects was low; however, there was a high incidence of minor signs and symptoms in a few countries, especially in Africa. A disproportionate number of incidents occurred during insecticide use relative to the time that they were sprayed. Failure to exercise caution as indicated by whether users had incidents involving agricultural equipment or livestock, and lack of confidence in their practices were the most important predictors of agrochemical-related incidents.

Acute pesticide poisoning among agricultural workers in the United States, 1998-2005

BACKGROUND

Approximately 75% of pesticide usage in the United States occurs in agriculture. As such, agricultural workers are at greater risk of pesticide exposure than non-agricultural workers. However, the magnitude, characteristics and trend of acute pesticide poisoning among agricultural workers are unknown.

METHODS

We identified acute pesticide poisoning cases in agricultural workers between the ages of 15 and 64 years that occurred from 1998 to 2005. The California Department of Pesticide Regulation and the SENSOR-Pesticides program provided the cases. Acute occupational pesticide poisoning incidence rates (IR) for those employed in agriculture were calculated, as were incidence rate ratios (IRR) among agricultural workers relative to non-agricultural workers.

RESULTS

Of the 3,271 cases included in the analysis, 2,334 (71%) were employed as farmworkers. The remaining cases were employed as processing/packing plant workers (12%), farmers (3%), and other miscellaneous agricultural workers (19%). The majority of cases had low severity illness (N = 2,848, 87%), while 402 (12%) were of medium severity and 20 (0.6%) were of high severity. One case was fatal. Rates of illness among various agricultural worker categories were highly variable but all, except farmers, showed risk for agricultural workers greater than risk for non-agricultural workers by an order of magnitude or more. Also, the rate among female agricultural workers was almost twofold higher compared to males.

CONCLUSION

The findings from this study suggest that acute pesticide poisoning in the agricultural industry continues to be an important problem. These findings reinforce the need for heightened efforts to better protect farmworkers from pesticide exposure.

Low level of exposure to pesticides leads to lung dysfunction in occupationally exposed subjects

Pesticides may contribute to adverse respiratory health effects among farmers and have been considered one causal factor for the rise in asthma prevalence. This cross-sectional study was conducted to evaluate potential respiratory function abnormalities following long-term pesticide exposure by means of a complete pulmonary function testing, including spirometry, lung volumes, and diffusing capacity for carbon monoxide. The study population was comprised by workers from a prominent intensive agriculture area of southern Spain that relied on pesticides for the control of plagues. Eighty-nine pesticide sprayers of plastic greenhouse farming and a control group of 25 nonspraying control farmers from the same area were interviewed by a general practitioner asking about sociodemographic factors, occupational exposure, and clinical symptoms by using a structured questionnaire. Multiple regression analyses showed a relationship of short-term exposure to pesticides (as indicated by a drop in serum cholinesterase > 25% of baseline levels) with reduced forced expired volume in 1 s, and of long-term exposure (as indicated by a cumulative pesticide exposure index) with reduced forced expiratory flow rate. Exposure to bipyridilium-class herbicides was a determinant of a fall in the diffusing capacity of the lungs, and neonicotinoid insecticides showed a relationship with lower pulmonary volumes (total lung capacity, residual volume, and functional residual capacity), suggestive of restrictive lung disease, and with an increased risk of reporting irritative symptoms.

Acute pesticide poisoning: a proposed classification tool

Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide. Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems. Previous research has demonstrated wide variability in incidence rates for APP. This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems. This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world. It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases. Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention. By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.

Pesticide multiresidue analysis in Panax ginseng (C. A. Meyer) by solid-phase extraction and gas chromatography with electron capture and nitrogen-phosphorus detection

An analytical multi-residue method using gas chromatography coupled with electron capture and a nitrogen-phosphorus detector was investigated for the simultaneous determination of 18 commonly used insecticides and fungicides in Korean ginseng (Panax ginseng C. A. Meyer). Samples were previously extracted with an acetonitrile and cleaned up by solid-phase extraction (SPE). The calibration curves were linear, with determination coefficients higher than 0.989. Recoveries at concentrations between 0.01 and 14.9 ppm ranged from 72.3 to 117.2%, with precision, which was expressed as relative standard deviation (RSD), at values lower than 5%. The proposed method was applied to the determination of pesticide levels from 12 ginseng samples, taken from four different agricultural areas of Jeonnam province, where several insecticides and fungicides were applied. Except in one sample, tolclofos-m was the only pesticide contained at a level lower than the maximum residue limits (MRL) authorized by the Korea Food and Drug Administration (KFDA) in real ginseng samples grown for 4, 5 and 6 years.

Acute pesticide poisoning in the U.S. retail industry, 1998-2004

OBJECTIVE

This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments.

METHODS

Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated.

RESULTS

A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004.

CONCLUSIONS

Preventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prevention.

Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ

Um estudo transversal foi realizado em uma comunidade agrícola localizada em Nova Friburgo, RJ, para conhecer os aspectos epidemiológicos, clínicos e laboratoriais da exposição múltipla a agrotóxicos em uma amostra representativa de 102 pequenos agricultores, de ambos os sexos. Os trabalhadores foram submetidos a um extenso protocolo que incluía aplicação de questionário ocupacional, coleta de amostras biológicas para exame toxicológico e avaliação clínica - geral e neurológica. Os resultados dos exames toxicológicos revelaram episódios leves a moderados de intoxicação aguda aos organofosforados descritos pelos agricultores ou observados durante o exame clínico. Foram também diagnosticados 13 (12,8 %) quadros de neuropatia tardia e 29 (28,5%) quadros de síndrome neurocomportamental e distúrbios neuropsiquiátricos associados ao uso crônico de agrotóxicos. Os resultados apontam para a ocorrência de episódios recorrentes de sobre-exposição múltipla, a elevadas concentrações de diversos produtos químicos, com grave prejuízo para as funções vitais desses trabalhadores, especialmente por se encontrarem em uma faixa etária jovem (média = 35 ± 11anos) e período produtivo da vida. Estes dados demonstram a importância do monitoramento da múltipla exposição a agrotóxicos, uma cadeia de eventos de grande repercussão na saúde pública e para o meio ambiente.

Organophosphate exposures in the United States: a longitudinal analysis of incidents reported to poison centers

The implementation of the Food Quality Protection Act of 1996 resulted in a decision by the U.S. Environmental Protection Agency to phase out and eliminate the use of organophosphate insecticides in residential environments. The phase-out and cancellation process began in the year 2000 and was complete in 2005. The purpose of this investigation was to utilize national Poison Control Center data to assess whether the risk mitigation decision had an impact on the number of incident cases involving organophosphates in the United States. Organophosphate exposure incident data were extracted from Annual Reports of the American Association of Poison Control Centers Toxic Exposure Surveillance System (TESS) for the years 1995 to 2004. The number of organophosphate exposure incidents peaked at 20,135 in 1997, and declined in each subsequent year. A statistically significant decrease was observed in the average annual number of organophosphate exposure incidents when comparing data from the time periods before (1995-1999) and after (2000-2004) the commencement of the phase-out process. The decrease in organophosphate incident cases was observed for all age categories, as well as for the circumstances surrounding the exposure (unintentional and intentional exposure incidents). TESS data showed a significant decrease in incident cases involving organophosphates in association with the phase-out from residential uses. The results of this investigation are consistent with other studies that have reported that regulatory restriction of access to pesticide formulations may have a significant impact on the number of human exposure incidents.

Permeation of Comite through protective gloves

The goal of the study was to assess how protective disposable (Safeskin) and chemical protective (Sol-Vex) nitrile gloves were against Comite emulsifiable concentrate formulation containing propargite (PROP) as active pesticidal ingredient, because there were no explicit recommendations for the gloves that should be worn for hand protection. The glove material was exposed in ASTM-type I-PTC-600 permeation cells at 30.0+/-0.5 degrees C, and gas chromatography-mass spectrometry used for PROP analysis. Aqueous solutions of Comite at 40.4 mg/mL permeated both Safeskin and Sol-Vex nitrile by 8h. Safeskin showed a mean PROP mass permeated of 176+/-27 microg after 8h compared with a mean mass permeated for Sol-Vex of 3.17+/-4.08 microg. Thus, Sol-Vex was about 56 times more protective than Safeskin for an 8-h exposure. However, the kinetics of the permeation revealed that Safeskin can be worn for at least 200 min before disposal. When undiluted Comite challenged both types of nitrile, much faster permeation was observed. Safeskin gloves showed two steady state periods. The first had lag times (t(l)) values of about 1h, although normalized breakthrough times (t(b)) were < 10 min. The second steady state rate (P(s)) was on average four times the rate of the first period, and the second steady state period t(l) was about three times as long as that of the first steady state period, and about the same t(l) as for the aqueous solution. Sol-Vex gloves exposed continuously to undiluted Comite permeated above the normalized breakthrough threshold beyond 2.7h. A risk assessment revealed that the PROP skin permeation rate of 7.1 ng cm(-2)h(-1) was much slower than the first steady state Safeskin glove P(s) of 62,000 ng cm(-2)h(-1). Infrared analysis showed that the glove surfaces were not degraded by the Comite challenge. The chemically protective Sol-Vex gloves protected adequately against undiluted formulation for about 2.7h, whereas they provided protection for nearly 8h when the formulation was diluted with water to the highest concentration for field application. In contrast, the disposable Safeskin gloves did not protect at all for the undiluted formulation, but did for 200 min when the formulation was diluted with water to the highest concentration for spraying.

Influence of exposure to pesticides on serum components and enzyme activities of cytotoxicity among intensive agriculture farmers

Although the effects of acute pesticide poisoning are well known for the pesticides most currently used, hardly any data exist on health effects after long-term low-dose exposures. Major unresolved issues include the effect of moderate exposure in the absence of poisoning. The increased utilization of pesticides other than organophosphates makes it even more difficult to find associations. In this study a cohort of 106 intensive agriculture workers were assessed twice during the course of a spraying season for changes in serum biochemistry, namely enzymes reflecting cytotoxicity (AST, ALT, LDH, CK, and amino-oxidase) and other biochemical parameters, such as markers of nephrotoxicity (urea, creatinine) and lipid profile (cholesterol and triglycerides). Several criteria for estimating pesticide exposure were used, the most important one being serum cholinesterase depression greater than 25% from baseline to peak exposure. Our results revealed an association of pesticide exposure with changes in AST (increased activity), LDH, and amino-oxidase (decreased activity) as well as with changes in serum creatinine and phosphorus (lower and higher levels, respectively). These results provide support for a very slight impairment of the liver function, but overall these findings are consistent with no clinically significant hepatotoxicity. Intriguingly, paraoxonase-1 R allele was found to be an independent predictor of higher rates of AST and lower rates of amino-oxidase, so that it may play a supporting role as an individual marker of susceptibility on pesticide-induced health effects. In conclusion, different biomarkers might be used to detect early biochemical effects of pesticides before adverse clinical health effects occur.

Improving the quality of randomized controlled trials in Chinese herbal medicine, Part Ⅲ: quality control of Chinese herbal medicine used in randomize

OBJECTIVE

To discuss quality control of Chinese herbal medicine (CHM) in randomized controlled trials (RCTs), and to provide suggestions for improving this aspect in future clinical study in this therapeutic area.

METHODS

A search of the Cochrane Library was conducted to identify RCTs of CHM. Quality control information reported in those RCTs was then assessed independently.

RESULTS

The search yielded a total of 167 RCTs of CHM for a variety of conditions. A total of 11 CHM preparations were used in those RCTs. Only one trial discussed quality control of the CHM interventions used. Issues affecting the safety and efficacy of CHM products used in RCTs were discussed including standardization of raw herbal materials, processing methods, screening for product contamination, and effects of combination products.

CONCLUSION

The overall quality of reporting of RCTs of CHM was poor, reflecting the need for improvements in reporting future clinical trials in this area.

RECOMMENDATIONS

To improve quality control of CHM used in RCTs in future, we recommend developing and implementing guidelines such as Good Agricultural Practice (GAP) for Chinese crude drugs, and current Good Manufacturing Practice (GMP) specific to CHM products. Chemical analyses of individual herbs of CHM and combination products are also recommended to provide reference standards for quality control.

Acute pesticide-related illness among emergency responders, 1993-2002

BACKGROUND

Emergency responders are among the first to arrive at a pesticide-related release event. Magnitude, severity, and risk factor information on acute pesticide poisoning among those workers is needed.

METHODS

Survey data collected from the SENSOR-Pesticides, CDPR and HSEES programs between 1993 and 2002 from 21 states were reviewed. Acute occupational pesticide-related illness incidence rates for each category of emergency responder were calculated, as were incidence rate ratios (IRR) among emergency responders compared to all other workers employed in non-agricultural industries.

RESULTS

A total of 291 cases were identified. Firefighters accounted for 111 cases (38%), law enforcement officers for 104 cases (36%), emergency medical technicians for 34 cases (12%), and 42 cases (14%) were unspecified emergency responders. Among the 200 cases with information on activity responsible for exposure, most were exposed while performing activities related to a pesticide release event (84%) and not involving patient care, while the remainder involved exposure to pesticide-contaminated patients. A majority of cases were exposed to insecticides (51%). Most had low severity illnesses (90%). The incidence rate was highest for firefighters (39.1/million) and law enforcement officers (26.6/million). The IRRs were also elevated for these professions (firefighters, IRR = 2.67; law enforcement officers, IRR = 1.69).

CONCLUSIONS

The findings suggest the need for greater efforts to prevent acute occupational pesticide-related illness among emergency responders.

Occupational exposures and movement abnormalities among Japanese-American men: the Honolulu-Asia Aging Study

OBJECTIVE

The authors analyzed data on 1,049 men aged 71-93 years (excluding those with prevalent Parkinson's disease and stroke) from the Honolulu Heart Program (1965-1968) and the Honolulu-Asia Aging Study (1991-1999) to determine whether occupational exposures to pesticides, solvents, metals, manganese, and mercury during middle age were associated with 14 movement abnormalities 25 years later.

METHODS

Analyses of variance and multivariate logistic regression were used to assess associations of interest.

RESULTS

After adjustment for age, BMI, cognitive functioning, smoking, alcohol drinking, education, and physical activity, there was a positive association between abnormal 'facial expression' and the highest exposure to metals [odds ratio (OR) = 2.62; 95% confidence interval (CI) = 1.35-5.11; trend, p = 0.02], and the highest exposure to mercury (OR = 1.91; 95% CI = 1.04-3.49; trend, p = 0.03). Age was positively associated with all movement abnormalities, and cognitive function, body mass index and physical activity were inversely associated with most movement abnormalities.

CONCLUSION

Higher exposure to any metal, and specifically mercury, was associated with abnormal facial expression.

Pesticides and electronic resources for health care providers

Agricultural workers are at higher risk of occupational injuries, including pesticide exposures. There is general agreement that the training of health care providers to recognize and manage such exposures is limited and in need of improvement. While the Internet presents opportunities for health care providers to access information and continue their medical education, it can be difficult to identify relevant resources in a timely manner. This case report presents a realistic scenario of a suspected pesticide exposure among symptomatic agricultural workers. The discussion that follows presents Web-based resources that health care providers can rely upon in recognizing, managing, and preventing pesticide-related illness.

Systematic evaluation of organochlorine pesticide residues in Chinese materia medica

A systematic evaluation on the levels of organochlorine pesticide residues (OCP) was conducted on four selected, authentic Chinese materia medica, namely: Radix Angelicae Sinensis, Radix Notoginseng, Radix Salviae Miltiorrhizae and Radix Ginseng. Altogether ten representative batches of samples were analysed for each herb. Six batches were collected in the major cultivation areas of the Mainland whilst the remaining four batches were procured in the Hong Kong herbal market. All except Radix Angelicae Sinensis have been identified as containing quintozene and hexachlorocyclohexane in various levels. Hexachlorobenzene and lindane were also reported in samples of Radix Ginseng. The banned pesticide, DDT and its derivatives, was also observed in one of the Radix Notoginseng samples. The investigation will be continued for a target list of common used herbs in Hong Kong. All the results will be gathered and analysed for setting up regulatory permissible limits of OCP residues in Chinese materia medica used in Hong Kong.

Developing a comprehensive pesticide health effects tracking system for an urban setting: New York City's approach

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors.

Association of pesticide exposure with neurologic dysfunction and disease

Poisoning by acute high-level exposure to certain pesticides has well-known neurotoxic effects, but whether chronic exposure to moderate levels of pesticides is also neurotoxic is more controversial. Most studies of moderate pesticide exposure have found increased prevalence of neurologic symptoms and changes in neurobehavioral performance, reflecting cognitive and psychomotor dysfunction. There is less evidence that moderate exposure is related to deficits in sensory or motor function or peripheral nerve conduction, but fewer studies have considered these outcomes. It is possible that the most sensitive manifestation of pesticide neurotoxicity is a general malaise lacking in specificity and related to mild cognitive dysfunction, similar to that described for Gulf War syndrome. Most studies have focused on organophosphate insecticides, but some found neurotoxic effects from other pesticides, including fungicides, fumigants, and organochlorine and carbamate insecticides. Pesticide exposure may also be associated with increased risk of Parkinson disease; several classes of pesticides, including insecticides, herbicides, and fungicides, have been implicated. Studies of other neurodegenerative diseases are limited and inconclusive. Future studies will need to improve assessment of pesticide exposure in individuals and consider the role of genetic susceptibility. More studies of pesticides other than organophosphates are needed. Major unresolved issues include the relative importance of acute and chronic exposure, the effect of moderate exposure in the absence of poisoning, and the relationship of pesticide-related neurotoxicity to neurodegenerative disease.