Health and safety of pesticide applicators in a high income agricultural setting: a knowledge, attitude, practice, and toxicity study from North-Eastern Italy

Climatic changes: knowledge and adaptation behavior to heat-related illness among solid waste disposal workers

BACKGROUND

Earth's climate changes are progressing at an alarming rate. One of the most severe effects of climate change is extreme heat. This study aimed to assess knowledge and adaptation behavior to heat-related illness (HRI) among solid waste disposal workers in the 10th of Ramadan City, Egypt, and to study the predictors for their knowledge and adaptation behavior.

METHODS

An exploratory cross-sectional study was conducted on 220 solid waste disposal workers. A structured interview questionnaire was used to assess the studied workers' sociodemographic and occupational characteristics, heat exposure risk, and their knowledge, and adaptation behavior.

RESULTS

The results showed that 40% and 30% of participants had adequate levels of total knowledge and adaptation behavior, respectively. There was a statistically significant relationship between workers' knowledge and both age and education. There was a statistically significant relationship between workers' adaptation behavior and age, duration of employment, working hours, and education. A binary logistic regression for significant predictors of knowledge and adaptation behavior showed that age and education were the most significant predictors.

CONCLUSION

Solid waste disposal workers were at high risk of HRI due to their low levels of knowledge and adaptation behavior regarding HRI. Educational health programs that guide workers to follow healthy behaviors and prevent HRI are recommended.

Assessing the suitability of self-healing rubber glove for safe handling of pesticides

Rubber gloves used for protection against chemicals or hazards are generally prone to tearing or leaking after repeated use, exposing the worker to potentially hazardous agents. Self-healing technology promises increased product durability and shelf life appears to be a feasible solution to address these issues. Herein, we aimed to fabricate a novel epoxidized natural rubber-based self-healable glove (SH glove) and investigate its suitability for handling pesticides safely. In this study, breakthrough time analysis and surface morphological observation were performed to determine the SH glove's ability to withstand dangerous chemicals. The chemical resistance performance of the fabricated SH glove was compared against four different types of commercial gloves at different temperatures. Using malathion as a model pesticide, the results showed that the SH glove presented chemical resistance ability comparable to those gloves made with nitrile and NR latex at room temperature and 37 °C. The self-healing test revealed that the SH glove could be self-healed and retained its chemical resistance ability close to its pre-cut value. Our findings suggested that the developed SH glove with proven chemical resistance capability could be a new suitable safety glove for effectively handling pesticides and reducing glove waste generation.

Farmers' knowledge and practice regarding good agricultural practices (GAP) on safe pesticide usage in Indonesia

Synthetic pesticides are widely applied for pest and disease control in Indonesia. However, a lack of knowledge and use of Good Agricultural Practices (GAP) for safe pesticide usage among Indonesian farmers remains a problem. This study aims to investigate the gap between farmers' knowledge of GAP for safe pesticide usage and their application of it. This research was conducted in 2020 in five Indonesian provinces. Primary data collection was by means of a survey, in which 298 respondents answered structured questionnaires. The survey also identified the sources of the information recorded and the respondents’ experience of pesticide exposure. The analysis tools used were the Wilcoxon Signed Ranked Test and Importance-Performance Analysis (IPA). There were significant differences in the results of the first analysis. These results appear to confirm the results of further analysis using IPA, which show that a high level of knowledge does not mean that farmers will apply this knowledge in practice: this is particularly relevant to wearing gloves and masks, using tools to remove blockages, never clearing blocked nozzles by blowing into them, and disposing of empty containers properly. Nevertheless, in some cases high levels of knowledge do result in high levels of application. Cases of pesticide exposure affecting human health by causing symptoms such as dizziness, nausea, and vomiting confirm that GAP for pesticide usage are not being implemented properly by some farmers. It is therefore recommended that their knowledge should be enhanced through the series of technical training programs using participatory approaches, so that farmers accumulate knowledge which will drive them to adopt GAP for safe pesticide usage.

A Comparison of Pesticide Risk Beliefs between Farmers and Farmworkers: Implications for Risk Communication and Education

Understanding the multi-dimensional risk beliefs of agricultural audiences allows risk communicators and educators to target those beliefs to improve practices. This study was designed to assess pesticide risk beliefs among English-speaking farmers and Spanish-speaking farmworkers and to compare their beliefs. The Pesticide Risk Beliefs Inventory (PRiBI) is a 19-item quantitative instrument used to assess the alignment of risk beliefs with those beliefs of experts in the field. A higher score on the PRiBI relates to an agreement with expert beliefs regarding pesticide risk. Farmers' and farmworkers' scores were signficiantly different on items corresponding to the use of physical properties to determine risk and specific adverse health outcomes associated with pesticide exposure. With an understanding that farmworkers rely on the physical properties of pesticides to assess risk, educators and farmers can encourage more reliable ways to assess pesticide hazards.

Occupational Eye Injuries in the agricultural settings: a retrospective study from North-Eastern Italy

Background: Occupational Eye Injury (OEI) represents a common world-wide event accounting for between 3.3% and 6.1% of all occupational compensation claims. In this retrospective study we evaluated all the recorded OEI which occurred in the Autonomous Province of Trento (APT) during the period 2000-2013. Methods: Data on OEI for all of APT were retrieved an institutional archive and the analysis included demographics of the injured, as well as characteristics and settings of the OEI. In order to assess the risk of OEI in Agricultural Workers (AWs) vs. all other Occupational groups, a multivariate analysis was eventually performed through a logistic regression analysis. Results: A total of 141,139 work-related injuries were recorded, including 5,065 (3.6%) OEI. 91.9% of all cases occurred in males, of Italian origin (77.2%), with a mean age of 38.4±11.7 years. The industrial sector reported the higher share of OEI (70.7%), whereas higher incidence rates were reported among AWs (6.04 vs. 3.85/1,000 workers/year). Agricultural OEI occurred in older workers (45.6±13.3 vs. 37.1±11.0 years), being more likely associated with “contusions” (OR 2.042, 95% 1.602-2.602) and “lacerations” (OR 2.386, 95%CI 1.877-3.033), and less frequently with exposures to chemicals, gases and vapours (OR 0.478, 95%CI 0.279-0.817). Conclusions: Despite a relatively low frequency of OEI, AWs were affected with a seemly higher incidence than that reported in other occupational groups. OEI in AWs exhibited a specific pattern, both in terms of lesion, and settings of the events, recommending tailored interventions in order to improve promotion strategies. (www.actabiomedica.it)

Prevalence of Parkinson Disease in Italy: a systematic review and meta-analysis

Introduction:

Parkinson’s disease (PD) is a common disease of unknown etiology. Even though accurate information on the epidemiology of PD is critical for defining appropriate health policies, epidemiological data on Parkinson’s disease (PD) in Italy are often defined as scant or conflicting. Our study attempted to provide an overview on the prevalence of (PD) by means of a systematic review and metanalysis of existing data.

Material and methods:

We searched into two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of PD in Italy. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared.

Results:

A total of 16 studies were eventually included in the analyses, with a prevalence rate of 193.7/100,000. Available reports were heterogeneous both in design and in eventual figures, and also prevalence estimates were affected by substantial heterogeneity. Interestingly, prevalence rates ranged from 37.8/100,000 inhabitants in subjects aged 0 to 64 years, to 578.7 in age group 65 to 75 years, and 1235.7 in age group 75 years or older. PD was significantly associated with male sex, but only in older age groups (i.e. Odds Ratio, OR 1.37 95%CI 1.22-1.53, and OR 1.31, 95%CI 1.21-1.42 for age groups 65-74 years and 75 years or more, respectively).

Discussion and conclusion:

While the observed variations in prevalence rates may result from environmental or genetic factors, differences in methodologies for case ascertainment and diagnostic criteria may have significantly affected our estimates. As a consequence, the comparability of existing studies is limited.

Air temperatures and occupational injuries in the agricultural settings: a report from Northern Italy (Po River Valley, 2013-2017)

Introduction:

High environmental temperatures are associated with an increased risk for occupational injuries (OIs), particularly where environmental exposure and heat sources in the workplace, are associated with internal heat generation by strenuous muscular work. As a consequence, Agricultural Workers (AWs) are among the most heavily affected occupational groups.

Methods and aims:

The aim of this study was to assess the relationship between environmental temperatures and OIs in AWs from the Po River Valley in the Northern Italy (27,736,158 total inhabitants; mean agricultural workforce of 312,195.6 individuals). Data about OIs from 2013 to 2017, and daily weather for the administrative unit of occurrence were retrieved. Days were classified by a) mininum (Tmin) / maximum (Tmax) air temperatures; b) average day temperature (Tday); c) daily temperature variation (TV), d) relative humidity. Risk for daily OIs was calculated as correspondent Odds Ratios (OR) through a Poisson regression model.

Results:

Estimated incidence for OIs was 66.3/1,000 workers-year. In regression analysis, for every Tday percentile increase equal to 2.5, an OR 1.007 (95% CI, 1.003 to 1.010) was reported. More precisely, higher risk for OIs was associated to Tmax > 25°C (OR 1.143, 95%CI 1.125-1.160) and to Tmax > 25°C + Tmin > 20°C (OR 1.158, 95%CI 1.138-1.179), Tmin < 0°C were associated with a significantly reduced risk (OR 0.879, 95%CI 0.850-0.910), with the notable exception of older age groups (OR 1.348, 95%CI 1.254; 1.449). During timeframes characterized by Tmax > 35°C (i.e. HW time period), the risk was higher during the first day (OR 1.266; 95%CI 1.206-1.330), and again from the fourth day onwards (OR 1.090; 95%CI 1.048 – 1.133). Analysis of TV identified an increased risk for occupational injuries in days characterized by higher variability, and particularly for TV ranging 4.0 – 4.9 (OR 1.042, 95%CI 1.017 – 1.068), and equals to 5.0 or greater (OR 1.143, 95%CI 1.118 – 1.167). Also increased relative humidity was associated with higher risk for OIs (OR 1.096, 95%CI 1.081-1.126, and OR 1.154, 95%CI 1.135-1.173 for relative humidity 70 – 89%, and ≥ 90%).

Conclusions:

Our findings recommend policymakers to develop appropriate procedures and guidelines, in particular for the HW time periods. (www.actabiomedica.it)

Risk perception of heat related disorders on the workplaces: a survey among health and safety representatives from the autonomous province of Trento, Northeastern Italy

Introduction

This study will investigate knowledge, attitude and practices towards heat-related health issues in a sample of safety representatives from Northern Italy (H&SRs).

Methods

A cross-sectional questionnaire survey was conducted in 2016-2017 among 298 H&SR. Knowledge status was measured both in general but as well and focusing on first-aid issues. Assessment of risk perception included severity and frequency of heat-related events. Multivariate logistic regression analysis assessed individual and work-related characteristics associated with H&SRs’ risk perception.

Results

258 questionnaires were retrieved (participation rate 86.6%; mean age 48.2 ± 8.4 years). Knowledge status was relatively good on technical/preventive issues (62.3% ± 16.8) and first aid measures (72.6% ± 27.2), but a large share of respondents ignored the risk from exertional heat stroke (35.9%), and for heat strokes elicited by non-environmental heat (e.g. machineries, use of protective equipment, etc. 47.9%). The majority of respondents acknowledged the high frequency of extreme events like heat waves (62.0%), but only 44.6% agreed on their potential health threat, with an unsatisfying cumulative risk perception score (55.4% ± 23.5). A specific first-aid formation course was reported by 49.2% of respondents, while 10.9% had any previous interaction with heat-related disorders. Specific countermeasures for heat waves had been put in place by parent company in 20.1% of cases. Eventually, higher educational achievements (mOR 2.239, 95% CI 1.184-4.233) and a better general knowledge status (mOR 1.703, 95% CI 1.073-2.979) were positive predictors for higher risk perception.

Conclusions

Although H&SRs exhibited a good understanding of heat-related health issues, stakeholders should improve the implementation of specific countermeasures on the workplaces.

Knowledge, attitudes, and practices of influenza and pneumococcal vaccines among agricultural workers: results of an Italian a cross-sectional study

BACKGROUND

Working age is increasing across Europe. Seasonal influenza (SID) and pneumococcal disease (PND) immunization programmes might be successfully implemented at the workplace. We conducted a cross-sectional survey among to assess SID and PND vaccine status, as well as knowledge, attitudes and practices (KAP) in a representative sample of agricultural workers (AWs) aged ≥55 years in North-Eastern Italy.

METHODS

A structured questionnaire was administered in person by trained personnel. Bivariate and multivariate logistic regression analyses were carried out to identify behavioral and work-related factors associated with SID and PND vaccine uptake.

RESULTS

Among 707 participants, 238 were aged 55 years or more (33.7% of total). Of them, 39.1% had an up-to-date immunization status towards influenza, and 17.6% towards pneumococcus. Factors associated with inadequate immunization were doubts about influenza vaccine safety (40.0%) and the confidence in natural immunity towards pneumococcus (30.8%). Attitude towards vaccinations was somehow favorable in 44.5% of participants for SID, and 37.8% for PND. Overall, 37.4% and 21.8% workers were aware of national recommendations on SID and PND immunization, respectively. This factor was characterized as a significant predictor for SID vaccination (multivariated Odds Ratio, OR 32.688 95%CI 12.015-88.930), as well as the perception of SID as a severe disease (OR 7.539 95%CI 3.312-17.164), and the perceived value of preventing new infections (OR 3.215 95%CI 1.205-8.578). A somehow favorable attitude towards vaccinations was the main predictor (OR 39.214 95%CI 10.179-151.1) for PND vaccination.

CONCLUSIONS

Our study indicates that older workers lack appropriate knowledge of national recommendations and correct risk perception of SID and PND infections, but also vaccines' side effects. As the latter has been recognized as predictive factor for SID vaccination, our results stress the importance for tailored informative interventions in the workplaces aimed to increase risk perception and vaccine acceptance. (www.actabiomedica.it).

Knowledge, Attitudes, and Practices on Tick-Borne Human Diseases and Tick-Borne Encephalitis Vaccine among Farmers from North-Eastern Italy (2017)

Objectives: Tick-borne diseases (T-BD) represent a potential health threat for outdoor workers in endemic areas, such as the Autonomous Province of Trento (APT). We conducted a questionnaire-based survey to assess T-BD knowledge, attitudes, and preventive practices among APT farmers, specifically focusing on the use of protective habits and the uptake of the tick-borne encephalitis (TBE) vaccine.Methods: A convenience sample of 106 farmers (all males, mean age 47.3 ± 13.6 years) attending pesticide training courses (12/2016-03/2017) completed the anonymous survey. Binary regression analysis, calculations of multivariate odds ratios (mOR) and 95% confidence intervals were used to assess knowledge, attitudes, and risk perceptions as predictors of preventive measures.Results: Though general understanding of T-BD was fairly low, the majority of the participants perceived TBE infection as a frequent (73.6%) and severe disease (61.3%). Overall, 43.3% of participants knew a TBE vaccine was available, and 24.5% had been vaccinated. Protective habits were reported by 53.8% of respondents, with self-checks for tick bites particularly low at 2.8% of participants. Better knowledge of T-BD and favorable attitudes toward vaccinations were associated with TBE immunization (mOR 4.708; 95%CI 1.273-17.409 and mOR 3.555; 95%CI 1.175-10.760, respectively), while previous history of tick bite and any interaction with T-BD significantly predicted adherence to protective measures (mOR 4.458; 95%CI 1.808-10.991, and mOR 9.433; 95%CI 1.127-78.973, respectively).Conclusions: Adherence to preventive measures (TBE vaccine) and protective habits was unsatisfactory in our sampled group, being a possible consequence of significant knowledge gaps. Public health communication on T-BD in farmers should, therefore, target understanding of health issues and appropriate preventive measures.

Pre-operative assessment of internal mucosal rectal prolapse in internal hemorrhoids: technical details and results from a single institution

Background:

The aim of the study was to assess safety and efficacy of pre-operative assessment for internal mucosal rectal prolapse (IMRP) in internal hemorrhoids, in order to achieve a tailored transanal stapled surgery.

Methods:

All consecutive patients (January 2011 to December 2014; age 18-80 years), affected by prolapses with II-IV degrees hemorrhoids that underwent Longo procedure with EEA® Auto Suture stapler (Covidien) were included in the present study.

Results:

A total of 100 consecutive patients (38 females) were enrolled in the study. Preoperative Visual Analogue Scale pain assessment was 7.33±2.68. The mean duration of the procedure was 34.1±17.8 min, and the median hospital stay was 2 days (range 2-6). No major complication occurred, including relapses of mucosal prolapse. Preoperative prolapse measurement with EEA® EEA® Auto Suture stapler (2.3±0.5 cm) was well correlated direct assessment (2.4±0.6, p<0.001), but a proportional bias was identified, with significant preoperative underestimation of IMRP, particularly for lesions larger than 3 cm (around 10% of actual extent).

Conclusions:

EEA® Auto Suture stapler seems to be safe and effective for a tailored approach to anorectal prolapse due to hemorrhoids. However, it reasonable that its actual impact may have been overestimated, beneficing of the repetitive, direct assessment of the operatory field guaranteed by preoperative IMRP measurement. (www.actabiomedica.it)

Heat-Related Illnesses among Pesticide Applicators in North-Eastern Italy (2017)

Objectives: Pesticide applicators (PAs) are potentially at high risk for developing heat-related illnesses (HRI). To identify HRI burden and potential targets for preventive interventions, a questionnaire-based cross-sectional study was performed on a sample of PAs from North Eastern Italy.Methods: The study inquired about HRI knowledge and relative risk perception as cumulative sum scores and behavioral adaptations, including the use of sun protective equipment, both as dichotomous factors and cumulative scores. Participants rated the frequency of HRI symptoms during the previous warm season: three or more occurring at least once/month defined HRI status. Association of individual/behavioral factors with HRI status was assessed through binary regression analysis by calculating odds ratios (OR) with the respective 95% confidence intervals (95%CI). A linear regression analysis was performed assuming the sum of symptoms as the outcome variable.Results: Participating in the survey was 131 Pas (81.7% males; mean age 46.5 ± 13.9 years). Although knowledge status was good (73.6%±18.1), risk perception was quite low (34.4%±16.9). HRI status was reported by 41.2% of participants, and was associated with manual hoeing/weeding (OR:8.847 95%CI 1.882-41.579), pesticide application (OR:2.975 95%CI 1.185-42.035), and rests in shady, not air-conditioned areas (OR:5.491 95%CI 1.372-21.971); while in regression analysis the sum of sun protective habits was the only negative predictor for the sum of reported symptoms (B -0.014, 95%CI -0.235 to -0.026, p = 0.014).Conclusion: Our results stress the opportunity for raising the risk perception of PAs through specifically tailored interventions. The use of sun-protective equipment should be promoted as an effective method to counter HRI symptoms.

Migrant Workers from the Eastern-Mediterranean Region and Occupational Injuries: A Retrospective Database-Based Analysis from North-Eastern Italy

The month of Ramadan is the ninth month of the Islamic lunar calendar, and, according to the Islamic tradition, it coincides with the month when the Noble Koran/Qur'an began to be revealed. In recent years, concerns about the potentially negative health effects of Ramadan fasting and the risks of work-related injuries have increased in Western European (EURO) countries. In the present study, we performed a retrospective database-based analysis assessing the impact of Ramadan fasting on occupational injuries (OIs) in North-Eastern Italy among migrant workers from the Eastern-Mediterranean Region (EMRO). Our results suggest that EMRO workers exhibit a significantly increased risk for OIs during Ramadan in periods characterized by heat-waves, while their frequency was somehow reduced for days associated with Ramadan characterized by increased but not extreme temperatures. However, these results may be attributable to an explanatory causation in the specific differences between EMRO and EURO workers in the job tasks performed at the workplace. Not coincidentally, no significant differences were found regarding industrial settings, mechanisms of OIs and final prognosis. Despite the obvious practical implications for health decision- and policy-makers, due to the limitations of the present investigation, further studies are warranted.