Anne-Catherine Lantin

Childhood leukaemia and parental occupational exposure to pesticides: a systematic review and meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis of published studies on the association between parental occupational exposure to pesticides and childhood leukaemia.MethodsStudies were identified from a MEDLINE search through 31 July 2009 and from the reference lists of identified publications. Relative risk (RR) estimates were extracted from 25 studies published between 1985 and 2008. Meta-rate ratio estimates (mRR) were calculated according to fixed and random-effect meta-analysis models. Separate analyses were conducted after stratification for study design, definition of exposure (employment in a farm/agriculture assuming exposure to pesticides versus exposure to pesticides stipulated), exposed parent, window of exposure, type of leukaemia and biocide category.ResultsNo statistically significant association between childhood leukaemia and parental occupation as farmers/agricultural workers was observed. When exposure to pesticides was stipulated, positive associations were reported for maternal exposure for all studies combined (mRR: 1.62; 95% CI: 1.22–2.16), in all exposure windows considered and for acute non-lymphocytic leukaemia (ANLL). There was no association with paternal exposure when combining all studies (mRR: 1.14; 95% CI: 0.76–1.69). However, significant increased risks were seen for paternal exposure, in some exposure windows as well as for the biocide category.ConclusionsThe strongest evidence of an increased risk of childhood leukaemia comes from studies with maternal occupational exposure to pesticides. The associations with paternal exposure were weaker and less consistent. These results add to the evidence leading to recommend minimizing parental occupational exposure to pesticides. Our findings also support the need to rely more on studies that clearly stipulate exposure to pesticides rather than those that assume pesticide exposure because of farm/agriculture employment.

Residential exposure to pesticides and childhood leukaemia: A systematic review and meta-analysis

OBJECTIVE To conduct a systematic review of published studies on the association between residential/household/domestic exposure to pesticides and childhood leukaemia, and to provide a quantitative estimate of the risk. METHODS Publications in English were searched in MEDLINE (1966-31 December 2009) and from the reference list of identified publications. Extraction of relative risk (RR) estimates was performed independently by 2 authors using predefined inclusion criteria. Meta-rate ratio estimates (mRR) were calculated according to fixed and random-effect models. Separate analyses were conducted after stratification for exposure time windows, residential exposure location, biocide category and type of leukaemia. RESULTS RR estimates were extracted from 13 case-control studies published between 1987 and 2009. Statistically significant associations with childhood leukaemia were observed when combining all studies (mRR: 1.74, 95% CI: 1.37-2.21). Exposure during and after pregnancy was positively associated with childhood leukaemia, with the strongest risk for exposure during pregnancy (mRR: 2.19, 95% CI: 1.92-2.50). Other stratifications showed the greatest risk estimates for indoor exposure (mRR: 1.74, 95% CI: 1.45-2.09), for exposure to insecticides (mRR: 1.73, 95% CI: 1.33-2.26) as well as for acute non-lymphocytic leukaemia (ANLL) (mRR: 2.30, 95% CI: 1.53-3.45). Outdoor exposure and exposure of children to herbicides (after pregnancy) were not significantly associated with childhood leukaemia (mRR: 1.21, 95% CI: 0.97-1.52; mRR: 1.16, 95% CI: 0.76-1.76, respectively). CONCLUSIONS Our findings support the assumption that residential pesticide exposure may be a contributing risk factor for childhood leukaemia but available data were too scarce for causality ascertainment. It may be opportune to consider preventive actions, including educational measures, to decrease the use of pesticides for residential purposes and particularly the use of indoor insecticides during pregnancy.

Functional impact of custom-made foot orthoses in patients with haemophilic ankle arthropathy.

Summary.  Although foot orthoses are often prescribed to patients with haemophilia (PWH) and ankle arthropathy, the efficacy and biomechanical effects of such devices are not fully understood. We experimentally investigated the effects of orthopedic insoles (OI) and shoes (OS) in PWH presenting ankle arthropathy, with specific attention being paid to pain, spatiotemporal parameters, kinematics and kinetics of lower limb joints, as well mechanical and energetic variables. Using three‐dimensional gait analysis (3DGA), synchronous kinematics, kinetics, spatiotemporal, mechanics, and metabolic gait parameters were measured in 16 PWH with ankle arthropathy. The revised Foot Function Index (FFI‐R) and 3DGA were determined in patients wearing neutral running shoes at two time points (T0 and T1), with OI (n = 11) or OS (n=5) being subsequently prescribed. Patients, while wearing their orthoses, were re‐evaluated using 3DGA, FFI‐R, and satisfaction questionnaires (T2). OI and OS provided significant pain relief and comfort improvement in more than half of the patients, with minimal side effects. OI had limited impact on gait pattern, whereas OS significantly improved the propulsive function of the ankle. Biomechanical changes induced by OI and OS were independent of their ability to improve comfort, while being insufficient to influence knee and hip kinematics and kinetics, or mechanical and energetic variables. These findings suggest that OI and OS may have beneficial effects on ankle joints in PWH. Self‐reported clinical tools such as FFI‐R and satisfaction questionnaires are sufficiently sensitive for assessing the efficacy of foot orthoses in PWH.

Absence of adverse effect on thyroid function and red blood cells in a population of workers exposed to cobalt compounds.

CONTEXT Hypothyroidism has been observed in the fifties and sixties as an undesirable side-effect of cobalt therapy used for its erythropoietic properties in the treatment of anemia. OBJECTIVE This study aims at evaluating the possible impact of both cumulative (long-term) and recent occupational exposure to cobalt on thyroid function and red blood cells. METHODS AND SETTING A cross-sectional survey was conducted from February 2008 to August 2009 in a population of 249 male workers from a cobalt production department in the North of Belgium. The possible effect of cobalt exposure on thyroid and red blood cells was investigated through multiple regression analyses. RESULTS Blood cobalt ranged from undetectable to 3.20 μg/100ml (median 0.10); urinary cobalt from 0.30 to 204.30 μg/g(creat) (median 3.90) and long-term exposure to cobalt ranged from 0.15 to 6990.46 μg/g(creat) · years (median 106.09). No effect of cobalt exposure on thyroid or red blood cell parameters was observed at these levels of exposure. CONCLUSION The results support the absence of effects on the thyroid and red blood cells when occupational exposure to cobalt is kept below the recommended biological limit of occupational exposure (15 μg Co/g(creat) in urine).

Blood lead levels in the Kinshasa population : a pilot study

ObjectiveLeaded gasoline and lead paints are still in use in the Democratic Republic of Congo but data on blood lead levels in the general population are not available. We evaluated the Pb impregnation in children and adults (0 - 70 years old) in Kinshasa.MethodsBlood lead was measured by atomic absorption in a sample of 485 healthy people (268 men and 217 women) living in Kinshasa between May 2003 and June 2004.ResultsGeometric mean blood lead was 120 µg/L (95% CI: 115-125), with a higher concentration in men than in women (127 vs 114 µg/L, p = 0.01). Sixty-three percent of children aged less than 6 years old presented blood lead levels above the 100 µg threshold. In the adult population, occupations with a potential risk of exposure to gasoline (car mechanics or garage owners, taxi drivers, conveyors and gas pump attendants) were associated with an extra blood lead of about 65µg/L.ConclusionThis study indicates a relatively important Pb impregnation of the Kinshasa population. It demonstrates the existence of a major public health issue requiring corrective actions and the implementation of an appropriate regulation.

Occupational exposure to cobalt is not associated with incipient signs of dilated cardiomyopathy in a Belgian refinery.

Background Excessive absorption of cobalt has been associated with cases of dilated cardiomyopathy in the past, but it is unclear whether occupationally exposed populations are at risk. Objective To assess the possible relationship between occupational exposure to cobalt and incipient signs of dilated cardiomyopathy. Methods A cross-sectional survey was conducted in a cobalt production facility in Belgium constituting one of the largest occupational populations worldwide (n=256 male workers). Exposure to cobalt was assessed by measuring urinary cobalt concentration (µg/gcreat), reflecting recent exposure, and by computing an integrated exposure index (µg/gcreat×years), reflecting long-term exposure. The effect on the myocardium was investigated by echocardiography and electrocardiography, and dose–effect relations with cobalt exposure were traced by multiple regression analysis. Results No dose–effect relationship between exposure to cobalt and parameters reflecting dilated cardiomyopathy was found in a population of workers characterised by a median recent cobalturia of 4 µg/gcreat and a median long-term cobalturia of 100 µg/gcreat×years. A reduction in the dimensions of the left ventricular internal cavity was associated with recent exposure to cobalt. Conclusions Occupational exposure to cobalt does not appear associated with incipient signs of dilated cardiomyopathy within the gradient of exposure recorded in this population.