Geoffrey M. Calvert

Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States

Background: Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease. Methods: Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis. Results: Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis. Conclusions: This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary tuberculosis. In addition, support is provided for an association between crystalline silica exposure and rheumatoid arthritis.

Surveillance of Pesticide-Related Illness and Injury in Humans

Publisher Summary nThis chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.Publisher Summary This chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.

Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place—Florida and North Carolina, 2004–2005

Context There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy. Case Presentation In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower’s Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied. Discussion Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency’s Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures. Relevance to Professional Practice The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.

Mortality and end-stage renal disease incidence among dry cleaning workers

Objective Perchloroethylene (PCE) is a known animal carcinogen and probable human carcinogen. Dry cleaning exposures, particularly PCE, are also associated with renal toxicity. The objective was to follow-up a cohort of dry cleaners to evaluate mortality and assess end-stage renal disease (ESRD) morbidity. Methods This study adds 8u2005years of mortality follow-up for 1704 dry cleaning workers in four cities. Employees eligible for inclusion worked for ≥1 year before 1960 in a shop using PCE as the primary solvent. Life table analyses for mortality and ESRD morbidity were conducted. Only employees alive on 1 January 1977 were included in ESRD analyses. Results Overall cancer deaths were in significant excess in this cohort (standardised mortality ratio (SMR) 1.22, 95% CI 1.09 to 1.36). Oesophageal, lung and tongue cancers had significant excesses of deaths. Oesophageal cancer risk was highest among those employed in a PCE-using shop for ≥5u2005years with ≥20u2005years latency since first such employment. Deaths from non-malignant underlying diseases of the stomach and duodenum were in significant excess. Hypertensive ESRD morbidity was significantly elevated in the entire cohort (standardised incidence ratio (SIR) 1.98, 95% CI 1.11 to 3.27), and among workers employed only in PCE-using dry cleaning shops for ≥5 years. Conclusion Employment in the dry cleaning industry and occupational exposure to PCE are associated with an increased risk for ESRD and for cancer at several sites. The employment duration findings for oesophageal cancer and hypertensive ESRD further support an association with PCE exposure instead of lifestyle or socioeconomic factors.

Chapter 27 – Surveillance of Pesticide-Related Illness and Injury in Humans*

Surveillance of pesticide-related illness and injury continues to be important because of public concern on pesticides toxicity and lack of perfectly safe form of pest control. Surveillance for pesticide poisoning identifies primarily two groups of cases, each of which requires different approaches for intervention. The first group consists of cases that are preventable by following the precautionary measures specified on product labels and in government regulation. The appropriate interventions for these cases include enhanced education and enforcement. The second group of cases occurs despite compliance with label instructions and regulatory measures, and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. This chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. The chapter also describes some of the tools of surveillance (for example, regulations that facilitate surveillance, efforts toward standardization of case definitions and variables, and guidelines for evaluating surveillance systems). In addition, the chapter provides a general discussion of the limitations and strengths of surveillance data, with specific reference to the surveillance of pesticide-related illness and injury. Finally, the chapter provides an exploration of the role played by epidemiologic studies in the surveillance of pesticide-related illness and injury.

Surveillance of Pesticide-Related Illness and Injury in Humans**The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health or each author’s state agency

Publisher Summary nThis chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.Publisher Summary This chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.

Chapter 61 – Surveillance of Pesticide-Related Illness and Injury in Humans*

Publisher Summary nThis chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.Publisher Summary This chapter describes state-based, national, and international surveillance systems for pesticide-related illness and injury. Surveillance systems are the network of individuals and activities that engage in the process of surveillance. Pesticide poisoning among humans generally occurs either because of lack of compliance with existing pesticide regulations or because existing pesticide regulations are insufficient. The first cause involves cases that are preventable by following the precautionary measures specified on product labels and in governmental pesticide regulations. The second cause arises despite compliance with label instructions and regulatory measures and therefore requires interventions aimed at changing pesticide use practices and/or modifying regulatory measures. The focus of this chapter is on surveillance systems that operate in the United States (both state based and national); however, some information is provided on international surveillance efforts. Also described are some of the tools of surveillance, such as regulations that facilitate surveillance, efforts made to standardize case definitions and variables, and guidelines for evaluating surveillance systems. A comprehensive national surveillance system for acute pesticide-related illness and injury does not currently exist. Through standardization and information sharing across surveillance systems, a national comprehensive surveillance system may be attainable.