Patricia Monge

Paraquat in Developing Countries

Abstract The herbicide, paraquat is considered safe by industry and the bulk of regulators worldwide. However, determinants of exposure from 30 years ago persist in developing countries. Little is known about systemic absorption from occupational exposures. The relationships between exposure determinants, levels of external exposure, biomarkers of exposure, and outcomes are not clear. High rates of severe acute poisonings have been documented. In addition, topical injuries occur in as many as 50% of exposed workers. Non-worker populations are also at risk, particularly children. Long-term and delayed health effects include Parkinsons disease, lung effects, and skin cancer. Regulatory agencies have not fully recognized either the inherent toxicity of paraquat or the particular risks derived from exposures in developing countries. Independent risk assessment in the developing; country context and application of the precautionary principle are necessary to prevent adverse effects of dangerous pesticides in susceptible populations.

Chronic nervous-system effects of long-term occupational exposure to DDT

Dichlorodiphenyltrichloroethane (DDT) is a compound with moderate toxicity that is judged to be safe for occupational use, although little is known about its long-term effects on the human nervous system. We investigated chronic nervous-system effects of long-term occupational exposure to DDT by comparing the neurobehavioural performance of retired malaria-control workers with a reference group of retired guards and drivers. DDT-exposed workers did worse on tests assessing various neurobehavioural functions than controls; performance significantly deteriorated with increasing years of DDT application. Our results could not be explained by exposure to cholinesterase-inhibiting pesticides or other potential confounding factors.

Hazardous Pesticides in Central America

Abstract Pesticides are an extensively documented occupational and environmental hazard in Central America. Yet, severe problems persist. Toxic pesticide use in the Region increased during 1985–1999. High exposure levels and ineffectiveness of personal protective equipment evidence the difficulties for risk reduction. Acute poisonings remain a severe problem. Delayed and/or long-lasting health effects include dermatoses, cancer, and genotoxic, neurotoxic, and respiratory effects. The use of hazardous pesticides persists through deficiencies in government driven assessment and risk management; excessive focus on regional harmonization; short-term economic interests; strong links between industry and governments; aggressive marketing; weak trade unions; and failure of universities to reach decision makers. Regulation based on local data is lacking. An agreement of the Ministries of Health for restricting the most toxic pesticides in Central America has potential for progress. The most effective way to reduce risk is to greatly reduce pesticide use. Actions needed include development of multidisciplinary strategies for local studies on health and environmental impact of pesticides; development of sustainable non chemical agricultural technologies; evaluation of interventions; extending and sharing of expertise within the Region; strengthening of unions and communities; and redefining the role of industry toward development of safer products, with responsible marketing and reliable information.

Pesticide-related Illness and Injuries among Banana Workers in Costa Rica: A Comparison between 1993 and 1996

Abstract An intervention program considerably decreased systemic poisonings on banana plantations in Costa Rica in the early 1990s. Nevertheless, pesticide safety continues to be controversial .To examine the determinants of acute pesticide related illness on banana plantations, the authors surveyed occupational injuries and illness among banana workers in the Atlantic Region of Costa. Rica that were reported during 1993 and 1996 to the National Insurance Institute. Incidence rates were calculated for categories of pesticides and types of medical problems, for all and subgroups of banana workers. Between 1993 and 1996, an overall 35% decrease in injuries was observed, attributable to a marked decline in topical injuries (3.3 vs 1.9 per 100 workers), whereas systemic poisonings remained the same (0.7 per 100 in both years). The decrease concerned selectively milder skin contlltioris, indicating underreporting of less severe health effects. In both years, paraquat was the pesticide most frequently associated with injuries, mostly skin and eye lesions. Workers at highest risk per unit time of exposure were nematocide applicators, herbicide applicators, and cleaners of packing plants. Despite control measures, further reduction of systemic illness had not been achieved. The decrease of topical injuries may be partly explained by improved work conditions, but possible underreporting hinders interpretation. Pesticide related illness on banana plantations is a persistent problem.

Workplace Carcinogen and Pesticide Exposures in Costa Rica

Abstract The CAREX data system converts national workforce volumes and proportions of workers exposed to workplace carcinogens into numbers of exposed in 55 industrial categories. CAREX was adapted for Costa Rica for 27 carcinogens and seven groups of pesticides. Widespread workplace carcinogens in the 1.3 million workforce of Costa Rica are solar radiation (333,000 workers), diesel engine exhaust (278,000), environmental tobacco smoke (71,000), hexavalent chromium compounds (55,000), benzene (52,000), wood dust (32,000), silica dust (27,000), lead and inorganic lead compounds (19,000), and polycyclic aromatic compounds (17,000). The most ubiquitous pesticides were paraquat and diquat (175,000), mancozeb, maneb, and zineb (49,000), chlorothalonil (38,000), benomyl (19,000), and chloro-phenoxy herbicides (11,000). Among women, formal-dehyde, radon, and methylene chloride overrode pesticides, chromium, wood dust, and silica dust in numbers of exposed. High-risk sectors included agriculture, construction, personal and household services, land and water transport and allied services, pottery and similar industries, woodworks, mining, forestry and logging, fishing, manufacturing of electrical machinery, and bar and restaurant personnel.

An Icon-based Interview for the Assessment of Occupational Pesticide Exposure in a Case–Control Study of Childhood Leukemia

Abstract An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parental exposures to pesticides is described. It includes calendar sheets, icons for life events, crops, jobs, regions, nonagricultural jobs, application techniques and personal protection, markers for durations of exposure patterns, and checklists of pesticides. The ICF collects monthly data from two years before birth until diagnosis of cancer (index children) or until either the interview date or age 15 (controls). Data ascertainment was easy in 62% of interviews, moderately easy in 32%, and difficult in 6%. Seventy-eight subjects delivered data on specific pesticides with pesticide checklists, which improved identification of pesticides. ICF performs satisfactorily for crops, tasks, and other determinants of exposure. Data on pesticides will be further improved by introducing external data use on different crops, time periods, and regions, and by exposure modeling for 27 pesticides.

Funding of pilot projects in Latin America: a tool for capacity building in occupational health research.

Abstract There is a global need for trained researchers who can address the increasing burden of illness and injury and prepare future generations of researchers. Developing countries have a special need for practical, action-oriented interventions to address workplace problems, based on identification of needs and priorities, development of locally available solutions, and consideration of the sociopolitical context of work and how best to translate research findings into policies. Effective translation and application of research products from industrialized nations to developing countries is essential, but differences in the contexts and local realities of other nations limit extrapolating such research. Funding pilot research projects in developing countries is an effective, practical, and useful tool for training new investigators in research techniques and developing collaborative relationships among countries.

Determinación del historial de exposiciones en la epidemiolgía ocupacional

In epidemiology, it is necessary that exposure indicators have good validity in order to obtain valid results when measuring the risks associated with occupational exposure to environmental noxious agents. However, ensuring the validity of past exposure data is no easy task. Because there are no environmental hygiene measures or representative levels of bioindicators signaling past exposure, self-reports have been used as a source of indirect exposure data. Unfortunately, data on specific agents are commonly poor and need to be complemented with data on the determinants of exposure. The validity of self-reports improves when certain techniques, such as control lists and icons, are employed, and the quality of individual exposure data improves when secondary data on exposure and its conditioning or determining factors are incorporated. Exposure can be determined by means of exposure matrices, assessment by experts, and exposure models, and by using a combination of primary and secondary data on exposure and its conditioning factors. Matrices contain pooled data and can thus lead to errors in classifying individual exposure and to biased risk estimates. Assessment by experts is probably the method with the highest validity, but it can become expensive when studies are large. It is also feasible to use a formal model for assessing perceivable exposures, complemented with expert assessments whenever the results of the model appear to deviate from reality.