RESUMO
BACKGROUND: Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America. OBJECTIVE: (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity. METHODS: Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records. RESULTS: Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3â tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes. CONCLUSIONS: A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health.
Assuntos
Promoção da Saúde/métodos , Transtornos de Estresse por Calor/prevenção & controle , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/prevenção & controle , Adolescente , Adulto , Água Potável , Eficiência , El Salvador , Ergonomia , Feminino , Grupos Focais , Temperatura Alta , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Descanso , Saccharum , Sacarose , Inquéritos e Questionários , Adulto JovemRESUMO
This paper summarizes experiences from long-term ongoing cooperation between Swedish research institutions and institutions at the National Universities in Nicaragua and Costa Rica. 24 researchers and teachers from the Central American institutions and ten Swedish research students have been trained. In addition to three full doctoral and three licentiate (two-year PhD program) theses, the two programs have so far published 15 articles in English-language, international, refereed journals and about three times as many abstracts for conferences in more than ten countries. A "sandwich" model for training is recommended, where the southern researchers come to the wealthier partner for collaborative analyses and write-ups of the publications, while spending 50-75% of their time in their home countries for data collection. Such collaboration should be planned for a time span of at least eight years and include substantial numbers of researchers and students. Means to minimize the risk of brain drain are suggested. The collaboration has been important for the globalization of the research cultures at the participating institutions and has trained international experts.
Assuntos
Saúde Ambiental , Intercâmbio Educacional Internacional , Saúde Ocupacional , Pesquisa/educação , Costa Rica , Nicarágua , Suécia , Toxicologia/educaçãoRESUMO
To evaluate time trends of occupational pesticide-related injuries in Costa Rica, a survey was carried out three times over a ten-year period at a national reporting system for occupational accidents and diseases among wage-earning workers. The sample comprised the accidents reported during the months of June of the years 1982, 1987, and 1992. The overall incidence rates were 1.8, 2.7, and 2.5 per 1,000 agricultural workers, respectively. Rates among female workers increased (3.1, 3.7, 5.4) and were elevated as compared with male workers (1.7, 2.6, 2.3). The trend for topical lesions was upgoing (1.2, 1.4, 2.1), consistent with an increased use of fungicides and lack of safety measures for pesticides with low acute toxicity. Systemic poisonings peaked in 1987 (0.6, 1.2, 0.5), declining in 1992 with increased use of biologic pest control and pyrethroid insecticides less toxic than cholinesterase inhibitors, and improved safety during nematocide applications on banana plantations. In 1992, despite the largest decline of systemic poisonings in the banana-producing Atlantic Region, poisonings as well as topical injuries were still four times more frequent in this region than in the rest of the country. Restriction of highly toxic pesticides together with implementation of occupational safety measures can reduce systemic poisonings in developing countries. Such policies need to be extended to other pesticides to prevent less life threatening but often disabling skin and eye injuries.
Assuntos
Acidentes de Trabalho/tendências , Doenças dos Trabalhadores Agrícolas/epidemiologia , Agricultura , Exposição Ocupacional/efeitos adversos , Praguicidas/efeitos adversos , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Costa Rica/epidemiologia , Feminino , Humanos , Masculino , Intoxicação/epidemiologia , Intoxicação/etiologia , Fatores Sexuais , Dermatopatias/induzido quimicamente , Dermatopatias/epidemiologia , Fatores de TempoRESUMO
BACKGROUND: This study describes geographical differences in cancer incidence in Costa Rica, and investigates if some of these differences may be related to pesticides. METHODS: Data were combined from the cancer registry (1981-1993), the 1984 population census, the 1984 agricultural census, and a national pesticide data set. The 81 counties of Costa Rica were the units for the ecological analyses. Adjacent counties were grouped into 14 regions (3 urban and 11 rural) with relatively similar socioeconomic characteristics. County indices for population density and agricultural variables were constructed and categorized. Differences across regions and categories were assessed by comparing observed numbers of incident cases to expected values derived from national rates. Within the tertile of most rural counties, rate ratios between categories of high and low pesticide use were calculated. RESULTS: In urban regions, excesses were observed for lung, colorectal, breast, uterus, ovary, prostate, testis, kidney, and bladder cancers; and in rural regions for gastric, cervical, penile, and skin cancers. Skin cancers (lip, melanoma, non-melanocytic skin and penile cancer) occurred in excess in coffee growing areas with extensive use of paraquat and lead arsenate. In the most rural subset, heavy pesticide use was associated with an increase of cancer incidence overall and at a considerable number of specific sites, including lung cancer (relative risk [RR] 2.0 for men and 2.6 for women) and all female hormone-related cancers (RR between 1.3 and 1.8). CONCLUSIONS: Regions and populations at high risk for specific cancers were identified. Several hypotheses for associations between pesticides and cancer emerged. The findings call for studies at the individual level.
Assuntos
Exposição Ambiental , Neoplasias/epidemiologia , Exposição Ocupacional , Praguicidas , Intervalos de Confiança , Costa Rica/epidemiologia , Feminino , Humanos , Incidência , Masculino , Razão de Chances , Saúde da População Rural , Saúde da População UrbanaRESUMO
This study analyzes the exposure circumstances of 15 fatal occupational paraquat poisonings. To evaluate the potential danger of dermal absorption and the amount needed to produce a fatal outcome in the event of oral intake, we reviewed the medical records and autopsy protocols and interviewed relatives. Five fatalities were due to ingestion of a mouthful of paraquat concentrate, and five to intake of a smaller amount; three cases were associated with dermal exposure, and in two, there was no evidence of either oral or dermal exposure. Several cases concerned diluted paraquat spray. The clinical and pathomorphological findings, including a "blinded" evaluation of lung slides, were consistent with paraquat poisoning in all cases. Difficulties in establishing the diagnosis and recognizing the exposure were identified, as well as classification of unintentional poisonings as suicides at autopsy. The findings suggest that paraquat may cause fatal poisonings by ingestion of small amounts, by dermal absorption of diluted paraquat, and possibly by inhalation. More conclusive studies are warranted.
Assuntos
Doenças dos Trabalhadores Agrícolas/epidemiologia , Herbicidas/intoxicação , Exposição Ocupacional/efeitos adversos , Paraquat/intoxicação , Administração Oral , Adolescente , Adulto , Idoso , Criança , Costa Rica/epidemiologia , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Humanos , Exposição por Inalação , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Intoxicação/diagnóstico , Intoxicação/mortalidade , Edema Pulmonar/induzido quimicamente , Edema Pulmonar/mortalidade , Síndrome do Desconforto Respiratório/induzido quimicamente , Síndrome do Desconforto Respiratório/mortalidade , Estudos Retrospectivos , Absorção Cutânea/efeitos dos fármacosRESUMO
Large worker populations in the Third World are exposed to increasing amounts of pesticides, including pesticides severely restricted and banned in industrialized countries. Studies on knowledge, attitudes, and practices indicate that unsafe use of pesticides is the rule in Third World countries. Surveys of acute poisonings show high rates in these countries, despite underregistration. The scarce studies on chronic health outcomes demonstrate neurotoxic, reproductive, and dermatologic effects. Exposure assessment consists mainly of cholinesterase testing, and few studies have quantified dermal and respiratory exposure. The few intervention studies demonstrate the need for evaluation of the impact of preventive measures and policies. There is no evidence that widespread "safe-use" programs have greatly affected exposure and morbidity. It was concluded that research should focus on simple methods for surveillance of exposure and on surveillance of acute illness and its causes in order to develop and evaluate rapid local interventions. Studies on chronic effects should be carried out in selected countries, aiming at long-term and broader interventions. Policies that promote the use of pesticides should be critically evaluated. North-South and South-South research collaborations must be encouraged to address this global health problem.
Assuntos
Agricultura , Países em Desenvolvimento , Exposição Ocupacional , Praguicidas/efeitos adversos , África , Conhecimentos, Atitudes e Prática em Saúde , Humanos , América Latina , Praguicidas/intoxicação , Política Pública , PesquisaRESUMO
OBJECTIVES: A cross-sectional study was conducted to evaluate the relationship between respiratory health and paraquat exposure. METHODS: The study population was selected from among workers at 15 Nicaraguan banana plantations which relied on paraquat for the control of weeds. All the workers were interviewed after they received their job assignment for the day of the survey, and all who reported never having applied paraquat and all who reported more than 2 years of cumulative exposure as applicators of paraquat with knapsack sprayers were invited for medical evaluation. One hundred and thirty-four exposed workers and 152 unexposed workers were administered a questionnaire interview asking about exposure and respiratory symptoms, and they underwent spirometric testing of forced expiratory volume in 1 s (FEV1.0) and forced vital capacity (FVC). RESULTS: In the exposed group 53% reported having experienced a skin rash or burn resulting from paraquat exposure, 25% reported epistaxis, 58% nail damage, and 42% paraquat splashed in the eyes. There was a consistent dose-response relationship between intensity of exposure (as indicated by a history of skin rash or burn) and the prevalence of dyspnea. This relationship was more marked for more severe dyspnea. There was a 3-fold increase in episodic wheezing accompanied by shortness of breath among the more intensely exposed workers. There was no relationship between exposure and FEV1.0 or FVC. CONCLUSIONS: The high prevalence of respiratory symptoms associated with exposure, in the absence of spirometric abnormalities associated with exposure, could be a result of unmeasured gas exchange abnormalities among workers with long-term exposure to paraquat.