The contamination of food and water through waste and agricultural runoff poses serious threats to humans. Pollution with microbes causes noticeable diarrheal diseases, whereas agrochemicals, heavy metals, fluoride, and toxins cause insidious diseases and premature deaths. Chronic kidney disease of unknown origin (CKDuo) was first seen in dry-zonal agricultural regions in equatorial countries in the mid-1960s, and in Sri Lanka, in mid-1990s. A number of agents and toxins have been postulated as the cause of CKD of multifactorial origin (CKDmfo/CKDuo), including heavy metals, agrochemicals, fluoride, fungal and bacterial toxins, climate change; and a number of behavioral factors. Meanwhile, several other potential nephrotoxic causes have not been investigated, including the indiscriminate and excessive use of non-steroidal anti- inflammatory drugs, illegal drugs and illicit alcohol, microbial agents (leptospirosis, Hanta virus etc.), chronic dehydration, and exposure to various combinations of these toxic agents in the presence of unhealthy habits. The incidence of CKDmfo is doubling every 4 to 5 years in Sri Lanka, leading to more than 5,000 deaths annually; excess of 150,000 people are currently affected. Although a number of agents have been postulated, no single offending agent has been identified as the cause of CKDmfo. To alleviate CKDmfo, it is essential to take a broader, holistic approach: carry out a massive awareness campaign, prevent environmental pollution, lessen malnutrition, correct unhealthy behaviors and habits acquired during recent past, and provide clean water completely devoid of nephrotoxins to all inhabitants in the affected communities. A sustained, coordinated, targeted, and effective approach is essential to decrease the disease incidence, prevention of premature deaths, and eradication of CKDmfo. This review explores pros and cons of agrochemicals as a potential cause of this deadly disease.
The CKD patients in this epidemic are asymptomatic until the later stages of the disease and show tubular interstitial nephritis associated with mononuclear cell in- filtration with development of glomerular sclerosis and tubular atrophy . The characteristic geographical dis- tribution of the disease and associated socioeconomic factors are suggestive of environmental and occupational origins. Tubulo-interstitial damage and negative immune- fluorescence for IgG, IgM, and complement-3 are more in favor of a toxic nephropathy . Several research studies conducted to determine the cause of CKDu, have specu- lated about the causative role of agrochemicals. Toxins postulated so far as etiological factors include arsenic (As), cadmium (Cd), nephrotoxic pesticides and fluoride [1,2,6]. However, none of the studies performed so far has focused on the link between the disease and the exact type of pesticides used. The objective of this study was to identify the major risk factors associated with the CKDu in the Padavi-Sripura area in Sri Lanka.
Another way to elucidate the cause of MeN was done by a team from Boston University School of Public Health . Semi-structured interviews were performed with 10 physicians and 9 pharmacists in North-western Nicaragua i.e. in areas with a high prevalence of chronic kidney disease (CKD) of unknown cause. The physicians and pharmacists regarded CKD as a major problem in the region, predominantly affecting men working with manual labour. The interviewed health professionals believed occupational and environmental sun and heat exposure as well as dehydration to be risk factors in the development of CKD. These risk factors were also thought to be associated with a set of symptoms referred to locally as “chistata,” characterized by painful urination and often accompanied by “kidney” and/or back pain. The interviewees indicated that reluctance among workers to drink water during the work day might be due to perceptions of water contamination. “Chiasta” symptoms were often treated with non-steroidal anti-inflammatory drugs, diuretics or antibiotics. Albeit the diagnosis of urinary tract infection was sometimes set ant treated with antibiotics this diagnose was usually not based on microbial culture. The incidence renal stones were not considered to be unusually high or frequently diagnosed. Despite the media attention given to the potential role of agrichemicals in causing CKD, physicians and pharmacists were much more likely to cite exposure to heat, physical work and dehydration as key factors responsible for the CKD development .
Extreme physical exertion, heat stress, water quality and exposure to agrochemicals are among the potential causes currently being considered for CKDu. The com- bination of heat stress and physically demanding occu- pations has received attention in the Central American outbreak based on studies reporting lower rates of CKDu at higher altitudes in the same agricultural pro- cesses . A recent pilot study in Brazilian sugarcane harvesters observed evidence of acute kidney injury over the course of a workday  The impact of repeated episodes of heat-induced dehydration has been exam- ined in an animal model to specifically address this cause . Pathology consistent with CKDu, including elevated serum creatinine, proximal tubular injury, and renal inflammation and fibrosis, was observed. Interest- ingly, this pathology was not observed in fructokinase deficient mice. Fructose containing drinks in combin- ation with heat-induced dehydration was implicated and intervention trials based on the United States’ Occupa- tional Safety and Health Administration (OSHA) Heat Illness Prevention Campaign were proposed . In considering this potential etiologic factor, one must consider whether agricultural work has changed within the time frame of the CKDu epidemic. The industrialization of
Statistical analysis was conducted using SAS 8.2 (Cary, NC). Bivariate analysis was conducted using the unpaired t-test for continuous variables and likelihood ratio chi- square test for dichotomous variables. We examined the impact of lifelong cumulative ETS exposure and the risk of COPD. Based on the distribution of cumulative ETS expo- sure at home and work, we defined quartiles of exposure. For lifetime work exposure, the first quartile was zero years, so the first and second quartiles were collapsed as the referent group (otherwise the first and second quartile groups would both include zero values). We used logistic regression analysis to examine the relationship between each measure of ETS exposure and the risk of self-reported COPD. We used multivariate logistic regression analysis to control for factors that could confound the relation between ETS exposure and COPD, including past smok- ing history, age, sex, race-ethnicity, educational attain- ment, marital status, and occupationalexposure to VGDF [12,19].
Since the beginning of this century many serious, debilitating and often fatal diseases have been linked to the respiration of asbestos fibers. Although the mechanism of asbestos related diseases is still not fully understood, it is known that there is normally a long waiting (latency) period between the time of exposure and the occurrence of disease. This latency period can typically be between ten to over forty years.
7. Reference A details MOD Environmental Policy. With regards to Environmental Noise, in particular aircraft operations, the MOD has a Noise Amelioration Scheme (Military) (NAS(M)) which is introduced on an airfield by airfield basis. Its aim is to compensate those people living in the immediate vicinity of military airfields in the United Kingdom and who are affected by noise from the activity. NAS(M) is based on the following criteria:
There are two major categories of research studies used to identify causes of cancer: animal and epidemiologic studies. Animal studies give the investigator the advantage of controlling the conditions under which animals are exposed at various levels to a given substance, their diet, and even their genetic make-up. Animal studies also allow the researcher to make conclusions about the likelihood that the tumor is caused by the exposure, since all other relevant factors are controlled. Human exposures, however, are not so easily controlled in either epidemiologic studies or case reports. In studies of individuals or groups of exposed people, there may be many unknown or uncontrolled factors that lead to difficulties in interpreting the results. People are continually exposed to multiple substances and these substances are likely to act synergistically at least some of the time. People also move from place to place and cancers often have a long latency period. In addition, many types of cancer are (or were) relatively rare, further complicating the ability of epidemiology to identify elevated rates.
On the other hand, it has been shown an increased, although not severe, drug (cocaine, BEG, 6-MACM, morphine, codeine) uptake into bleached or permanent waved hair fibers from the sebum or the sweat (Skopp et al. 1997). It has been also reported that permed hair absorbs less cocaine, during exposure to crack smoke, compared to the untreated hair, irrespective of the hair type (Henderson et al. 1993) and that bleaching lowers signifi- cantly cocaine binding for all hair types (Joseph, Su, and Cone 1996). Moreover, both treatments, as well as, the environmen- tal conditions and hair care habits could potentially affect the drug molecules incorporated in the hair shaft either by convert- ing them to other chemical forms or by completely destroying them. It has been reported loss of up to 50% of methamphetamine incorporated in hair after five months (Nakahara, Shimanine, and Takahashi 1992) and of deuterated cocaine after six months (Henderson 1993). On the other hand, under certain circum- stances, such as absence of moisture, drugs have been reported to remain in hair for long periods of time, even for centuries (Springfield et al. 1993; Baez et al. 2000).
Graph 1 shows how the media coverage manifested itself up until May 2018. As was explained in the case description, the attention takes a sharp increase when the issue is moved within the scope of media attention by the victims in June 2014, when the report came out of former employees who were concerned for their health after a message came out that a workshop they had worked at was heavily polluted (Dagblad de Limburger, 2014a, p. 1). This is where the highest peak of attention takes place, as all media report on this. The media attention dies down over time but keeps some momentum through the revealing of small details or new developments, such as the minister of Defence engaging in debate or controversial problems. Another driver in media attention surrounds the news that the Dutch railways used chromium-6 to paint trains and did not protect employees (van Ast, 2015), which renewed the interest for the problem of chromium-6 exposure and kept it on the agenda. The media attention, which was decreasing slowly, was kept at a steady level, and prevented the media attention from going to zero.
Finally, only four cross-sectional studies performed respiratory function measurements. In 2004, a study was performed in Ethiopia in the Great Rift Valley among 102 pesticide sprayers on orchards, cereal and vegetable crops, and in a control group of 69 nonapplicator farm workers. Sprayers were backpack applicators of organophosphate insecticides (chlorpyrifos, diazinon and malathion). The 15–24-year age group of pesticide sprayers had signi ﬁ cantly reduced forced expiratory vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ) compared to a similarly aged group of nonsprayers . In greenhouse truck farms in Andalusia, Spain, respiratory function was studied in 89 pesticide applicators and 25 nonapplicators. Recent exposure to cholinesterase inhibitors was associated with a decrease in FEV 1 , and cumulative lifetime exposure to pesticides with a reduction in forced expiratory ﬂ ow at 25 – 75% of FVC (FEF 25–75% ); both are signs of obstructive airway syndrome. Recent use of neonicotinoid insecticides was associated with various impairments in lung function suggesting a restrictive syndrome, and use of bipyridilium herbicides with abnormal alveolar–capillary diffusion . C HAKRABORTY et al.  compared respiratory function of 376 nonsmoking male farmers in rural Bengal, India, who applied organophosphate and carbamate insecticides to rice, wheat and vegetable crops, and 348 nonagricultural workers. A signi ﬁ cant reduction in lung function (FVC and FEV 1 /FVC) was observed in the farmers . A study conducted among South Korean farmers (2508 applicators of paraquat and 374 nonapplicators) found signi ﬁ cantly lower FVC and FEV 1 in applicators with a dose – response relationship for duration of paraquat application (>30 years: OR 1.89, 95% CI 1.11–3.24; >150 days: OR 1.76, 95% CI 1.04–2.98) .
Twenty subjects who were residents within 500 meter radius from the metallurgic zone formed the exposed group (EG: n=20), and 27 subjects residing in two communities at a distance of 15 and 18 km, respectively from this zone formed the non-exposed group (NEG). In order to control for possible confounding sources of lead, all subjects were interviewed using a questionnaire, which included items on living conditions, socioeconomic status and occupational factors.
In African populations, dyslipidemia as a risk factor for cardiovascular disease and increasing incidents of death due to cardiovascular disease in both urbanised and underdeveloped rural countries have been reported . There is also increasing evidence that environmental fac- tors contribute to this dyslipidemia . In this present study, we evaluated the distribution of some blood lipids in a population of artisans who are occupationally exposed to lead, an occupational and environmental pol- lutant. We found that majority of the artisans had HDL cholesterol and triglyceride levels not significantly differ- ent from controls. On the contrary, total cholesterol levels in the artisans were between 1.5 and 2.0 times higher than controls. In addition, LDL cholesterol in some of the arti- sans was considerably higher when compared with con- trols. To our knowledge, the distribution of blood lipids in artisans in Nigeria has not been reported in the litera- ture. We were compelled to compare our data with the guidelines of risk factors for cardiovascular disease given by the American Heart Association . According to these guidelines, blood pressure < 130/85 mmHg; total cholesterol < 200 mg/dl; triglycerides < 200 mg/dl; HDL > 40 mg/dl and LDL < 130 mg/dl, are favourable risk factors. In addition, certain lipid ratios like total choles- terol/HDL cholesterol and the LDL cholesterol/HDL cho- lesterol ratio also correlate with cardiovascular disease. The recommended ratios for the two are ≤ 3.5 . Indi- cations from this comparison are that while the HDL cho- lesterol and triglyceride concentrations of both the controls and artisans were within the acceptable range prescribed by the American Heart Association, the battery chargers with total cholesterol of 203.50 ± 48.51 mg/dl and LDL cholesterol of 147.00 ± 49.50 mg/dl, drivers with LDL cholesterol of 133.85 ± 81.69 mg/dl, and petrol sta- tion attendants with LDL cholesterol of 148.52 ± 29.62
12. Aliabadi A, Hesam Gh, Moradpour Z. Occupationalexposure to non-ionizing radiation and the effectiveness of personal protective equipment in a variety of conventional electric arc welding. Iranian Ergonomics and Human Factors Engineering. 2014;2(4): 1-0. [Persian]
Recommendations for HIV PEP apply to situation in which a person has been exposed to a source person with HIV infection or in which information suggests that there is a likelihood that the source person is HIV infected (Table-II) .These recommendations are based on the risk for HIV infection after different types of exposure and limited data regarding efficacy and toxicity of PEP. Because most occupational HIV exposures do not result in the transmission of HIV, potential toxicity must be considered carefully when prescribing PEP. In selecting drug regimen for HIV PEP, clinician must strive to balance the risk of infection against the potential toxicity of the agents used, because PEP is potentially toxic, its use is not justified for an exposure that possesses a negligible risk for transmission. Therefore, two regimens for PEP are provided: 1) Basic 2-drug regimen that should be appropriate
In the Decennial Supplements, expected numbers of deaths for each occupation in men of working age were calculated by applying five year age-specific death rates for pneumonia in the general population to an estimate of the occupational population derived from national census in the mid year of the study period (1961 or 1971). The relation of observed to expected deaths was expressed as a standardised mortality ratio (SMR). The report for 1970-72 also presented proportional mortality ratios (PMRs) for the age range 65-74 years, with expected numbers of deaths derived by applying age-specific proportions of death from pneumonia in the general population to the total number of deaths at each age in the occupational population. Death reports for 1979-80 and 1982-90 were used to derive PMRs for pneumonia by occupation, standardised for age in five year strata and for social class (SMRs could not be calculated as the population denominators for this period were not available).
management support “redefines patients’ medical interests in terms of their broader life goals” (Oprea et al., 2010, p. 62). The good thereby shifts from an expert-determined disease-focused conceptualization to one consistent with Meyer’s (1922) focus on “living” (p. 9). While self-management support does not impose the clinician’s perception of good, neither does it abandon the individual to take control of his or her own care. Autonomy thus shifts from an individualistic view to a relational view of collaboration between clinician and individual (Katz, 1984/2002; Oprea et al., 2010). The clinician’s responsibility is not lessened but instead is transformed from responsibility for the individual to responsibility to the individual (Dwarswaard & van de Bovenkamp, 2015). Thus, in the paradigm described in this
The complexity and biodiversity of agriculture dust ex- posures is increasingly recognized, and animal and hu- man studies have defined roles for TLR2/TLR4/TLR9- signaling pathways [8–12]. The TLR/IL-1R/IL-18R adaptor protein myeloid differentiation factor 88 (MyD88) that is used by all TLRs except for TLR3  has been shown to have a fundamental role in the acute inflammatory response to organic dust [10, 14, 15] as well as other inflammatory exposures [16, 17]. MyD88 signaling mediates bleomycin-induced IL-17B expression in alveolar macrophages to promote pulmonary fibrosis . In silica-induced fibrosis, silica dust increases MyD88 expression in macrophages . In experimental asthma, MyD88 expression in epithelial cells mediates eosinophilia whereas MyD88 expression in conventional dendritic cells controls the neutrophilic response . In response to agriculture organic dust extract (ODE), MyD88 knockout (KO) mice demonstrate reduced air- way hyper-responsiveness and near absence of neutro- phil influx and inflammatory cytokine release following acute ODE exposure . However, these animals dem- onstrate an elevated, as opposed to reduced, mucus metaplasia response to acute ODE challenges . Des- pite the well-characterized role for MyD88 in mediating acute responses to ODE, its impact on airway inflamma- tory responses to repetitive, prolonged exposures is un- known. This information could be important in future targeted approaches.
In this study, we demonstrated that low environmental soil exposure was an independent predictor of no relapse and treatment success after adjustments for various clinical factors involving unfavorable microbiologic responses. Because these microbiological outcomes were better associated with soil exposure during or after the start of treatment rather than before treatment, the discontinuation of soil exposure is likely to influence treatment outcomes (Tables 3 and Table 4). Behavioral activities regarding environmentalexposure should be considered potential confounding factors in microbiological responses in pulmonary MAC disease.