Leukemia among Nebraska farmers: a death certificate study.

The risk of leukemia among farmers was studied using records of death certificates from Nebraska, 1957--1974. Comparison of occupation, as recorded on the death certificate, for 1084 leukemia deaths and 2168 deaths from other causes, matched for age at death, year of death, county of residence, race, and sex, revealed an elevated risk of leukemia among farmers (odds ratio = 1.25). The risk was greatest among farmers born after 1900 and dying before age 66 (odds ratio = 1.83). Stratification by county of residence showed a significantly elevated risk for farmers from heavy corn producing counties.     

Pesticide application practices in agricultural workers

OBJECTIVE: We describe the sociodemographic characteristics and determinants of pesticide exposure in agricultural workers applying pesticides. METHODS: The workers selected were included in a case-control study carried out in the Autonomous Community of Valencia in Spain. Contact was made by telephone and individuals who had been involved in agricultural work during the relevant period of exposure were interviewed face-to-face to gain information on the following determinants of pesticide exposure: crops and periods worked, mixing of products, treatment equipment, participation in the washing of equipment, use of personal protection during the treatments and knowledge of the risks of pesticide exposure. RESULTS: Eighty-nine workers, aged between 16 and 46 years old, were included. Most of the interviewees had primary education or less. Pesticide treatments were mostly applied on high crops (82%), with manual equipment (61%) and throughout the year (45%). Workers frequently performed tasks involving additional exposure to pesticides (mixing chemicals, 66%, or washing equipment, 60%). Sixty-five percent of the workers used no personal protection or used it defectively. No differences were found in personal protection use according to age, family income or education. Most of the workers (90%) reported knowledge of the health risks of pesticide exposure and 21% of them rated the risk as null. CONCLUSIONS: Workers involved in pesticide application use personal protection measures very defectively. There is a clear need to develop specific prevention programs for these workers. The determinants of pesticide exposure in agricultural workers described in this study should be properly assessed in epidemiological studies of the health effects of pesticides on agricultural workers.     

Infectious waste. A survey of handling practices in Lincoln, Nebraska.

Concerns surrounding the issue of infectious waste prompted a City-County Health Department survey of infectious waste handling in Lincoln, Neb. (pop. 205,000). A detailed questionnaire was mailed to 347 facilities identified as possible infectious waste generators. The participation rate was 38 percent overall and 49.5 percent for reported generators. Treatment and storage deficiencies were found in eight of 11 categories.     

Evaluation of genotoxic and cytotoxic properties of pesticides employed in Italian agricultural practices

In a program coordinated by the Italian Ministry of Works, we tested in vitro four pesticides widely employed in a developed agricultural region of central Italy. The four commercial agents were chosen on the basis of their diffusion in agricultural practice, knowledge of their active principle(s), and scant availability of data concerning their toxic and genotoxic activity. The agents were Cirtoxin, Decis, Tramat Combi (TC), and Lasso Micromix (LM). All substances were tested in three in vitro systems: Chinese hamster ovary (CHO) cells, a metabolically competent hamster cell line (Chinese hamster epithelial liver; CHEL), and root tips of Vicia faba (VF). The cytotoxic and genotoxic end points challenged were micronuclei and root tip length (RTL) in VF and mitotic index (MI), proliferation index (PI), cell survival (CS), cell growth (CG), cell cycle length (CCL), sister chromatid exchanges, chromosomal aberrations, and single-cell gel electrophoresis, or comet assay, in CHEL and CHO cells. Tested doses ranged from the field dose up to 200x the field dose to take into account accumulation effects. On the whole, tested agents appear to induce genotoxic damage only at subtoxic or toxic doses, indicating a low clastogenic risk. MI, PI, CS, CG, RTL, and CCL appear to be the less sensitive end points, showing no effects in the presence of a clear positive response in some or all of the other tests. Using cytogenetic tests, we obtained positive results for TC and LM treatments in CHO but not in CHEL cells. These data could be accounted for by postulating a detoxifying activity exerted by this cell line. However, cytogenetic end points appear to be more sensitive than those referring to cytotoxicity.     

Leukemia among New Zealand agricultural workers. A cancer registry-based study

Mortality studies have indicated that workers in agriculture and forestry may be at increased risk of leukemia. Findings are reported from a New Zealand Cancer Registry-based case-control study involving 546 male leukemia patients registered during 1979-1983 and aged 20 years or more at time of registration. Controls were also males chosen from the Cancer Registry with four controls per case, matched on age and year of registration. The case group contained an excess of the occupational category involving agriculture and forestry (odds ratio (OR) = 1.24, 95% confidence interval (CI) = 0.95-1.61) with the greatest relative risk being for livestock farmers (OR = 3.00, 95% CI = 1.23-7.32). There was also an excess of electrical workers (OR = 1.72, 95% CI = 0.92-3.20). The agricultural excess was greatest in patients aged 65 years or more at time of registration (OR = 1.29, 95% CI = 0.94-1.78), particularly in patients with acute myeloid leukemia (OR = 1.55, 95% CI = 0.90-2.67) or acute monocytic leukemia OR = 10.38, 95% CI = 1.99-54.29), although the latter excess only involved five cases. Acute myeloid leukemia was also elevated in meat workers (OR = 2.51, 95% CI = 1.19-5.30).     

Process and outcome evaluation of preventive care for infants in two types of practices

Process and outcome of preventive and promotive infant care have been evaluated in a maternal and child health (MCH) service and compared with that of a comprehensive care family practice (FP), both serving a low middle class population in West Jerusalem. Both services are provided by the Community Health Center of the Department of Social Medicine. Community oriented primary care is integrated into the practices, including ongoing surveillance of the communities' health status. Preventive and promotive programs have been developed, implemented and evaluated.The process evaluation indicated a similar use of the preventive service in the MCH and FP services. Some of the routines were carried out to a lesser extent in the FP than in the MCH framework, such as growth monitoring, hearing tests and advice on iron supplementation. The small difference in compliance with routines did not affect a child's growth between birth and one year of age, but the anemia rate in the FP practice was higher than in the MCH practice. The high level of care and relatively small differences in process and outcome between the two types of services have been achieved by ongoing inservice training, a high level of personnel, similar protocols and supervision in both practices.H. Palti, M.D. M.P.H., Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; D. Haustein, M.D. M.P.H., former student at the School of Public Health, Hebrew University and Hadassah, Jerusalem. Present address: Chabrier 179, San Isidro, Lima 27, Peru; R. Gofin, M.D. M.P.H., Lecturer & Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Knishkowy, M.D. M.P.H., Family Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Adler, M.Sc., Statistician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel.This study was supported by The Temin Endowment Fund. We wish to express our thanks to staff of MCH and FP practices of the Hadassah Community Research and Health Center, for their ongoing contribution to the MCH programs.     

Mortality study of Canadian male farm operators: cancer mortality and agricultural practices in Saskatchewan

The present investigation involved an analysis of approximately 70,000 male Saskatchewan farm operators, a subset of the 365,000 Canadian farm operators to be investigated in the Canadian Farm Operator Mortality Study. The results of the Saskatchewan analysis indicate that during the interval studied, overall mortality among Saskatchewan farmers was 25% lower than that for all Saskatchewan men, and that, during the same time interval, the risk of death from all types of cancer was also about 25% lower among Saskatchewan farmers than to all Saskatchewan men. Although the present study indicates that overall mortality of death from cancer was 25% lower among Saskatchewan male farmers, there was a relationship between non-Hodgkin's lymphoma mortality and acres sprayed for weeds; a similar risk relationship between expenditures on fuel oil and risk of death from non-Hodgkin's lymphoma was also evident. The magnitude of risk for Saskatchewan farmers is probably greater than that reflected in the estimates in this study, due to the likelihood of misclassification of exposure. There is a particular need for further studies in this area to improve the quantification of farming-related exposures, and to study the exposure history of individuals who develop non-Hodgkin's lymphoma.     

Irrigated crop production is associated with less malaria than traditional agricultural practices in Tanzania

There is concern that crop irrigation that results in increased numbers of vector mosquitoes will lead to a rise in malaria in local communities. We evaluated the level of malaria experienced in 3 communities in northern Tanzania with different agricultural practices: rice irrigation, sugar-cane irrigation and traditional maize cultivation. Five cross-sectional surveys were used to measure the prevalence of infection with falciparum malaria in 1-4 years old children in each community over a period of 12 months. Active case detection was also carried out to record clinical episodes of malaria during the study period. Information on antimalarial measures was also recorded. Results from the cross-sectional surveys showed that the overall prevalence of malaria parasites was less near the rice irrigation (12.5%) and sugar-cane (16.9%) schemes than the savannah village (29.4%). There were also significantly fewer clinical episodes of malaria in the rice village (15 cases/1000 child-weeks at risk [cwar]) than either the sugar-cane (36 cases/1000 cwar) or savannah (40 cases/1000 cwar) villages. Overall, rice irrigation was associated with less malaria than alternative agricultural practices, despite the considerable numbers of vectors produced in the paddies. This finding supports other studies that indicate that irrigation in much of sub-Saharan Africa will not lead to increased malaria. Nonetheless, African governments planning irrigation projects need effective policies to encourage local communities to use personal protection measures, such as insecticide-treated bednets, and to ensure that these communities have access to effective antimalarial drugs and efficient health services.     

Using social marketing to address barriers and motivators to agricultural safety and health best practices

Social marketing is an intervention development strategy that pays considerable attention to barriers to and motivators for behavioral change or adoption of recommended behaviors. Barriers are obstacles that prevent individuals from changing or adopting behaviors and are often referred to as the "cons" or "costs" of doing something. Motivators, on the other hand, are factors that encourage individuals to change or adopt behaviors and are often referred to as the "pros," "benefits," or "influencing factors" of doing something. Importantly, social marketing does not target education or knowledge change as an end point; rather, it targets behavior change. Studies across several types of desired behaviors (e.g., smoking cessation, weight control, more exercise, sunscreen use, radon testing) using the Stages of Change model have found systematic relationships between stages of change and pros and cons of changing behavior. A review of literature identifies numerous research and intervention studies that directly reference social marketing in agricultural safety and health, studies that identify reasons why parents allow their children to be exposed to hazardous situations on the farm, and reasons why youth engage in risky behaviors, but only two studies were found that show evidence of systematically researching specific behavioral change motivating factors. The authors offer several suggestions to help address issues relating to social marketing and agricultural safety and health.     

Knowledge,attitudes and practices (KAP) among agricultural extension workers concerning the reduction of the adverse impact of pesticides in agricultural areas in Tanzania

BACKGROUND: Extension workers are educated locally to enable them to train farmers in using improved local farming methods and imported technology, such as pesticides, to increase crop production. However, the extension workers are not adequately trained in health aspects of pesticides and hence are unable to provide adequate services to farmers with regard to safe use of pesticides. OBJECTIVE: The present study assessed the knowledge, attitudes and practices of agricultural extension workers with respect to health effects of pesticides in order to develop strategies for the control of pesticide exposure and prevention of pesticide poisoning in Tanzania. METHODS: A survey of Tanzanian agricultural extensionists was undertaken in 1991-1994 using a standardized questionnaire in face-to-face interviews. Extensionists who were district agricultural officers, assistant agricultural officers, agricultural assistants, and field assistants, working in the coffee and cotton growing areas (N = 61) within a radius of 15 km of farm, estate or village under farm worker study (reported elsewhere) were included in the survey. RESULTS: The majority of extensionists knew that pesticides could enter the human body but only a quarter perceived pesticides as a major problem in the community they served. The majority showed awareness of potential health hazards of the different pesticides used in their service areas, but they did not recognize what pesticides were responsible for poisoning. A high proportion was familiar with first aid procedures in case of pesticide poisoning; however, many procedures described were not appropriate for pesticide poisoning. CONCLUSIONS: The survey indicated that training of agricultural workers in health aspects of pesticide exposure is an important task for adequate provision of service to farmers with regard to safe use of pesticides in Tanzania. Nevertheless, the appropriate role of extensionists in reducing the health impact of pesticides would be to advocate pesticides of low toxicity or non-chemical pest control.     

Health and Related Factors for Sudanese Refugees in Nebraska

Results of a health survey covering demographics, health risk/prevention factors, and barriers to health care among 263 refugees from Sudan, now living in Nebraska, are presented. Data are compared to Nebraska's general and minority populations. Sudanese refugees are generally young, highly mobile, uneducated, and live in poverty. Refugees are proportionally different from other Nebraskans, in terms of risk factors and rates of common U.S. conditions, but are unable to use preventive systems for maintaining high health status. Nearly 40% do not have health or dental insurance, 20% have never visited a dental or eye care professional, and 11% have never been to a doctor. Federal programs should standardize resettlement site screening so that mobile populations can begin the resettlement process healthy and prevent the spread of infectious disease. Good health at the outset will allow more time and resources for education, language, and employment acquisition, all of critical importance to the Sudanese refugee community.     

Agricultural practices and personal hygiene among agricultural workers in a rural area of Howrah district, West Bengal

The study attempted to assess agricultural practices and personal hygiene among 100 agricultural workers in a rural area of West Bengal in 1999. 69% of the study population was marginal farmer with less than 2 acres of land. Organophosphorus group of pesticides were most commonly used pesticides (68%); spraying was irregular in nature (98%), through semiautomatic sprayer (99%) and only 5% used any special dress while spraying pesticides. 40% of workers used to store pesticides either in living room or in food storage area. 88% of them did not take any food during work with pesticides, only 37% used to take regular bath after working with pesticides but regular hand washing was practiced by all of them.     

Changes in blood pesticide levels in booted eagle (Hieraaetus pennatus) associated with agricultural land practices

We estimated the degree of exposure to lindane and endosulfan in the blood of booted eagle nestlings (Hieraaetus pennatus) (1999-2003), in order to assess the usefulness of these samples as a unit for monitoring changes in exposure as a result of shifts in agricultural practices and the implementation of legal measures. The highest blood lindane concentrations were obtained 1 year prior to its prohibition by the European Union. Subsequent to that year, the drop in blood concentrations was dramatic. Furthermore, endosulfan blood concentrations follow a progression coinciding with an increase in olive, grape and plum-tree crops. We conclude that concentrations of organochlorine pesticides in the blood of booted eagle nestlings may be used to monitor the use of those pesticides over a particular agricultural region and alert the authorities of possible environmental or health risks.     

Cancer Community Education in Somali Refugees in Nebraska

Nebraska has one of the highest numbers of refugees per capita in the U.S. A high number of Somalis have resettled in Nebraska due to job opportunities and the low cost of living. In this paper, we report the process and the results of a cervical and breast cancer education program for Somali women conducted through a collaboration among public health, academia, and community entities. The curriculum was built to be suitable for the literacy level and cultural values of this community. Topics include female reproductive anatomy; breast and cervical cancer knowledge and screening; hepatitis C and liver cancer; and preparing for a health screening visit. Two community members trained as lay health workers conducted a pilot and an actual education session. The 2-day education program was attended by 52 women. Qualitative data showed the intervention to be promising for this and other African refugee populations.     

Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.     

Copper in drinking water, Nebraska, 1994

In 1993, the levels of copper (Cu) in much of Nebraska's drinking water exceeded the U.S. Environmental Protection Agency's (EPA) action level of 1.3 mg/L. To determine the association of copper with gastrointestinal (GI) illness in August 1994 the authors interviewed persons living in households with 1993 Cu levels > 3 mg/L (51 households), 2-3 mg/L (54 households), and < 1.3 mg/L (43 households). Cases were defined as persons who had experienced the rapid onset of vomiting or nausea with abdominal pain during the preceding two weeks. To validate their exposure index, the authors immediately resampled drinking water in the households of 25 cases and 27 controls matched for age. Reassessment in December 1994 of the exposure and case status of the original cohort showed no association between copper in drinking water in 1993 and case status in 1994. The risk of GI illness seemed no greater with Cu > 3 mg/L (RR = 1.03; 95% CI = 0.43, 2.49) or 2-3 mg/L (RR = 0.50; 95% CI = 0.18, 1.41) than with Cu < 1.3 mg/L. The 1993 Cu concentrations could not be reproduced in August 1994; resampling in December 1994 again showed no association between GI illness and Cu exposure (RR > 1.3-2.9 mg/L, < or = 1.3 mg/L = 0.25, 95% CI = 0.10, 0.64, and RR > or = 3.0 mg/L, < or = 1.3 mg/L = 0.36, 95% CI = 0.09, 1.49).