Human Health Effects: Cancer, Pesticides, Ergonomics Steven Kirkhorn, MD, MPH Immanuel St....
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Transcript of Human Health Effects: Cancer, Pesticides, Ergonomics Steven Kirkhorn, MD, MPH Immanuel St....
Human Health Effects:Cancer, Pesticides, Ergonomics
Steven Kirkhorn, MD, MPHImmanuel St. Joseph’sMayo Health System
Health issues
Increased respiratory disease, arthritis, hearing loss, skin
cancer Migrant health clinic issues-dermatitis, enteric
infectious diseases, respiratory, musculoskeletal, diabetes
Decreased generally decreased mortality of all causes tobacco and alcohol-related cancers cardiovascular
Cancers of Concern
Increase in cancers that are increasing in other segments of the population also
LipMultiple myelomaChildhood brain tumorsProstate-weak association but
significant
Inconsistent associations
NHL and phenoxyacetic acid herbicides
Breast/ovarian cancer and DDT/DDEProstateSkin, melanomasoft tissue sarcomaRectal, colon-increased PMRs in Iowa
No apparent associations
Leukemia and herbicidesOvarian cancer and atrazineColon, soft tissue sarcoma,
melanoma, rectal -Wisconsin study 1981-1990
Weaknesses of studies
Heterogeneity of studies, type of farming, geographic area
Limitations of exposure assessmentMultiple hazard exposures
pesticides, fertilizers, paints, solvents, infectious microorganisms, endotoxin dusts
Recommendations
Improved biomarkersIncreased use of biological monitoringImproved homogeneity of studiesStandardization of endpointsFocus upon populations with greater
exposures to pesticides(fruit, vegetable, hot houses) Present focus upon grain producers with
average of 7-28 days/year of exposure
Pesticide-related illnesses
Annual decreases in pesticide fatalities, hospitalizations, and acute poisonings
Possible explanations improved worker education -WPS Improved technology-application/mixing De-registration of more toxic agents Better labeling and regulation
Common symptoms in pesticide applicator
20-44% of applicators have exposures and symptoms headache skin irritation respiratory and flu-like symptoms in
animal applications
Neurologic complications: Acute pesticide exposure
Organophosphate induced delayed polyneuropathy (OPIDP)
Intermediate syndrome
Long-term neurologic effects of pesticides
Dose-response relationship suggested
Peripheral neuropathySlowed reaction timeAltered concentrationNon-specific CNS effects? Parkinson’s/motion disorders
Endocrine disrupter effects of pesticides
Female cancer concerns Breast cancer Ovarian cancer
Male reproductive effects
Endocrine disrupter effects of agricultural chemicals
No strong association with exposure and time to pregnancy
Reproductive effects Increased male:female ratio(Garry et al 1996)
Not seen-Savitz et al 1997
Infertility Delayed time to conception Spontaneous abortions, pre-term delivery
•
Pesticides and birth defects
Birth defects-limb reduction, oral-facial, cryptorchidism
Minor defects in ecological study of applicators in area with high use of fungicides and chlorphenoxy More pronounced in infants conceived in
spring
Pesticide issues-Monitoring Concerns
Lack of inter-laboratory standards Variable results depending upon kit/lab variable reporting units
Lack of consistent collection and storage techniques Activation/inactivation of cholinesterase
Lack of reliable, inexpensive field monitoring
Recommendations
Improved causal linkages and dose-response relationships
Improved biomarkersImproved consistency and accuracy
of evaluation of acute and chronic cholinesterase depression
Recommendations
Improved reporting of pesticide-related illnesses
Nation-wide effort to improve and standardize medical surveillance of pesticide applicators and others with regular exposure to pesticides
Ergonomic issues
High incidence of musculoskeletal conditions- primarily back pain
California-Back 24%, upper back 19%, wrist 18%
Osorio et al, 1998
Chronic low back pain prevalence
Nursery workers back 46% of injuries Chronic back pain-71% swine producers
Von Essen and McCurdy, 1998
Back pain-26% of farmers and ranchersXiang et al, 1999
Arthritis of hips and knees in dairyMay, 1998, Thelin 1991
Ergonomic issues
Increasing labor intensive agricultural work
Fruit harvesting, nurseries, small vegetable
Raised arms, pressure from straps of bags, repetitive forceful lifting, pinching, stooping, bending and twisting
Varied duties at multiple locations
Interventions
Handles on pots in nurseries-decrease pinch
Pallet trucks and tracks, automated washers
Loading rampsMove to smaller potsImproved fruit bags and straps, vests
Hinged boxes (Fulmer et al. 2000)
Recommendations
Thorough functional job assessmentsDevelopment of lighter, more flexible
equipment, new tools, raising bedsDevelop simple solutions that are
inexpensive to produce and applyMeyers et al. 1995, 1997
Other areas of concern
Zoonoses Hepatitis E Cryptosporodiosis Coliforms Sin nombre virus Q fever
Dermatitis Contact dermatitis Under-reported
Emerging concerns of biotechnology
Probable improvement in hazard exposures
New exposures may occur
Bacillus thuringiensis (Bt) exposure issues
Positive skin prick tests, specific IgE antibodies, and nasal lavage cultures higher in high Bt-exposure workers.
No respiratory symptoms Berstein et al. Immune responses in
farm workers after exposure to Bt pesticides.Environ Health Perspect 107: 575-82.
(1999)
General recommendations
Improved medical surveillanceImproved reporting of illnesses, repetitive
stress injuriesEstablishment of dose-response
relationships, biological monitoringBetter definition of study end-pointsContinued support of prospective studies:
The Agricultural Health, Keokuk, California Farmer Cohort Studies