Availability and storage of hazardous products in households in the metropolitan region of manaus: a population-based survey, 2015 / Disponibilidade e armazenamento de produtos perigosos em domicílios da região metropolitana de manaus: estudo de base populacional, 2015

ABSTRACT Objective: The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus. Methods: Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted. Results: A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13). Conclusions: Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.

RESUMO Objetivo: A disponibilidade de produtos perigosos em domicílios aumenta os riscos de intoxicações. Este estudo objetivou avaliar a frequência e os fatores associados à disponibilidade e armazenamento de produtos perigosos em residências da Região Metropolitana de Manaus. Métodos: Estudo transversal de base populacional realizado em 2015 com adultos selecionados por amostragem probabilística em três estágios. Os participantes foram entrevistados pessoalmente. A razão de prevalência (RP) da presença de produtos perigosos (presença de chumbinho [rodenticida anticolinesterase ilegal], produtos de limpeza artesanais e armazenamento inseguro desses produtos e de medicamentos) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson com variância robusta, ponderada pela amostragem complexa adotada. Resultados: 4.001 participantes foram incluídos, dos quais 53,0% (IC95% 51,5-54,6) reportaram a presença de produtos perigosos em seus domicílios, 36,3% (IC95% 34,8-37,8) apresentaram armazenamento inseguro, 16,2% (IC95% 15,1-17,4) possuíam produtos de limpeza artesanais e 8,2% (IC95% 7,4-9,1) possuíam chumbinho. Os domicílios com crianças menores de 5 anos apresentaram armazenamento mais seguro (RP=0,78; IC95% 0,71-0,86) e mais produtos artesanais (RP=1,30; IC95% 1,11-1,51). Presença de produtos artesanais foi maior em menores níveis de escolaridade (RP=2,20; IC95% 1,36-3,57) e menores classificações econômicas (RP=1,63; IC95% 1,25-2,13). Conclusões: Mais da metade dos domicílios da Região Metropolitana de Manaus possuía produtos perigosos; um terço os armazenava sem segurança. Produtos de limpeza artesanais e chumbinho estavam frequentemente presentes. Os domicílios com crianças apresentaram armazenamento mais seguro de produtos e fatores socioeconômicos afetaram a disponibilidade de tais produtos perigosos.

[Occupational acute mixed gas poisoning due to improper disposal of hazardous waste].

Objective: To investigate an occupational hazardous gas poisoning incident caused by gas leakage in the process of hazardous waste treatment. Methods: An investigation was conducted on a case of occupational acute hazardous gas poisoning caused by waste treatment gas leakage in Shandong province in December 2017. Meanwhile, the clinical data of 5 cases of poisoning patients were analyzed, and the accident related poison test report and other relevant data were analyzed. Results: The incident was caused by the toxic waste did not do labeling work, the workers' protection measures were not in place, the illegal operation and the blind rescue, resulting in a total of 5 people died on the spot, 12 people were hospitalized with poisoning. Among them, 5 patients admitted to our hospital showed varying degrees of damage to the nervous system and respiratory system. After active treatment, they all got better and were discharged. Conclusion: The poisoning is mainly caused by hydrogen sulfide dichloromethane hydrogen cyanide gas leakage serious production liability accident, clinical main performance for the nervous system circulatory system respiratory system and other system damage.

[The functional activity of lymphocytes in the spleen and peripheral blood in association with the toxic effect of household gas].

The objective of the present work was to study the population composition and functional activity of lymphocytes in the spleen and peripheral blood of the rats exposed experimentally to the toxic effect of household gas. The study included the morphofunctional examination of the state of the immune organs and the immunological investigation of the population composition and functional activity of lymphocytes from the peripheral blood of the experimental animals. We also evaluated the activity of nucleic acids, NADH2-dehydrogenase, and 5'-nucleotidase. The study revealed the relationship between the pathological and histochemical changes and the shifts in the population composition and functional activity of lymphocytes in the spleen and peripheral blood of the rats. Specifically, the action of household gas induced by the profound inhibition of the proliferative activity of the lymphocytes, enhanced the suppressive activity of the immunoregulatory cells (T-suppressors), and altered the population composition of the effector cells in the spleen and peripheral blood. It is concluded that the impairment of the functional activity of T-lymphocytes under the influence of household gas should be attributed not only to its direct toxic action but also to the increased activity of T-suppressors.

Illegal Dumping of Toxic Waste and Its Effect on Human Health in Campania, Italy.

The region of Campania (particularly Naples and Caserta) has experienced an emergency in the waste management cycle during past years. Although the most critical phase has been overcome after the construction of the incineration plant in Acerra (an old-fashioned technology built up over a few months, whose impact on environment and health has not yet been assessed), most of the underlying problems have not been resolved. The illegal burning of wheels, plastics, textiles, and other industrial residuals, along with the detection of two thousand toxic substance dumping sites, still represents major concerns of environmental pollution and population health. This review summarizes the most relevant studies, which analyzed chemical contamination (primarily dioxins and polychlorinated biphenyls (PCBs)) of the air, soil, water, animals, and humans in Campania. In addition, we reviewed information on population health (i.e., mortality data, congenital malformations, and cancer incidence). Moving from a detailed mapping of (mostly illegal) waste dumping sites in Campania, we have focused on recent studies which have found: (a) high concentrations of dioxins (≥5.0 pg TEQ/g fat) in milk samples from sheep, cows, and river buffaloes; (b) remarkable contamination of dioxin and PCBs in human milk samples from those living in the Naples and Caserta areas (PCDDs+PCDFs and dioxin-like-PCBs (dl-PCBs) assessed at 16.6 pg TEQ/g of fat; range: 7.5-43 pg/g of fat); (c) potential age-adjusted standardized mortality rates associated with some specific cancer types; (d) a statistically significant association between exposure to illegal toxic waste dumping sites and cancer mortality, even after adjustment by socio-economic factors and other environmental indicators.

Impact of chemical exposure on cancer mortality in a French cohort of uranium processing workers.

BACKGROUND: Nuclear workers may be exposed to a variety of chemical hazards, in addition to radiation. We examined the effect of chemical exposures on cancer mortality among French uranium processing workers at the AREVA NC Pierrelatte facility. METHODS: A cohort of 2,897 uranium processing workers employed for at least 6 months was followed from 1968 through 2006. Exposure to uranium and potentially carcinogenic chemicals was assessed with a plant-specific job-exposure matrix. Mortality hazard ratios (HRs) for cancers of the lung, lymphohematopoietic system, kidney and bladder, brain and central nervous system (BCNS), and prostate were estimated for each specific chemical exposure, with Cox regression models stratified for sex and calendar period and adjusted for socioeconomic status. Additional adjustments enabled us to examine the effect of co-exposure to uranium and other chemicals. RESULTS: Exposure to aromatic solvents was associated with increased risk of BCNS malignancies after adjustment for other chemicals (HR=6.53, 95% CI=1.14-37.41; n=6) and for other chemicals and uranium (HR=7.26, 95% CI=0.90-58.19) in the annual exposure status model. Selected groups of lymphohematopoietic cancers were found associated with solvent exposure. Inconclusive results were found regarding chromium (VI) exposure, since only 2 workers died from lung cancer among 109 exposed. CONCLUSION: Based on our pilot study, it seemed important to take into account chemical exposures in the analyses of cancer mortality among French uranium processing workers.

Protocolo de atención en salud integral con pertinencia cultural para la niñez y la adolescencia en situación de trabajo infantil y sus peores formas / Comprehensive health care protocol with cultural relevance for children and adolescents in child labor situations and their worst forms

El documento aborda, desde el marco teórico, los conceptos inherentes al tema, para luego describir las condiciones y características de los peores trabajos a los que tanto niños como adolescentes son sometidos. Va describiendo los niveles de riesgo, así como las formas de detectarlos por el personal sanitario. Incluye un marco legal en el que contextualiza la vulnerabilidad así como los derechos de los niños y adolescentes, para finalmente presentar los algoritmos de atención en salud integral, así como las rutas y derivación.

Polish mother and child cohort study (REPRO_PL)--methodology of follow-up of the children.

BACKGROUND: A prospective cohort study design gives the opportunity for identification, update of different exposures and their verification by biomarker measurements. The aim of The Polish Mother and Child Cohort Study (REPRO_PL) is to evaluate the impact of exposure to different environmental factors during pregnancy and, after birth, on the pregnancy outcome, children's health and neurodevelopment. MATERIALS AND METHODS: REPRO_PL cohort was established in 2007. From the cohort of 1300 mother-child pairs, 300 children are followed-up until they are two years old to asses the exposure, health status and neurodevelopment. Children are examined twice: at one and two years of age by a pediatrician and a psychologist/child development specialist. During each visit, detailed questionnaire is conducted with the mothers and supplemented with the information from the medical charts to have appropriate recognition of the child's health and development. Additionally, the current health status of the child is checked and his/her biometry is performed. A urine sample is collected from each child for the verification of environmental tobacco smoke (ETS) and polycyclic aromatic hydrocarbons (PAH) exposure. Some children have a blood sample collected for the assessment of the lead and cadmium levels. Child's neurodevelopment is assessed based on Bayley Scales for Infant and Toddler Development (Bayley-III). RESULTS AND CONCLUSIONS: The results of the study will become available within the next few years and will help to determine the impact of the environmental exposures on children's health and neurodevelopment. REPRO_PL cohort is a middle-sized cohort, very much focused on specific research questions with the potential for future extension and cooperation.

Effects of a television drama about environmental exposure to toxic substances.

OBJECTIVE: This study assessed short-term outcomes of viewing an episode of a prime-time television drama in which a child developed cancer after environmental exposure to an illegal pesticide. The study explored the effects among viewers of feeling transported into a narrative world. METHODS: Respondents (n = 2,139) to a post-episode Internet panel survey were asked if they had seen the show and asked questions about their demographic information, their frequency of viewing the television show, the degree to which they had felt transported into a narrative world created by the drama, and their knowledge and beliefs about the health effects of environmental exposure. Conversations with key informants from federal agencies and advocacy groups were also held. RESULTS: Episode viewing and narrative transportation were positively associated with knowledge of toxic exposure effects, and transported viewers reported being more likely to report an unusually high number of cancer cases to authorities. The show also appeared to have prompted a clarification of federal pesticide-testing policy. CONCLUSIONS: Entertainment Education is a promising strategy for disseminating key points of information about environmental health.

Deciphering diseases and biological targets for environmental chemicals using toxicogenomics networks.

Exposure to environmental chemicals and drugs may have a negative effect on human health. A better understanding of the molecular mechanism of such compounds is needed to determine the risk. We present a high confidence human protein-protein association network built upon the integration of chemical toxicology and systems biology. This computational systems chemical biology model reveals uncharacterized connections between compounds and diseases, thus predicting which compounds may be risk factors for human health. Additionally, the network can be used to identify unexpected potential associations between chemicals and proteins. Examples are shown for chemicals associated with breast cancer, lung cancer and necrosis, and potential protein targets for di-ethylhexyl-phthalate, 2,3,7,8-tetrachlorodibenzo-p-dioxin, pirinixic acid and permethrine. The chemical-protein associations are supported through recent published studies, which illustrate the power of our approach that integrates toxicogenomics data with other data types.

Activation of Hedgehog signaling by the environmental toxicant arsenic may contribute to the etiology of arsenic-induced tumors.

Exposure to the environmental toxicant arsenic, through both contaminated water and food, contributes to significant health problems worldwide. In particular, arsenic exposure is thought to function as a carcinogen for lung, skin, and bladder cancer via mechanisms that remain largely unknown. More recently, the Hedgehog signaling pathway has also been implicated in the progression and maintenance of these same cancers. Based on these similarities, we tested the hypothesis that arsenic may act in part through activating Hedgehog signaling. Here, we show that arsenic is able to activate Hedgehog signaling in several primary and established tissue culture cells as well as in vivo. Arsenic activates Hedgehog signaling by decreasing the stability of the repressor form of GLI3, one of the transcription factors that ultimately regulate Hedgehog activity. We also show, using tumor samples from a cohort of bladder cancer patients, that high levels of arsenic exposure are associated with high levels of Hedgehog activity. Given the important role Hedgehog signaling plays in the maintenance and progression of a variety of tumors, including bladder cancer, these results suggest that arsenic exposure may in part promote cancer through the activation of Hedgehog signaling. Thus, we provide an important insight into the etiology of arsenic-induced human carcinogenesis, which may be relevant to millions of people exposed to high levels of arsenic worldwide.

Reducing workplace cytotoxic surface contamination using a closed-system drug transfer device.

BACKGROUND: The potential for staff exposure to antineoplastic agents exists in the workplace despite current recommended safe handling procedures. Reliance on cytotoxic drug safety cabinets (CDSC) to provide total protection from exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimise exposure. PhaSeal is a commercially available system for ensuring the leak-free transfer of hazardous drugs, fitting both the NIOSH and ISOPP definitions of a closed system. To date, there have been no published studies examining the use of a closed system drug transfer device (PhaSeal) under Australian conditions.The purpose of this study is to determine the impact of a closed system drug transfer device on cytotoxic surface contamination in the cytotoxic preparation areas of two Australian metropolitan public hospitals. METHOD: This was a pre- and post-intervention study in which chemical contamination was tested at baseline then at five and 12 months after the introduction of the a closed system drug transfer device. Cyclophosphamide was used as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified sites within the cytotoxic suite using a standardized technique. Commercial products of cyclophosphamide were also sampled. RESULTS: After five months, contamination was reduced in 13 of the 22 sites sampled (59%), with four of these samples showing undetectable levels of contamination. Two other site samples (9%) remained unchanged. The total contamination of surfaces tested was reduced by 24%. After five months hospital 1 withdrew from the study. After 12 months, surface contamination was reduced in 75% of sample sites. The total contamination of surfaces tested was reduced by 68%. The wipes of the external surface of commercial products detected cyclophosphamide contamination. CONCLUSION: When used inside a CDSC, the closed system drug transfer device PhaSeal further reduces surface contamination, in some instances to undetectable levels.

State of the evidence: the connection between breast cancer and the environment.

A substantial body of scientific evidence indicates that exposures to common chemicals and radiation, alone and in combination, are contributing to the increase in breast cancer incidence observed over the past several decades. Key recurring themes in the growing scientific literature on breast cancer and environmental risk factors are: (a) the importance of understanding the effects of mixtures and interactions between various chemicals, radiation and other risk factors for the disease; and (b) the increasing evidence that timing of exposures matters, with exposures during early periods of development being particularly critical to later risk of developing breast cancer. A review of the scientific literature shows several classes of environmental factors have been implicated in an increased risk for breast cancer, including hormones and endocrine-disrupting compounds, organic chemicals and by-products of industrial and vehicular combustion, and both ionizing and non-ionizing radiation.

Occupational exposures and non-Hodgkin's lymphoma: Canadian case-control study.

BACKGROUND: The objective was to study the association between Non-Hodgkin's Lymphoma (NHL) and occupational exposures related to long held occupations among males in six provinces of Canada. METHODS: A population based case-control study was conducted from 1991 to 1994. Males with newly diagnosed NHL (ICD-10) were stratified by province of residence and age group. A total of 513 incident cases and 1506 population based controls were included in the analysis. Conditional logistic regression was conducted to fit statistical models. RESULTS: Based on conditional logistic regression modeling, the following factors independently increased the risk of NHL: farmer and machinist as long held occupations; constant exposure to diesel exhaust fumes; constant exposure to ionizing radiation (radium); and personal history of another cancer. Men who had worked for 20 years or more as farmer and machinist were the most likely to develop NHL. CONCLUSION: An increased risk of developing NHL is associated with the following: long held occupations of faer and machinist; exposure to diesel fumes; and exposure to ionizing radiation (radium). The risk of NHL increased with the duration of employment as a farmer or machinist.

[Analysis of environmental factors and polycystic ovary syndrome].

OBJECTIVE: To investigate environmental risk factors associated with polycystic ovary syndrome (PCOS). METHODS: A retrospective study was carried out from Feb 2005 to Apr 2006. A total of 108 cases with PCOS and 108 patients without PCOS (control group) were interviewed using a designed questionnaire. RESULTS: Univariate analysis of environmental factors indicated that risk factors related to PCOS were: occupation, education, disposable plastic cup for drinking, cooking oil fume and indoor decoration, all of which were significantly related to PCOS (P < 0.05). Multi-variate analysis confirmed that the risk factors associated with PCOS were disposable plastic cup for drinking, cooking oil fume and indoor decoration (P value: 0.011, 0.012, 0.026, 0.011, OR value: 2.800, 3.027, 2.370, 2.478). CONCLUSIONS: PCOS is related to environmental endocrine-disrupting chemicals.

Protecting children from toxic exposure: three strategies.

To a toxicologist, "poisonings" are cases in which the child has a defined pattern of symptoms, corresponding to toxic effects at a mid to high level of exposure. "Toxicity" refers to a broader spectrum of effects. At lower levels of toxicity a child may have no specific, individual symptoms but may be affected subclinically. There are three basic strategies to protect children: individual intervention, the preventive medicine strategy, and the public health strategy. This article uses lead exposure as a model for discussing these differences in terminology and the three different protective strategies.

Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children.

OBJECTIVE: The purpose of this study was to examine the association of exposures to tobacco smoke and environmental lead with attention deficit hyperactivity disorder (ADHD). METHODS: Data were obtained from the National Health and Nutrition Examination Survey 1999-2002. Prenatal and postnatal tobacco exposure was based on parent report; lead exposure was measured using blood lead concentration. ADHD was defined as having current stimulant medication use and parent report of ADHD diagnosed by a doctor or health professional. RESULTS: Of 4,704 children 4-15 years of age, 4.2% were reported to have ADHD and stimulant medication use, equivalent to 1.8 million children in the United States. In multivariable analysis, prenatal tobacco exposure [odds ratio (OR) = 2.5; 95% confidence interval (CI), 1.2-5.2] and higher blood lead concentration (first vs. fifth quintile, OR = 4.1; 95% CI, 1.2-14.0) were significantly associated with ADHD. Postnatal tobacco smoke exposure was not associated with ADHD (OR = 0.6; 95% CI, 0.3-1.3; p = 0.22). If causally linked, these data suggest that prenatal tobacco exposure accounts for 270,000 excess cases of ADHD, and lead exposure accounts for 290,000 excess cases of ADHD in U.S. children. CONCLUSIONS: We conclude that exposure to prenatal tobacco and environmental lead are risk factors for ADHD in U.S. children.

Geographical distribution of acute symptoms after a train collision involving epichlorohydrin exposure.

In September 2002, two freight trains collided in a northern German town. The inhabitants were potentially exposed to the probable human carcinogen epichlorohydrin. As no objective data on the level of exposure were available, we aimed to assess the geographical distribution of acute symptoms among local residents and subjects occupationally involved in the accident (e.g., firemen). A random sample of 932 adult local residents and 342 occupationally involved subjects were invited to answer a mail-in questionnaire. The main outcome measures were self-reported acute symptoms potentially associated with combustion products (e.g., irritation of the eyes, nose, or throat) and stress-related nonspecific symptoms. The main location during the first 26 h after the accident served as exposure proxy. For occupationally involved subjects, the time spent at the accident site was also used. The overall prevalence of symptoms potentially associated with combustion products was 9.8% for residents and 25.4% for occupationally involved subjects. After adjustment, subjects whose main location was close to the accident site had an increased risk for such symptoms. Among occupationally involved subjects the risk increased with duration at the accident site. Neither main location nor time at the accident site was significantly associated with non-specific symptoms. We could provide an example for designing and carrying out an epidemiologic study shortly after a local accident with potential public health impact. We could define parts of the population at increased risk for symptoms potentially specific for the exposure under study.

[A system for predicting the toxicity and hazard of chemical substances, based on the joint use of logistic and numerical methods].

A version of a logical combinatorial intellectual system (DMS system) has been developed to predict the toxicity and hazards of chemical substances. The system is based on the combined description of the substances, which includes both structural and numerical descriptors, particularly those characterizing the reactivity of compounds or their metabolites. The selection of numerical descriptors is based on the classification of processes of the interaction of the substance with the body in accordance with the key stage of the mechanism responsible for its toxic action. The new version of the DSM system takes into account the fact that the toxicity and hazard of chemicals are frequently determined by their bioactivation. Examples of how to apply the system to the prediction of carcinogenicity are given.