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1.
Environ Health ; 18(1): 91, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665024

RESUMO

BACKGROUND: Exposure to the herbicide Agent Orange during the Vietnam War was widespread and is associated with numerous adverse health outcomes. A continuing concern of veterans is the possibility that exposure to the dioxin-containing herbicide might induce adverse reproductive outcomes. We sought to assess whether exposure to Agent Orange in Vietnam was associated with changes in DNA methylation in sperm in a subset of Vietnam veterans who participated in the Air Force Health Study (AFHS). METHODS: We studied 37 members of the AFHS chosen to have no, low, medium or high exposure to Agent Orange, based upon serum dioxin levels obtained during a series of examinations. DNA from stored semen was extracted and DNA methylation assessed on the Illumina 450 K platform. RESULTS: Initial epigenome-wide analysis returned no loci that survived control for false discovery. However, the TEAD3 gene had four different CpG sites that showed loss of DNA methylation associated with dioxin exposure. Analysis assessing regional DNA methylation changes revealed 36 gene regions, including the region of the imprinted gene H19 to have altered DNA methylation associated with high exposure compared to the low exposure group. Additional comparison of our data with sperm DNA methylation data from Russian boys exposed to dioxin found an additional 5 loci that were altered in both studies and exhibited a consistent direction of association. CONCLUSIONS: Studying a small number of sperm samples from veterans enrolled in the AFHS, we did not find evidence of significant epigenome-wide alterations associated with exposure to Agent Orange. However, additional analysis showed that the H19 gene region is altered in the sperm of Agent Orange-exposed Ranch Hand veterans. Our study also replicated several findings of a prior study of dioxin-exposed Russian boys. These results provide additional candidate loci for further investigation and may have implications for the reproductive health of dioxin-exposed individuals.


Assuntos
Metilação de DNA/efeitos dos fármacos , Dioxinas/sangue , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/efeitos adversos , Espermatozoides/efeitos dos fármacos , Veteranos/estatística & dados numéricos , Guerra do Vietnã , Idoso , Idoso de 80 Anos ou mais , Agente Laranja/efeitos adversos , Herbicidas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos
2.
Sci Total Environ ; 678: 217-226, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31075589

RESUMO

Bien Hoa airbase is the most contaminated area of dioxin contamination from Agent Orange in Vietnam, but little is known about the neurodevelopmental effects of perinatal dioxin exposure on children living nearby. We recruited 210 mother-newborn resident pairs in 2012 and 78 pairs in 2015 and followed them for 2 years to assess the children's neurodevelopment. As a control group, we used 120 mother-child pairs recruited in 2014 in the Ha Dong district of Ha Noi City, an unexposed area. Perinatal dioxin exposure levels were indicated by levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and toxic equivalency values of polychlorodibenzodioxins, polychlorodibenzofurans, and nonortho-polychlorinated biphenyls (TEQ-PCDD/Fs/noPCBs) in maternal breast milk. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) were used to assess neurodevelopment, and scores in each domain were compared between children with different exposure levels using general linear regression models and stratification by sex. Decreased expressive and composite language scores in boys and gross motor scores in girls were found in children exposed to TCDD ≥ 5.5 (pg/g lipid) compared with children with TCDD < 1.8. However, in matched pair analysis between children with TCDD ≥ 5.5 and <1.8 (pg/g lipid), lower expressive and composite language scores in boys exposed to TCDD ≥ 5.5 were significant, but lower gross motor scores in girls did not reach statistical significance. In addition, significant association was found between levels of PCDD congeners other than TCDD and gross motor scores in boys. These findings suggest that perinatal exposure of TCDD and other PCDD congeners affects development of language and gross motor skills, respectively, in boys at 2 years of age exposed to dioxins originating from Agent Orange in Vietnam.


Assuntos
Agente Laranja , Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais/análise , Poluição Ambiental/estatística & dados numéricos , Transtornos do Neurodesenvolvimento/induzido quimicamente , Dibenzodioxinas Policloradas , Pré-Escolar , Feminino , Humanos , Idioma , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Vietnã/epidemiologia
4.
Clin Dermatol ; 37(2): 136-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981294

RESUMO

Dermatology is frequently viewed by physician and surgical colleagues as a specialty with few emergencies. Although the majority of dermatology practice is in the office setting, cutaneous emergencies do occur through referrals from primary care and as ward consults. Even though cutaneous signs of poisoning would be an uncommon emergency consultation, it is important for dermatologists to be aware of the clinical presentations so as to be able instigate appropriate time critical treatments.


Assuntos
Intoxicação por Arsênico/complicações , Intoxicação por Arsênico/patologia , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/patologia , Dioxinas/envenenamento , Exantema/etiologia , Exantema/patologia , Intoxicação por Mercúrio/complicações , Intoxicação por Mercúrio/patologia , Pele/patologia , Doença Aguda , Agente Laranja/envenenamento , Doença Crônica , Feminino , Humanos , Masculino
5.
J Urol ; 201(4): 749, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947453
6.
J Urol ; 201(4): 749, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947464
8.
J Urol ; 201(4): 742-750, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30321553

RESUMO

PURPOSE: In this study we explored the effect of Agent Orange exposure on prostate cancer survival in VA (Veterans Affairs) patients receiving androgen deprivation therapy for advanced prostate cancer. MATERIALS AND METHODS: We retrospectively examined the association between Agent Orange exposure in men with prostate cancer in national VA databases who were being treated with androgen deprivation therapy. Patients were diagnosed with prostate cancer from 2000 to 2008 with followup through May 2016. Clinical, pathological and demographic variables were compared by Agent Orange exposure. Associations of Agent Orange with overall survival, skeletal related events and cancer specific survival were performed using adjusted Cox proportional hazard models after IPSW (inverse propensity score weighted) adjustment. RESULTS: Overall 87,344 patients were identified. The 3,475 Agent Orange exposed patients were younger (p <0.001), had lower prostate specific antigen (p = 0.002) and were more likely to receive local therapy and chemotherapy (p <0.001) than the 83,869 nonexposed patients. The Charlson comorbidity index was similar in the groups (p = 0.40). After IPSW adjustment Agent Orange exposure was associated with improved overall survival (HR 0.84, 95% CI 0.73-0.97, p = 0.02). However, no difference was observed in the risk of skeletal related events (HR 1.04, 95% CI 0.80-1.35, p = 0.77) or cancer specific survival (HR 0.79, 95% CI 0.60-1.03, p = 0.08). CONCLUSIONS: Agent Orange exposure was associated with a decreased risk of death in men receiving androgen deprivation therapy for advanced prostate cancer. It does not appear to be associated with worse oncologic outcomes.


Assuntos
Agente Laranja/toxicidade , Desfolhantes Químicos/toxicidade , Neoplasias da Próstata/mortalidade , Saúde dos Veteranos , Idoso , Antagonistas de Receptores de Andrógenos/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Taxa de Sobrevida
10.
Fed Regist ; 83(204): 53179-82, 2018 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-30358958

RESUMO

The Department of Veterans Affairs (VA) is adopting as final an interim final rule published on June 19, 2015, to amend its adjudication regulation governing individuals presumed to have been exposed to certain herbicides. Specifically, VA expanded the regulation to include an additional group consisting of individuals who performed service in the Air Force or Air Force Reserve under circumstances in which they had regular and repeated contact with C-123 aircraft known to have been used to spray an herbicide agent ("Agent Orange") during the Vietnam era. In addition, the regulation established a presumption that members of this group who later develop an Agent Orange presumptive condition were disabled during the relevant period of service, thus establishing that service as "active military, naval, or air service." The effect of this action is to presume herbicide exposure for these individuals and to create a presumption that the individuals who are presumed exposed to herbicides during reserve service also meet the statutory definition of "veteran" (hereinafter, "veteran status") for VA purposes and eligibility for some VA benefits.


Assuntos
Agente Laranja/efeitos adversos , Avaliação da Deficiência , Pessoas com Deficiência/legislação & jurisprudência , Definição da Elegibilidade/legislação & jurisprudência , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/legislação & jurisprudência , Saúde dos Veteranos/legislação & jurisprudência , Veteranos/legislação & jurisprudência , Herbicidas/efeitos adversos , Humanos , Estados Unidos
11.
Environ Pollut ; 242(Pt A): 976-985, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30373043

RESUMO

During the Vietnam War, the United States military sprayed over 74 million litres of Agent Orange (AO) to destroy forest cover as a counterinsurgency tactic in Vietnam, Laos and Cambodia. The main ingredient was contaminated by 2,3,7,8-tetrachlorodibenzo-paradioxin (TCDD). DNA methylation (DNAm) differences are potential biomarker of environmental toxicants exposure. The aim of this study was to perform a preliminary investigation of the DNAm levels from peripheral blood of the present-day Vietnamese population, including individuals whose parents, according to historical data, were exposed to AO/TCDD during the war. 94 individuals from heavily sprayed areas (cases) and 94 individuals from non-sprayed areas (controls) were studied, and historical data on alleged exposure of parents collected. 94 cases were analysed considering those whose father/parents participated in the war (N = 29) and considering the place of residence of both parents (64 living in sprayed areas versus 30 in non-contaminated areas). DNAm levels in CYP1A1 and IGF2 genes were measured (MALDI-TOF technology). The analyses showed that: 1) one CpG site in the CYP1A1 and one in the IGF2 gene showed significant differences in DNAm levels between cases and controls; 2) the CYP1A1 region resulted to be hypomethylated (in 9 out of 16 sites/units; p-val<0.01) in 29 individuals whose father/parents participated in the war in the spray zones; 3) we showed that the place of residence of both parents influenced methylation levels of the CYP1A1 and IGF2 genes (p-val<0.05). In conclusion this study indicates that past environmental exposure to dioxin (AO/TCDD) shapes the DNAm profile of CYP1A1 and that the place of living for parents in former spray zones influences DNAm of CYP1A1 and IGF2 genes. These results open the way to new applications of DNAm as potential biomarker(s) of past human exposure to dioxin.


Assuntos
Citocromo P-450 CYP1A1/genética , Metilação de DNA , Dioxinas/toxicidade , Exposição Ambiental/estatística & dados numéricos , Fator de Crescimento Insulin-Like II/genética , Ácido 2,4,5-Triclorofenoxiacético , Ácido 2,4-Diclorofenoxiacético , Agente Laranja , Camboja , Desfolhantes Químicos , Dioxinas/análise , Exposição Ambiental/análise , Feminino , Humanos , Militares , Dibenzodioxinas Policloradas/análise , Vietnã
12.
Int J Health Serv ; 48(3): 586-591, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29895204

RESUMO

Jock William McCulloch, who died at Melbourne, Australia, in January 2018, was one of the foremost historians of occupational health of his generation. This tribute reviews his career and oeuvre, which was tragically ended by his death from mesothelioma.


Assuntos
Saúde do Trabalhador/história , Agente Laranja/história , Agente Laranja/toxicidade , Asbestose/história , Austrália , História do Século XX , História do Século XXI , Humanos , Doenças Profissionais/história , África do Sul
14.
Medicine (Baltimore) ; 97(19): e0662, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29742706

RESUMO

During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Ajuda a Veteranos Incapacitados/legislação & jurisprudência , Veteranos/estatística & dados numéricos , Guerra do Vietnã , Agente Laranja/toxicidade , Estudos Transversais , Desfolhantes Químicos/toxicidade , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs , Revisão da Utilização de Recursos de Saúde , Exposição à Guerra
15.
Leuk Lymphoma ; 59(6): 1348-1355, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28905668

RESUMO

Exposure to Agent Orange (AO) has been associated with the development of chronic lymphocytic leukemia (CLL). We performed a retrospective study of 2052 Vietnam veterans identified in the National VA Tumor Registry to assess the impact of AO exposure on CLL prognosis, treatment and survival. Prognostic factors did not differ based on exposure. Veterans exposed to AO were diagnosed younger (63.2 vs. 70.5 years, p < .0001) and had longer overall survival (median not reached vs. 91 months, p < .001). This prolonged survival was in the subgroups of patients aged 60-69 years (p< .0001) and those with 11q deletion (p < .0001). Those exposed to AO were more likely to be treated with fludarabine, chlorambucil and rituximab (38 vs. 21%, p < .001) and bendamustine plus rituximab (25 vs. 18%, p = 0.039) as first line therapy. Exposure to AO was not associated with either poor prognostic factors or shortened overall survival in our large veteran population with CLL.


Assuntos
Agente Laranja/efeitos adversos , Leucemia Linfocítica Crônica de Células B/epidemiologia , Leucemia Linfocítica Crônica de Células B/etiologia , Exposição Ocupacional/efeitos adversos , Veteranos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Aberrações Cromossômicas , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Linfocítica Crônica de Células B/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Vigilância da População , Prognóstico , Sistema de Registros , Fatores de Risco , Análise de Sobrevida , Vietnã/epidemiologia
16.
PLoS One ; 12(10): e0185751, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29016608

RESUMO

BACKGROUND: Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases. METHODS: We followed 616 medical record-confirmed cases from enrollment (2005-2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment. RESULTS: We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73. CONCLUSIONS: Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans.


Assuntos
Esclerose Amiotrófica Lateral/epidemiologia , Militares , Sobreviventes/estatística & dados numéricos , Veteranos , Ácido 2,4,5-Triclorofenoxiacético/toxicidade , Ácido 2,4-Diclorofenoxiacético/toxicidade , Adulto , Idoso , Agente Laranja , Esclerose Amiotrófica Lateral/etiologia , Esclerose Amiotrófica Lateral/mortalidade , Conflitos Armados/história , Substâncias para a Guerra Química/toxicidade , Exposição Ambiental/efeitos adversos , Feminino , História do Século XX , História do Século XXI , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Dibenzodioxinas Policloradas/toxicidade , Modelos de Riscos Proporcionais , Estados Unidos/epidemiologia
17.
Urol Oncol ; 35(11): 633-639, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28947305

RESUMO

Agent Orange is an herbicide sprayed widely in Vietnam that is linked to a variety of malignancies in as early as 1991.Since then, there has been concern for, and subsequent interest in studying, the potential connection between Agent Orange and other malignancies. In the past 2 decades, there have been significant changes in the opinion of the National Academy of Science regarding Agent Orange and certain genitourinary malignancies. Herein, we review the literature regarding the potential link between Agent Orange and various urological cancers, including prostate, bladder, testicular, and renal cancers.


Assuntos
Agente Laranja/envenenamento , Neoplasias Renais/diagnóstico , Dibenzodioxinas Policloradas/envenenamento , Neoplasias da Próstata/diagnóstico , Neoplasias Testiculares/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Agente Laranja/química , Desfolhantes Químicos/química , Desfolhantes Químicos/envenenamento , Humanos , Neoplasias Renais/induzido quimicamente , Masculino , Neoplasias da Próstata/induzido quimicamente , Fatores de Risco , Neoplasias Testiculares/induzido quimicamente , Neoplasias da Bexiga Urinária/induzido quimicamente
19.
Urol Oncol ; 35(11): 627-632, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28826703

RESUMO

BACKGROUND: During the Vietnam War, many veterans were exposed to Agent Orange (AO), a chemical defoliant containing varying levels of the carcinogen dioxin. The health effects of AO exposure have been widely studied in the VA population. Here we review and interpret data regarding the association between AO exposure and bladder cancer (BC) mortality. MAIN FINDINGS: Data evaluating the association between AO and BC is limited. Methods characterizing exposure have become more sophisticated over time. Several studies support the link between AO exposure and increased mortality due to BC, including the Korean Veterans Health Study. CONCLUSIONS: Available data suggest an association with exposure to AO and increased mortality due to BC. In patients exposed to AO, increased frequency of cystoscopic surveillance and potentially more aggressive therapy for those with BC may be warranted but utility of these strategies remains to be proven. Additional research is required to better understand the relationship between AO and BC.


Assuntos
Agente Laranja/envenenamento , Exposição Ambiental/análise , Dibenzodioxinas Policloradas/envenenamento , Neoplasias da Bexiga Urinária/diagnóstico , Agente Laranja/química , Desfolhantes Químicos/envenenamento , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/envenenamento , Humanos , Fatores de Risco , Neoplasias da Bexiga Urinária/induzido quimicamente , Neoplasias da Bexiga Urinária/mortalidade , Veteranos/estatística & dados numéricos , Guerra do Vietnã
20.
Chemosphere ; 182: 647-655, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28527418

RESUMO

Vietnam has a double burden of dioxin from both industrial sources and historical sources. To evaluate the concentration of PCDD/Fs in ambient air in different areas of Vietnam and their possible sources, atmospheric samples were collected from three areas namely Son La (rural area) and Da Nang (harbor - Agent Orange hotspot area), and Ho Chi Minh City (metropolitan - industrial city). Vapor and solid phases of PCDD/Fs were collected and analyzed following the TO-9A sampling method. Principal Component Analysis and Positive Matrix Factorization model were applied to characterize the possible source. The average concentrations of PCDD/Fs were found to be 21.3 ± 13 fg I-TEQ/m3 in Son La (n = 32), 65.2 ± 34 fg I-TEQ/m3 in Da Nang (n = 16) and 139 ± 84 fg I-TEQ/m3 in Ho Chi Minh City (n = 8). The findings of this study targeted open burning (42%) and biomass burning (51%) as the major emission sources of PCDD/Fs in ambient air of Son La, Vietnam. Major possible sources of PCDD/Fs in Da Nang could be transportation activities (64%), however, the other factor (36%) was suspected to be contaminated with 2,3,7,8-TeCDD from Agent Orange. Most of PCDD/Fs emitted in Ho Chi Minh City related to industrial activities (93%).


Assuntos
Ácido 2,4,5-Triclorofenoxiacético/análise , Ácido 2,4-Diclorofenoxiacético/análise , Poluentes Atmosféricos/análise , Benzofuranos/análise , Dioxinas/análise , Dibenzodioxinas Policloradas/análise , Agente Laranja , Monitoramento Ambiental/métodos , Indústrias , Vietnã
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