A Preliminary Human Health Risk Assessment of Organochlorine Pesticide Residues Associated with Aquatic Organisms from the Rangsit Agricultural Area,Central Thailand

Food consumption is one of the main routes of human exposure to organochlorine pesticide residues (OCPRs). To assess the potential health risks associated with OCPRs contaminants due to freshwater organism consumption, a number of vegetables, prawn, snail, and fish were collected from Khlong 7 (canal), Rangsit agricultural area, Pathum-Thani Province, Thailand. The samples were extracted using a multiresidue extraction method and then analyzed by gas chromatography with microelectron capture detector (μ -ECD). The results show that low concentrations of OCPRs were detected in parts per billion (ppb) levels. Based on a plausible worst-case scenario, the local population could be at risk for cancer due to consumption of fish contaminated by α -, β -HCH, heptachlor, heptachlor epoxide, aldrin, dieldrin, DDD, DDE, and DDT. Likewise, individuals may be at risk from consumption of Lanchester's freshwater prawn Macrobrachium lanchesteri, freshwater snail Filopaludina mertensi, swamp morning-glory Ipomomea aquatica, neptunia Neptunia oleracea, and water lily Nymphaea lotus because these species all contained elevated concentrations of α -, β -HCH, heptachlor, heptachlor epoxide, aldrin, and dieldrin.     

Organophosphate Pesticide Residues in Drinking Water from Artesian Wells and Health Risk Assessment of Agricultural Communities,Thailand

Organophosphate pesticide (OPPs) concentrations in artesian wells located in Thai agricultural and non-agricultural communities were studied during both wet and dry seasons. A total of 100 water samples were collected and subjects were asked to complete a survey. Gas chromatography flame photometric detector was used for OPP analysis. The average OPP concentration in the agricultural communities (0.085 and 0.418 μg/l in dry and wet season) was higher than in the non-agricultural communities (0.004 μg/l in both seasons). Ingestion of OPPs in contaminated water in the agricultural communities were estimated to be 0.187 and 0.919 μg/day during the dry and wet seasons, respectively, and 0.008 μg/day during both seasons in the non-agricultural communities. Agricultural communities were exposed to pesticide residues under the oral chronic reference dose. This study suggests that people in agricultural communities may be exposed to significantly greater levels of pesticides than non-agricultural populations during the dry and wet seasons (p < .001, .001).     

Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review

Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I² statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.     

Exposure to MTBE and Acute Human Health Effects: A Critical Literature Review

Whether use of oxygen-rich gasoline additives to reduce air pollution is a cause of acute adverse health effects is an ongoing concern in the United States. Attention has focused in particular on use of methyl tert-butyl ether (MTBE, CAS #1634-04-4) and, despite considerable published research, debate persists regarding its potential for adverse health effects. To better understand the debate, we critically reviewed published and unpublished reports to assess whether differences in methodological approach or quality could explain the variable results reported. We considered studies on acute human health effects of inhalation exposure to MTBE either alone or in gasoline (19 reports) as well as clinical use of parenteral MTBE to dissolve cholesterol gall stones (12 reports). Each study was reviewed from three perspectives (epidemiology, industrial hygiene, and, clinical diagnostics), judged satisfactory, limited adequacy, or unsatisfactory for each criterion, and grouped into one of three categories from most to least adequate in overall methodology. The studies judged most adequate on individual criteria and those with highest overall adequacy found no significant association between MTBE exposure and symptoms. We propose that the persistent debate has been fueled by the findings of methodologically weak hypothesis-generating studies.     

Uncertainty in Health Risks from Artificial Lighting due to Disruption of Circadian Rhythm and Melatonin Secretion: A Review

Incandescent lighting in many domestic and commercial applications is in the process of replacement by more efficient light sources, such as the compact fluorescent light (CFL) and the light emitting diode (LED). For household use, both CFL and LED sources have a significant blue component in the emitted spectrum in comparison to the warmer incandescent globes and this has been the cause of emerging health concerns. Recent research suggests that the blue light bandwidth in the visible spectrum has a significant impact on physical health, including disruption of the internal body clock and suppression of melatonin secretion at night. This disruptive effect has been linked to a range of illnesses, including breast cancer, prostate cancer, heart disease, obesity, and diabetes. There have also been positive effects observed, including re-setting the body clock to the required sleep pattern, boosting mood, alertness, cognitive performance, and alleviating seasonal affective depression (SAD). In this article, an introduction and review of recent research is provided, relevant health issues are highlighted and discussed, and uncertainty analysis completed for the dose–response curve for melatonin suppression as a function of incident photon density.     

The Precautionary Principle,Science and Human Health Protection

As technology advances rapidly, so do applications with potential adverse implications on human health. The possible threats include risks that can be substantial, far-reaching and irreversible, and currently available methods of investigation, designed to deal with direct exposure-disease associations, are not always suitable. Growing interest is being paid to health effects that may be the consequence of distal, “upstream” determinants. Considering the complex chain of events that links such determinants with health can be extremely difficult, and exposes severe limitations in science. Thus, there is often a mismatch between what is known and what would be required to inform rational, evidence-based decision making, which is increasingly called for. It has become apparent how production and use of scientific evidence in decision making must be accompanied by precaution, especially in those circumstances, more and more common in recent times, where there is an uncertain possibility that serious health consequences might take place. Several cautionary approaches have been proposed, but the Precautionary Principle (PP) has been the object of especially intense debate in recent years. Developed in the field of environmental health, the PP has been clarified, and has been applied or called for in several instances in public health. Although a unique definition is not available, the principle has been characterised, and criteria for its application have been proposed. However, many questions remain open on general as well as specific issues. In this paper, we address some of the questions that are relevant for the PP to support rational decision making in environment and health and more in general to strengthen its contribution towards human health protection.     

Health Risk Assessment and Vapor Intrusion: A Review and Australian Perspective

Soil contamination by volatile hydrocarbons is of public health importance due to vapor intrusion and indoor inhalation exposures. These are assessed using measurement or predictive modeling and need to consider the key areas of subsurface partitioning and transport, dwelling ventilation, and receptor inhalation dosimetry. While subsurface partitioning and transport have been subject to intensive international investigation, limited consideration has been given to the latter. Building ventilation research has developed multi-zone airflow and contaminant dispersal models including AccuRate, an Australian model that examines natural ventilation modeling, roof and sub-floor ventilation, and identifies the importance of geometry and thermal factors on ventilation (the most sensitive variable) and indoor pollutant concentrations. Inhalation dosimetry has received recent attention due to concerns over child inhalation susceptibility and dose metrics. Research using coupled computational fluid dynamics (CFD) and physiologically based pharmaco-kinetic (PBPK) models has reported variance from previous animal models’ extrapolation while CFD modeling of transient lung vapor absorption suggests the significance of transient versus steady-state evaluation of volatiles absorption into tissue and blood. The transient nature of sub-surface fate and transport, ventilation, and inhalation uptake thus warrants integrated exploration and application in order to realize improvements in vapor intrusion assessments. These perspectives and Australian modeling initiatives are presented in this article.     

Computerised Decision Support System for Remote Health Monitoring: A Systematic Review

Background

Remote health monitoring plays a major role in handling the critical situation of patients and avoiding death and also enhancing the quality of healthcare services. The effective real time monitoring with accurate decision has to be made in advance with the help of decision making system by continuously acquiring biosignals.

The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas

Previous studies have found that the expansion of primary health care in Brazil following the country-wide family health strategy (ESF), one of the largest primary care programs in the world, has improved health outcomes. However, these studies have relied either on aggregate data or on limited individual data, with no fine-grained information available concerning household participation in the ESF or local supply of ESF services, which represent crucial aspects for analytical and policy purposes. This study analyzes the relationship between the ESF and health outcomes for the adult population in metropolitan areas in Brazil. We investigate this relationship through two linked dimensions of the ESF: the program’s local supply of health teams and ESF household registration. In contrast with previous studies focusing on comparisons between certain definitions of "treated" versus "nontreated" populations, our results indicate that the local density of health teams is important to the observed effects of the ESF on adult health. We also find evidence consistent with the presence of positive primary health care spillovers to people not registered with the ESF. However, current ESF coverage levels in metropolitan areas have limited ability to address prevailing health inequalities. Our analysis suggests that the local intensity of ESF coverage should be a key consideration for evaluations and policy efforts related to future ESF expansion.     

The Thermic Effect of Food and Obesity: A Critical Review

DE JONGE, LILIAN, GEORGE BRAY. The thermic effect of food and obesity: A critical review. This review has examined the factors that influence the thermic effect of food (TEF) by evaluating 49 studies that have compared subjects who are obese with those who are lean. Meal size, meal composition, the nature of the previous diet, insulin resistance, physical activity, and ageing influence TEF. In the studies of individuals who are obese or lean, of those who used intravenous glucose infusions, all but one found an impaired thermic response. A total of 29 out of 49 studies of individuals of normal weight or with obesity were identified where there was no difference in age between the groups, and where the subjects who were “overweight” were clearly obese. Of these 29, 22 reported a statistically significant reduction in TEF, 3 studies were not designed to look primarily at the effect of obesity on TEF, and the other 4 may not have had sufficiently palatable meals. From this review, we conclude that the reduction of TEF in obesity is related to the degree of insulin resistance, which may be influenced by a low level of sympathetic activity.     

Estimating the Toxicity of Pesticide Mixtures to Aquatic Organisms: A Review

A major difficulty in addressing chemical mixtures through legislation or regulations revolves around our limited understanding of their potential impacts. This review provides an overview of recent research on pesticide mixture toxicity to aquatic biota and the methods employed to predict toxic effects. The most common approaches are to assume concentration-addition or independent action of chemicals in a mixture. There are a number of cases in the literature of interactions between pesticides. However, models accounting for possible interactions between mixture components are used infrequently. Although results are limited, studies investigating the effects of pesticide mixtures have not demonstrated significant synergism at environmentally relevant concentrations. Based on the results of our review, we conclude that the concentration-addition model is a generally conservative and practical first-tier model for the ecological assessment of pesticide mixtures in aquatic systems.     

Applying Health Risk Analysis to Assess the Chemical Quality of Water for Recreational Bathing: The Case of Tres Arroyos Creek,Buenos Aires,Argentina

The aim of the study is to assess the probabilistic non-cancer and cancer risks by recreational bathing in Tres Arroyos creeks (southeastern Buenos Aires Province, Argentina). In these waters, hazardous substances (heavy metals, pesticides) have been detected, possibly related to agricultural activities. To assess such risk, USEPA models in aggregated (exposure through accidental oral water intake and dermal contact simultaneously) and cumulative approaches (combined exposure to more than one substance) were applied, performed for bathers of 5, 10, 15, and 20 years old. The results show that chronic bathing in these waters is not harmful at the concentrations and the exposure scenarios considered. Arsenic was the riskiest substance for both non-cancer and cancer effects, affecting mainly the youngest age group, and the accidental water intake during bathing was the most relevant pathway of exposure. On the other hand, the study highlights the key role of the frequency and duration of the bath event. We discuss the results in light of a previous paper of our authorship concluding that the health risk assessment is a valid alternative to analyze recreational water quality, which, unfortunately, is unused by water management agencies in Argentina.     

The Contribution of Systematic Review and Meta-Analysis Methods to Human Health Risk Assessment: Neurobehavioral Effects of Manganese

Current methods of human health risk assessment may lack transparency in respect of identification, review, and synthesis of potentially relevant human and animal evidence. The nature, degree, and source of uncertainties are often unclear. This article aims to demonstrate the contribution that systematic review and meta-analysis methods can make to providing more structured, transparent, and systematic risk assessments. We focus on disparities between five risk assessments for neurobehavioral effects of manganese, and then illustrate advantages of a systematic approach. Fifty-five human epidemiological studies and 37 animal experiments were identified. Where appropriate, meta-analysis methods demonstrated consistent adverse effects associated with manganese exposure across species. In particular, there was reduced activity in subjects exposed to manganese, although exposed rats tended to be more active than controls. Limitations of exposure measurement and reporting restricted use of more quantitative methods of evidence synthesis. From a methodological viewpoint, we conclude that systematic review and meta-analysis methods can contribute to a more systematic and transparent human health risk assessment making more efficient use of available evidence, compared to current methods of risk assessment. More complex methods could encompass further differences between relevant studies and so further improve the risk assessment process.     

The Ethics of Research Biobanking: A Critical Review of the Literature

Abstract

Human tissue has been stored and used for research on a regular basis for more than 80 years. During the 1990s, collections of human tissue suddenly became framed as ethical problems in a process reflecting developments in genetic research intertwined with developments in patient rights and steps towards increased commercialization of research. This review describes the process of framing tissue storage as an ethical problem and the solutions proposed in the process. It gives an overview of the academic debate and relates this debate to empirical studies of donor attitudes and interests. It points to the clear discrepancy between the concerns of donors, legislators and ethicists. The academic debate and legislatory action tend to focus on informed consent, and most of the concerns that donors have remain unattended to.     

Effects of Environmental Pesticides on the Health of Rural Communities in the Malwa Region of Punjab,India: A Review

The Malwa region of Punjab, India, is facing an unprecedented crisis of environmental health linked to indiscriminate, excessive, and unsafe use of pesticides, fertilizers, and poor groundwater quality. The region has been described as India's “cancer capital” due to abnormally high number of cancer cases, which have increased 3-fold in the last 10 years. Studies of this region have also highlighted a sharp increase in many other pesticide-related diseases, such as mental retardation and reproductive disorders. The most affected individuals are the agricultural workers who are directly exposed to pesticides. The Malwa region of Punjab, India, is less than 15% of the total area of Punjab (only 0.5% of the total geographical area of India), but it consumes nearly 75% of the total pesticides used in Punjab. The high use of pesticides, along with environmental and social factors, is responsible for the high concentration of pesticide residues in the food chain of this region. Moreover, many banned and restricted pesticides are still in use in this region, warranting strict periodical health checkups and other interventions. The present review describes occupational, environmental, and social factors associated with pesticide use in the Malwa region of Punjab, India, and proposes some risk reduction interventions.     

Tribute to Tinbergen: The Four Problems of Biology. A Critical Appraisal

Tinbergen's (1963, Z. Tierpsychol. 20 , 410–433) four questions have guided the conceptual thinking of behavioural biologists over five decades. This is partly based on a misunderstanding of the aims and virtue of this article. Tinbergen called attention to the fact that his classification of problems is somehow illogical. Here, an attempt is made to remove some of the inconsistency by reformulating the levels of analysis of biological (including behavioural) traits. Furthermore, important merits of Tinbergen's milestone paper that have remained largely unnoticed are put in perspective. Perhaps the most lasting of several functions of that article has been its pivotal role in establishing a new research discipline, behavioural ecology.     

Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study

Objective: The objective was to examine the role of total and beverage‐specific alcohol consumption on the incidence of type 2 diabetes mellitus (DM) among elderly men and women. Research Methods and Procedures: We studied prospectively 4655 participants of the Cardiovascular Health Study who were free of DM at baseline. Alcohol consumption was obtained at baseline and during follow‐up examinations. DM was defined using fasting glucose and/or use of hypoglycemic medications. We used Cox proportional hazard models to estimate adjusted relative risks of diabetes across alcohol categories. Results: During a mean follow‐up of 6.3 years, 234 incident cases of DM were documented. Compared with never drinkers, hazard ratios [95% confidence interval (CI)] for DM were 0.7 (0.3 to 1.4), 0.5 (0.3 to 0.9), 0.6 (0.4 to 1.1), and 0.8 (0.4 to 1.3) for former drinkers and current drinkers of <1, 1 to 6, and 7+ drinks per week, respectively, for men after adjustment for age, BMI, education, and smoking. Corresponding values for women were 1.2 (0.6 to 2.3), 0.7 (0.4 to 1.1), 0.6 (0.3 to 1.1), and 0.4 (0.2 to 1.0), respectively. A reduced risk of DM was observed with all types of beverage consumed. Similar findings were observed when we repeated the above analyses using simple or weighted cumulative alcohol update and covariates over time. Discussion: Light to moderate alcohol consumption was associated with a lower incidence of DM among elderly people, irrespective of the type of beverage consumed.     

Care Giver Perception of Children's Obesity‐Related Health Risk: A Study of African American Families

Objective: To examine care giver perception of children's weight‐related health risk in African American families. Research Methods and Procedures: One‐hundred and eleven families (representing 48 boys and 63 girls) screened for participation in a diabetes prevention study participated. Care givers completed a health awareness questionnaire that assessed their perception of the child's weight, eating habits, appearance, exercise habits, and health risk. The care givers also reported each subject's family history of obesity, diabetes, and other chronic diseases. After a physical examination, height and weight were used to compute an age‐ and sex‐adjusted body mass index for each child. Results: Despite the fact that a substantial number of children were obese (57%) and super‐obese (12%), only 44% of the care givers perceived the child's weight to be a potential health problem. Regression analysis showed that 21% of the variance in parental perception of obesity‐related health risk could be predicted by child age, body mass index, perception of frame size, and perception of exercise habits. Discussion: A number of reasons for the apparent minimization of child health risk are discussed, including cultural differences in the acceptance of a large body habitus, lack of knowledge about the connection between childhood obesity and future health risk, and an optimistic bias in the perception of personal health risk.