Participatory action research in health systems : a methods reader

This “reader” in participatory action research (PAR) serves to inform, motivate and strengthen PAR as a research methodology useful for both health policy and systems research. It includes examples of PAR across all income areas and global regions, and provides a selection of readings on the subject. The texts are backed by references and resources, as well as ethics concerns and innovations in the field. Methods and tools for gathering evidence along with context are demonstrated, as well as guidance in the communication of findings. Social determinants of health may be more easily factored in to qualitative and participatory action research endeavours

TICAREX: Exposiciones laborales a agentes cancerígenos y plaguicidas en Costa Rica

The European data system CAREX takes the workforce of a country grouped into 55 economic sectors according to the International Economic Activity Classification (IEAC) of the United Nations, the second 1968 revision and through the application of proportions of workers exposed to 139 carcinogenic agents based on data from industrial hygiene studies, converting it into the total workforce exposed to carcinogens by sector. . In this article we describe a modification and extension of of the CAREX system in order to calculate the number of workers exposed to carcinogens in Costa Rica. It is the first use of CAREX outside Europe (TICAREX) in Costa Rica, Central America, for 27carcinogens and 7 groups of pesticides thought to be of interest for the country, with separate estimations for men and women. The most frequent agents of exposure for the 1.3 million workers of Costa Rica were solar radiation (333,000 workers); diesel exhaust (278,000); paraquat and diquat (175,000); environmental tobacco smoke (71,000); hexavalent chromium compounds (55,000); benzene (52,000); mancozeb, maneb and zineb (49,000); chlorothalonil (38,000); wood dust (32,000); quartz (27,000); benomyl (19,000); lead and its inorganic compounds (19,000); tetrachloroethylene (18,000); and polycyclic aromatic hydrocarbons (17,000). Owing to the different occupational distribution between the genders, exposures to formaldehyde, radon and methylene chloride were more frequent than pesticides, hexavalent chromium, wood dust, and quartz in women. Agriculture, construction, personal and domestic services, manufacture of wood products, mining, forestry, fishing, manufacture of electrical products, and bars and restaurants were sectors with frequent exposures. Substantial reduction of occupational and environmental exposures to these agents would significantly improve public and occupational health. Reduction of occupational exposures is usually also followed by improvement of environmental quality. Monitoring of exposures and health of workers and the general public is an essential element in the control of environmental contamination and human exposures.El sistema europeo de datos CAREX ( CARcinogen Exposure ) considera la fuerza laboral de un país agrupada en 55 sectores económicos según la Clasificación Internacional de Actividades Económicas ( CIAE ) de las Naciones Unidas, segunda revisión de 1968 y mediante la aplicación de proporciones de trabajadores expuestos a partir de datos generados en estudios de higiene industrial para 139 agentes carcinógenos , los convierte a total de fuerza laboral expuesta y número de trabajadores expuestos a agentes carcinogénicos según rama de actividad. . En este artículo se describe una modificación y extensión del sistema CAREX (de CARcinogen Exposure) para calcular los números de trabajadores expuestos a agentes cancerígenos y plaguicidas en Costa Rica. Esta es la primera aplicación de CAREX fuera de Europa (TICAREX) fue realizada en Costa Rica, Centroamérica para 27 agentes cancerígenos y 7 grupos de plaguicidas, considerados de interés para el país, realizando estimaciones por separado para mujeres y hombres . Los agentes cancerígenos más frecuentes a los que se expone la fuerza laboral de Costa Rica de 1.3 millones fueron la radiación solar (333,000 trabajadores); las emisiones de diesel (278,000); paraquat y diquat (175,000); el humo de tabaco ambiental (71,000); los compuestos de cromo hexavalente (55,000); el benceno (52,000); mancozeb, maneb y zineb (49,000); clorotalonil (38,000); el polvo de madera (32,000); el cuarzo (27,000); benomil (19,000); el plomo y sus compuestos inorgánicos (19,000); tetracloroetileno (18,000); y los compuestos aromáticos policíclicos (17,000). En los hombres , la distribución se mantuvo muy ajustada a los anteriores rangos, sin embargo en las mujeres, debido a su diferente distribución en los sectores, el formaldehído, el radón y el cloruro de metileno superaron a los plaguicidas, el cromo (VI), el polvo de madera y el cuarzo. La agricultura, la construcción, los servicios personales y domésticos, el transporte terrestre y acuático y los servicios asociados al transporte , la fabricación de productos cerámicos y semejantes, la manufactura de productos de madera, la minería, la silvicultura, la pesca, la fabricación de maquinaria y aparatos eléctricos, bares y restaurantes fueron sectores de donde las exposiciones son frecuentes. Una reducción drástica de exposiciones laborales y ambientales a estos agentes daría por resultado mejoras sustanciales en los niveles de salud pública y ocupacional. . La vigilancia de las exposiciones laborales y de la salud en el trabajo son esenciales para el control de la contaminación y de las exposiciones a los agentes cancerígenos. La adopción de políticas efectivas para la reducción de los peligros por estos agentes , debe considerar todas las fuentes de exposición y la coordinación intersectorial para la creación, administración e implementación de las regulaciones en esta materia. La reducción de los peligros químicos en el trabajo frecuentemente es seguida por una reducción en las emisiones industriales al ambiente cercano a la planta o proceso productivo

Molecular dosimetry of DNA and hemoglobin adducts in mice and rats exposed to ethylene oxide.

Experiments involving ethylene oxide (ETO) have been used to support the concept of using adducts in hemoglobin as a surrogate for DNA adducts in target tissues. The relationship between repeated exposures to ETO and the formation of N-(2-hydroxyethyl)valine (HEtVal) in hemoglobin and 7-(2-hydroxyethyl)guanine (7-HEG) in DNA was investigated in male rats and mice exposed by inhalation to 0, 3, 10, 33, or 100 ppm ETO for 6 hr/day for 4 weeks, or exposed to 100 ppm (mice) or 300 ppm (rats) for 1, 3, 5, 10, or 20 days (5 days/week). HEtVal was determined by Edman degradation, and 7-HEG was quantitated by HPLC separation and fluorescence detection. HEtVal formation was linear between 3 and 33 ppm ETO and increased in slope above 33 ppm. The dose-response curves for 7-HEG in rat tissues were linear between 10 and 100 ppm ETO and increased in slope above 100 ppm. In contrast, only exposures to 100 ppm ETO resulted in significant accumulation of 7-HEG in mice. Hemoglobin adducts were lost at a greater rate than predicted by normal erythrocyte life span. The loss of 7-HEG from DNA was both species and tissue dependent, with the adduct half-lives ranging from 2.9 to 5.8 days in rat tissues (brain, kidney, liver, lung, spleen, testis) and 1.0 to 2.3 days in all mouse tissues except kidney (t1/2 = 6.9 days). The concentrations of HEtVal were similar in concurrently exposed rats and mice, whereas DNA from rats had at least 2-fold greater concentrations of 7-HEG than DNA from mice.(ABSTRACT TRUNCATED AT 250 WORDS

Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP)

COVID-19 and Precarious Employment: Consequences of the Evolving Crisis

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis

Neuropsychological effects of chronic low-dose exposure to polychlorinated biphenyls (PCBs): A cross-sectional study

BACKGROUND: Exposure to indoor air of private or public buildings contaminated with polychlorinated biphenyls (PCBs) has raised health concerns in long-term users. This exploratory neuropsychological group study investigated the potential adverse effects of chronic low-dose exposure to specific air-borne low chlorinated PCBs on well-being and behavioral measures in adult humans. METHODS: Thirty employees exposed to indoor air contaminated with PCBs from elastic sealants in a school building were compared to 30 non-exposed controls matched for education and age, controlling for gender (age range 37–61 years). PCB exposure was verified by external exposure data and biological monitoring (PCB 28, 101, 138, 153, 180). Subjective complaints, learning and memory, executive function, and visual-spatial function was assessed by standardized neuropsychological testing. Since exposure status depended on the use of contaminated rooms, an objectively exposed subgroup (N = 16; PCB 28 = 0.20 μg/l; weighted exposure duration 17.9 ± 7 years) was identified and compared with 16 paired controls. RESULTS: Blood analyses indicated a moderate exposure effect size (d) relative to expected background exposure for total PCB (4.45 ± 2.44 μg/l; d = 0.4). A significant exposure effect was found for the low chlorinated PCBs 28 (0.28 ± 0.25 μg/l; d = 1.5) and 101 (0.07 ± 0.09 μg/l; d = 0.7). Although no neuropsychological effects exceeded the adjusted significance level, estimation statistics showed elevated effect sizes for several variables. The objectively exposed subgroup showed a trend towards increased subjective attentional and emotional complaints (tiredness and slowing of practical activities, emotional state) as well as attenuated attentional performance (response shifting and alertness in a cued reaction task). CONCLUSION: Chronic inhalation of low chlorinated PCBs that involved elevated blood levels was associated with a subtle attenuation of emotional well-being and attentional function. Extended research is needed to replicate the potential long-term low PCB effects in a larger sample

Lung cancer mortality in towns near paper, pulp and board industries in Spain: a point source pollution study

<p>Abstract</p> <p>Background</p> <p>This study sought to ascertain whether there might be excess lung cancer mortality among the population residing in the vicinity of Spanish paper and board industries which report their emissions to the European Pollutant Emission Register (EPER).</p> <p>Methods</p> <p>This was an ecological study that modelled the Standardised Mortality Ratio (SMR) for lung cancer in 8073 Spanish towns over the period 1994–2003. Population exposure to industrial pollution was estimated on the basis of distance from town of residence to pollution source. An exploratory, near-versus-far analysis was conducted, using mixed Poisson regression models and an analysis of the effect of municipal proximity within a 50-kilometre radius of each of the 18 installations.</p> <p>Results</p> <p>Results varied for the different facilities. In two instances there was an increasing mortality gradient with proximity to the installation, though this was exclusively observed among men.</p> <p>Conclusion</p> <p>The study of cancer mortality in areas surrounding pollutant foci is a useful tool for environmental surveillance, and serves to highlight areas of interest susceptible to being investigated by ad hoc studies. Despite present limitations, recognition is therefore due to the advance represented by publication of the EPER and the study of pollutant foci.</p

Drug dosing during pregnancy—opportunities for physiologically based pharmacokinetic models

Drugs can have harmful effects on the embryo or the fetus at any point during pregnancy. Not all the damaging effects of intrauterine exposure to drugs are obvious at birth, some may only manifest later in life. Thus, drugs should be prescribed in pregnancy only if the expected benefit to the mother is thought to be greater than the risk to the fetus. Dosing of drugs during pregnancy is often empirically determined and based upon evidence from studies of non-pregnant subjects, which may lead to suboptimal dosing, particularly during the third trimester. This review collates examples of drugs with known recommendations for dose adjustment during pregnancy, in addition to providing an example of the potential use of PBPK models in dose adjustment recommendation during pregnancy within the context of drug-drug interactions. For many drugs, such as antidepressants and antiretroviral drugs, dose adjustment has been recommended based on pharmacokinetic studies demonstrating a reduction in drug concentrations. However, there is relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Examples of using pregnancy PBPK models to predict feto-maternal drug exposures and their applications to facilitate and guide dose assessment throughout gestation are discussed