Examinando por Autor "Monge, Patricia"

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Assessment of pesticide exposure in the agricultural population of Costa Rica
(British Occupational Hygiene Society, 2005) Monge, Patricia; Partanen, Timo; Wesseling, Catharina; Bravo, Viria; Ruepert, Clemens; Burstyn, Igor
We describe a model for the retrospective assessment of parental exposure to 26 pesticides, selected by toxicity-based prioritization, in a population-based case–control study of childhood leukaemia in Costa Rica (301 cases, 582 controls). The model was applied to a subset of 227 parents who had been employed or self-employed in agriculture or livestock breeding. It combines external data on pesticide use for 14 crops, 21 calendar years and 14 regions, and individual interview data on determinants (task and technology, personal protective equipment, field reentry, storing of pesticides, personal hygiene) of exposure. Recall was enhanced by use of checklists of pesticides in the interview. An external database provided information on the application rate (proxy for intensity of potential exposure) for each pesticide. The calendar time was individually converted to five time windows (year before conception, first, second and third trimester, and first year of the child). Time-windowed individual data on determinants of exposure and their expert-based general weights and their category-specific hazard values jointly provided an individual determinant score. This score was multiplied by the application rate to obtain an individual index of exposure intensity during application. Finally, average exposure intensity during entire time windows was estimated by incorporating in the model the individual time fraction of exposure during application. Estimates of exposure intensities were proxies assumed to be proportional to dermal exposure intensity, which represents the major pathway of occupational exposure to pesticides. A simulated sensitivity analysis resulted in a correlation coefficient of 0.91 between two sets of 10 000 values of individual exposure indices, based on two different but realistic sets expert-assigned weights. Lack of measurement data on concurrent exposures in comparable circumstances precluded direct validation of the model.
Central nervous system tumours in children in Costa Rica: 1981–96
(Blackwell Science, 2002) Reutfors, Johan; Kramárová, Eva; Weiderpass, Elisabete; Monge, Patricia; Wesseling, Catharina; Ahlbom, Anders
Incidence rates of malignant central nervous system (CNS) tumours in children in Costa Rica are presented in an international perspective. For the 16-year period 1981–96, a total of 256 CNS tumours were registered in children below age 15 years by the National Tumour Registry of Costa Rica. The age-standardised incidence rate was 15.2 per million person–years, with a male-to-female ratio of 1.4. The median age-standardised incidence rates of selected registries in other Latin American countries were 19.3, in other developing countries 12.0 and in industrialised countries 29.6 per million person–years. The comparatively low incidence rates in Costa Rica were evident in all diagnostic subgroups, most notably in the youngest age group and for tumours in the brain stem. In the Central Valley, where the capital and the only specialised paediatric hospital are situated, the crude incidence rate was 18.1 [95% CI 15.1, 21.1] compared with 10.5 [95% CI 8.3, 12.8] per million person–years in the rest of the country (RR = 1.7, 95% CI 1.3, 2.3). There was no evidence of any increase over time. The data in this study cannot exclude under-diagnosis and, to a lesser degree, under-registration as a partial explanation of the low incidence rates of malignant CNS tumours in children in Costa Rica.
Childhood leukaemia in Costa Rica, 1981-96
(Blackwell Science, 2002) Monge, Patricia; Wesseling, Catharina; Rodríguez, Ana Cecilia; Cantor, Kenneth P; Weiderpass, Elisabete; Reutfors, Johan; Ahlbom, Anders; Partanen, Timo
Childhood leukaemia incidence in Costa Rica during 1981-96, among the highest in the world, was analysed by histology, gender, birth year, time period of diagnosis, age at diagnosis and region. Numbers of cases were extracted from the database of the National Cancer Registry (RNT) of Costa Rica. Person-years at risk were calculated from census data and post-census population estimates. During the follow-up, 918 cases of leukaemia in children under 15 years (510 boys, 408 girls) were reported to the RNT (41% of all childhood malignancies), with an overall age-standardised incidence rate of 56 per million person-years. Acute lymphocytic leukaemia (ALL) represented 79% and acute non-lymphocytic leukaemia (ANLL) 16% of the cases, with rates of 43 and 9 per million person-years respectively. There were downward trends in incidence of total leukaemias, ALL and ANLL and 'not otherwise specified' (NOS) combined. Incidence of ALL was highest at 1-4 years of age in boys and girls, whereas ANLL peaked in girls during the first year of life. During 1991-96, the decrease in ALL was significant (P = 0.042). A multivariable Poisson regression model identified significant excesses of ALL for boys, for age groups 1-4 and 5-9 years and for three out of seven regions. Possible reasons for the high rates in Costa Rica are discussed.
Determinación del historial de exposiciones en la epidemiolgía ocupacional
(World Health Organization, 2005-01) Espinosa, Maria Teresa; Partanen, Timo; Piñeros, Marion; Chaves, Jorge; Posso, Héctor; Monge, Patricia; Blanco, Luís; Wesseling, Catharina
La validez de los indicadores de exposición es una condición necesaria en epidemiología si se han de obtener resultados válidos en la medición de los riesgos asociados con la exposición a agentes nocivos en el entorno laboral. Sin embargo, llevar a cabo la validación de estos indica dores de exposiciones pasadas no es tarea fácil. Debido a la falta de mediciones de referencia en el ámbito de la higiene industrial y de con centraciones representativas de bioindicadores que reflejen las exposiciones pasadas, el método de los autoinformes se ha utilizado para recoger datos de exposición indirectos. No obstante, los datos acerca de agentes nocivos específicos son a menudo deficientes y deben completarse con otros sobre los factores condicionantes de la exposición. La validez de los autoinformes me jora cuando se utilizan listas de verificación e iconos ilustrativos, mientras que la calidad de la información sobre las exposiciones personales mejora cuando se incorporan datos secundarios acerca de las exposiciones y de los factores que las condicionan o determinan. La exposición se puede determinar mediante matrices de exposición, evaluación por exper tos y modelos de exposición, integrando datos primarios y secundarios acerca de las exposicio nes y sus factores condicionantes. Las matrices contienen datos agrupados y, por consiguiente, pueden llevar a errores a la hora de clasificar las exposiciones individuales e introducir sesgos en la estimación de los riesgos. La evaluación por expertos es probablemente el método con el índice de validez más alto, pero puede entrañar costos muy altos en el caso de estudios de cierta magnitud. Otra posibilidad con buenas perspectivas es la de utilizar un modelo formal para evaluar las exposiciones pa tentes y mejorarlo mediante la evaluación por expertos en situaciones en las cuales los resul tados del modelo parezcan alejarse de la realidad.
Social Conditions and Urban Health Inequities: Realities, Challenges and Opportunities to Transform the Urban Landscape through Research and Action
(Journal of Urban Health, 2011-12) Salgado de Snyder, V. Nelly; Friel, Sharon; Fotso, Jean Christophe; Khadr, Zeinab; Meresman, Sergio; Monge, Patricia; Patil-Deshmukh, Anita
The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a “natural” or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low- and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.
Urban Health Inequities and the Added Pressure of Climate Change: An Action-Oriented Research Agenda
(Springer Nature, 2011-08-23) Friel, Sharon; Hancock, Trevor; Kjellstrom, Tord; McGranahan, Gordon; Monge, Patricia; Roy, Joyashree
Climate change will likely exacerbate already existing urban social inequities and health risks, thereby exacerbating existing urban health inequities. Cities in low- and middle-income countries are particularly vulnerable. Urbanization is both a cause of and potential solution to global climate change. Most population growth in the foreseeable future will occur in urban areas primarily in developing countries. How this growth is managed has enormous implications for climate change given the increasing concentration and magnitude of economic production in urban localities, as well as the higher consumption practices of urbanites, especially the middle classes, compared to rural populations. There is still much to learn about the extent to which climate change affects urban health equity and what can be done effectively in different socio-political and socio-economic contexts to improve the health of urban dwelling humans and the environment. But it is clear that equity-oriented climate change adaptation means attention to the social conditions in which urban populations live this is not just a climate change policy issue, it requires inter-sectoral action. Policies and programs in urban planning and design, workplace health and safety, and urban agriculture can help mitigate further climate change and adapt to existing climate change. If done well, these will also be good for urban health equity.
Workplace Carcinogen and Pesticide Exposures in Costa Rica
(Taylor & Francis, 2003) Partanen, Timo; Chaves, Jorge; Wesseling, Catharina; Chaverri, Fabio; Monge, Patricia; Ruepert, Clemens; Aragón, Aurora; Kogevinas, Manolis; Hogstedt, Christer; Kauppinen, Timo
The CAREX data system converts national workforce volumes and proportions of workers exposed to workplace carcinogens into numbers of exposed in 55 industrial categories. CAREX was adapted for Costa Rica for 27 carcinogens and seven groups of pesticides. Widespread workplace carcinogens in the 1.3 million workforce of Costa Rica are solar radiation (333,000 workers), diesel engine exhaust (278,000), environmental tobacco smoke (71,000), hexavalent chromium compounds (55,000), benzene (52,000), wood dust (32,000), silica dust (27,000), lead and inorganic lead compounds (19,000), and polycyclic aromatic compounds (17,000). The most ubiquitous pesticides were paraquat and diquat (175,000), mancozeb, maneb, and zineb (49,000), chlorothalonil (38,000), benomyl (19,000), and chloro-phenoxy herbicides (11,000). Among women, formal-dehyde, radon, and methylene chloride overrode pesticides, chromium, wood dust, and silica dust in numbers of exposed. High-risk sectors included agriculture, construction, personal and household services, land and water transport and allied services, pottery and similar industries, woodworks, mining, forestry and logging, fishing, manufacturing of electrical machinery, and bar and restaurant personnel.