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Oct 25Oct 25PesticidesPesticides
Classification based on type of pest they controlClassification based on type of pest they control InsecticidesInsecticides FungicidesFungicides HerbicidesHerbicides RodenticidesRodenticides--more in your EPA reading--more in your EPA reading
PesticidesPesticides
OrganophosphatesOrganophosphates CarbamatesCarbamates OrganochlorinesOrganochlorines Pyrethrins & PyrethroidsPyrethrins & Pyrethroids
Toxicology in environmental healthToxicology in environmental health
Molecular toxicologyMolecular toxicology EpidemiologyEpidemiology Clinical diagnosisClinical diagnosis
Toxico-epidemiologyToxico-epidemiology
Exposure-outcome relationshipsExposure-outcome relationships Dose-effect relationshipsDose-effect relationships
Exposure assessmentExposure assessment
Environmental samplingEnvironmental sampling– AirAir– WaterWater– Soil/dustSoil/dust
Biomarker samplingBiomarker sampling
BloodBlood UrineUrine FecesFeces FatFat
HairHair NailNail MeconiumMeconium
Pilot study on the developmental Pilot study on the developmental effects of pesticide exposure in effects of pesticide exposure in
rural South Africarural South Africa
Makhatini flats in the KwaZulu Makhatini flats in the KwaZulu Natal ProvinceNatal Province
From left to right: Dr. Mariam Murtharda, Patricia Janulewicz, Jane Kvalsvig, Pumla Mkhiva, Dr. Saloshni Naidoo, Dr. Roberta White, Simphiwe Mnyzaiza, Mtheliseni Dladla, Dr. Lawrence Mubaiwa
Study team 1: South AfricaStudy team 1: South Africa
Leslie LondonLeslie London– Occupational medicineOccupational medicine– Environmental epidemiologyEnvironmental epidemiology
Saloshni NaidooSaloshni Naidoo– Occupational and environmental medicineOccupational and environmental medicine
Lawrence MubaiwaLawrence Mubaiwa– Pediatric neurologyPediatric neurology
Simphiwe MnyzaizaSimphiwe Mnyzaiza– Environmental exposure assessmentEnvironmental exposure assessment
Study team-2: USAStudy team-2: USA
Roberta WhiteRoberta White– NeuropsychologyNeuropsychology– Behavioral toxicologyBehavioral toxicology
Richard ClappRichard Clapp– Environmental epidemiologyEnvironmental epidemiology
Veronica VieiraVeronica Vieira– Exposure assessmentExposure assessment– GIS methodologyGIS methodology
Patricia JanulewiczPatricia Janulewicz– Developmental assessment/neuroscienceDevelopmental assessment/neuroscience– Environmental health sciencesEnvironmental health sciences
Background historyBackground history– Pesticides commonly used as mode of suicide Pesticides commonly used as mode of suicide
and poisoning and occupational exposures and poisoning and occupational exposures (Leslie London) (Leslie London)
– Years of soil contamination of pesticides from Years of soil contamination of pesticides from agricultural use and mosquito controlagricultural use and mosquito control
– People live close to and work on the fields and People live close to and work on the fields and have for yearshave for years
– Homogeneous group who have lived there for Homogeneous group who have lived there for generationsgenerations
Types of pesticides used in this areaTypes of pesticides used in this area
DDTDDT Organophosphates Organophosphates Carbamates Carbamates PyrethroidsPyrethroids
– Diuron Diuron – MetribuzinMetribuzin
Neurotoxicity of these compoundsNeurotoxicity of these compounds
Insect CNS target of compoundsInsect CNS target of compounds Cholinesterase effectsCholinesterase effects Endocrine disruptionEndocrine disruption
Overall study aimsOverall study aims
Determine relationship between prenatal Determine relationship between prenatal exposure to pesticides and CNS function in exposure to pesticides and CNS function in early childhood early childhood (Exposure-outcome relationships)(Exposure-outcome relationships)
Create dose-outcome curves relating Create dose-outcome curves relating measures of exposure to measures of CNS measures of exposure to measures of CNS function function (Dose-effect relationships)(Dose-effect relationships)
Routes of ExposureRoutes of Exposure OccupationalOccupational
– Dermal - lack of proper protective gear and use of soil as Dermal - lack of proper protective gear and use of soil as sunscreen and foot protection for those without shoessunscreen and foot protection for those without shoes
– Inhalation - lack of proper protective gearInhalation - lack of proper protective gear– Ingestion - lack of knowledge concerning hygieneIngestion - lack of knowledge concerning hygiene
Home environmentHome environment– Dermal - use of soil as sunscreenDermal - use of soil as sunscreen– Inhalation - use of pesticides in the home and being downwind of Inhalation - use of pesticides in the home and being downwind of
the farmsthe farms– Ingestion - use of old pesticide containers for waterIngestion - use of old pesticide containers for water
Routes of Exposure – Routes of Exposure – Occupational (dermal, Occupational (dermal, inhalation, ingestion)inhalation, ingestion)
Routes of Exposure - dRoutes of Exposure - dermalermal
Routes of Exposure – Routes of Exposure – home use of pesticideshome use of pesticides
Routes of Exposure - Routes of Exposure - ingestioningestion
Pesticides used on fields are kept inside the Pesticides used on fields are kept inside the workers homesworkers homes
Pilot study aimsPilot study aims Pilot feasibility of neurobehavioral tests on 2.5 and 4 Pilot feasibility of neurobehavioral tests on 2.5 and 4
year old children at the crêche in Makhathini.year old children at the crêche in Makhathini. Pilot neurological and physical exam on six week olds in Pilot neurological and physical exam on six week olds in
clinics in Jozini and Bethesda, and 2.5 and 4 year old clinics in Jozini and Bethesda, and 2.5 and 4 year old children at the crêche in Makhathini.children at the crêche in Makhathini.
Pilot environmental sampling techniques in the homes Pilot environmental sampling techniques in the homes in Makhathini and hand wipes at crêche.in Makhathini and hand wipes at crêche.
Pilot and collect data from focus groups with 10 Pilot and collect data from focus groups with 10 women/day residing in Makhathini. Total of 50.women/day residing in Makhathini. Total of 50.
Meet with local public health and governmental leaders.Meet with local public health and governmental leaders. Recruit a sample of 60 expectant mothersRecruit a sample of 60 expectant mothers Pilot questionnaire methodsPilot questionnaire methods Pilot biomarker sampling and analysisPilot biomarker sampling and analysis
Pilot study vs. Full studyPilot study vs. Full study
Full study –Full study – Make connections Make connections ProspectiveProspective LongitudinalLongitudinal Biological samples Biological samples (meconium, cord blood, hair, urine, blood)(meconium, cord blood, hair, urine, blood) Environmental samples Environmental samples (home, hand wipes, *work environment)(home, hand wipes, *work environment) Neurological and physical examsNeurological and physical exams Neurobehavioral testingNeurobehavioral testing (*behavioral and diagnostic questionnaires/methods)(*behavioral and diagnostic questionnaires/methods) Seen at birth, six weeks, 2.5 years, 4 years (other ages?)Seen at birth, six weeks, 2.5 years, 4 years (other ages?)
Pilot study –Pilot study – Assess feasibility Assess feasibility Pilot ability to… Pilot ability to… collect and run biological and environmental samplescollect and run biological and environmental samples Administer neuro and physical exams Administer neuro and physical exams (do they work? Do they give us (do they work? Do they give us
enough info?)enough info?) Administer neurobehavioral tests Administer neurobehavioral tests (do they work? Can the kids do them? How (do they work? Can the kids do them? How
much do they need to be adapted? )much do they need to be adapted? )
The kids at the CrècheThe kids at the Crèche (infants to 5 year olds)(infants to 5 year olds)
The classroomThe classroom
The playgroundThe playground
Aim 1Aim 1
Neurobehavioral TestingNeurobehavioral Testing
Neurobehavioral Testing – 2.5 year olds – Neurobehavioral Testing – 2.5 year olds – Bayley Scales of Infant DevelopmentBayley Scales of Infant Development
Cognitive Domains to assessCognitive Domains to assess
LanguageLanguage Memory (verbal and nonverbal)Memory (verbal and nonverbal) Visual spatial (drawing and constructional)Visual spatial (drawing and constructional) AttentionAttention MotorMotor
Neurobehavioral Testing – 4 year oldsNeurobehavioral Testing – 4 year olds
BatteryBatteryBoston Naming Test (with recall condition) Boston Naming Test (with recall condition) Stanford-Binet Copying Test (with recall condition) Stanford-Binet Copying Test (with recall condition) Block DesignBlock DesignFinger TappingFinger TappingDigit SpanDigit SpanSpatial SpanSpatial Span
Boston Naming TestBoston Naming Test
Block DesignBlock Design
Finger TappingFinger Tapping
Spatial SpanSpatial Span
Aim 2Aim 2
Physical and Neurological Exams: 2.5 and Physical and Neurological Exams: 2.5 and 4.0 year olds4.0 year olds
Clinic in JoziniClinic in Jozini (six week olds)(six week olds)
Physical Exam Physical Exam (2.5 year old)(2.5 year old)
Neurological Exam Neurological Exam (4 year old)(4 year old)
Aim 3Aim 3
Environmental SamplingEnvironmental Sampling
Environmental SamplingEnvironmental Sampling
At homes of the children who had neurobehavioral testing At homes of the children who had neurobehavioral testing (10 (10 randomly selected)randomly selected)
– Floor wipes Floor wipes (3 areas, two samples at each site)(3 areas, two samples at each site)
Sleeping areaSleeping area Play areaPlay area Work boot areaWork boot area
– Soil samples Soil samples (1 area, two samples at site)(1 area, two samples at site)
– ControlControl
At the Crèche, near the end of the day At the Crèche, near the end of the day (same kids that had home samples (same kids that had home samples taken)taken)
– Hand samples Hand samples (two wipes from each hand)(two wipes from each hand)
– One soil sample at the crèche, with a blankOne soil sample at the crèche, with a blank
Floor wipesFloor wipes
More floor wipesMore floor wipes
Soil SamplesSoil Samples
Sample collectionSample collection
Cohort recruitmentCohort recruitment
Recruit 60 women in second trimester of Recruit 60 women in second trimester of pregnancypregnancy
Questionnaires:Questionnaires:– Pregnancy, delivery, 6 weeks post, 6 months postPregnancy, delivery, 6 weeks post, 6 months post
Biological samplesBiological samples– Birth: cord blood, meconium, infant urine, maternal Birth: cord blood, meconium, infant urine, maternal
bloodblood– Four weeks post delivery: infant urine, breast milkFour weeks post delivery: infant urine, breast milk
Issues/IdeasIssues/IdeasNeurobehavioral TestingNeurobehavioral Testing ExaminersExaminers
– Need examiners fluent in English and Zulu.Need examiners fluent in English and Zulu.– Need to train examiners.Need to train examiners.– Need to create and organize testing materials, administration Need to create and organize testing materials, administration
manuals, and testing protocols.manuals, and testing protocols.
TestsTests– Need to add diagnostic tests.Need to add diagnostic tests.– Verbal vs. visuospatial tests.Verbal vs. visuospatial tests.– Cultural context of test stimuli.Cultural context of test stimuli.
KidsKids– Need to be knowledge enough about tests and kids in general to Need to be knowledge enough about tests and kids in general to
know if tests work, kids are giving full effort, distractions too know if tests work, kids are giving full effort, distractions too much etc…much etc…
Issues/Ideas cont…Issues/Ideas cont…
Physical and Neurological examsPhysical and Neurological exams Six week oldsSix week olds
– Lack of communication or presence of miscommunication between the Lack of communication or presence of miscommunication between the sisters (nurses) at the same clinic and between clinics.sisters (nurses) at the same clinic and between clinics.
2.5 and 4 year olds2.5 and 4 year olds– Need more in depth tools.Need more in depth tools.
GeneralGeneral– Need to hire a nurse or midwife or OT to recruit and be present and Need to hire a nurse or midwife or OT to recruit and be present and
able to administer infant exams able to administer infant exams
Issues/Ideas cont…Issues/Ideas cont…
Environmental SamplingEnvironmental Sampling People were very welcoming and willing to allow us into People were very welcoming and willing to allow us into
their homestheir homes Need help from one of the villagers (school teachers) to Need help from one of the villagers (school teachers) to
find the homes of the childrenfind the homes of the children Could possibly train some of the school teachers to help Could possibly train some of the school teachers to help
with collection of sampleswith collection of samples
Issues/Ideas cont…Issues/Ideas cont…
Focus GroupsFocus Groups HIV/AIDSHIV/AIDS Water and lack there ofWater and lack there of Work environment – bootsWork environment – boots Knowledge of clinical effects of pesticide poisoningKnowledge of clinical effects of pesticide poisoning
Issues/Ideas cont…Issues/Ideas cont…
Sample RecruitmentSample Recruitment HIV ratesHIV rates Follow-up successFollow-up success Follow-up problemsFollow-up problems
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