Browsing by Subject "Environmental Exposure"
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Item Epigenetics in medicine: the rise and fall and rise of Lamarckian thought(2014-11-14) Terada, Lance S.Item Imapct [sic] of Pesticide Exposure on Motor Function and Mortality Among Patients with Parkinson's Disease in Southern Brazil(2020-05-01T05:00:00.000Z) Reddy, Sumanth Palvai; Dewey, Richard B., Jr.; Chang, Mary; Chitnis, ShilpaBACKGROUND: Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson's disease (PD). However, few studies have examined the impact of pesticide exposure on motor impairment and the risk of mortality among patients with PD. This study takes place in the context of growing pesticide use in Brazil as well as many other low- and middle-income countries around the world. OBJECTIVE: This study examines whether occupational pesticide exposure influences motor impairment and the risk of mortality among patients with PD in Southern Brazil, when accounting for socioeconomic status, disease-specific factors, nicotine exposure, and caffeine exposure. METHODS: 150 patients with idiopathic PD in Porto Alegre, Brazil were enrolled from 2008-2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding environmental exposures. 105 of these patients also completed an additional survey regarding socioeconomic factors. The primary outcomes were whether occupational pesticide exposure was associated with motor impairment (as measured by linear regression with UPDRS-III score) and mortality (as determined by the log-rank test and Kaplan-Meier testing). Secondary analyses included models that accounted for relevant socioeconomic and disease specific characteristics (multiple linear regression for motor function, and multivariate cox proportionate hazards regressions for mortality). RESULTS: Of the 150 patients in this prospective cohort, 20 (13.3%) reported a history of occupational pesticide exposure, with an average duration of exposure of 14.3 years (SD = 10.6, median = 10). In the univariate analysis, occupational pesticide exposure was associated with a 16.10 point increase in the UPDRS-III (motor function) score (95% CI: [7.11, 25.02], p < 0.001). Similarly, in the multiple linear regression which controlled for several socioeconomic and disease-related covariates, pesticide exposure was associated with a 16.84 point increase in the UPDRS-III score (95% CI: [8.84, 24.85], p < 0.001). Patients with occupational pesticide exposure were more than two times as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.22). This was significant when controlling for smoking history, caffeine intake, and socioeconomic factors such as historical monthly income, education, and a history of working predominately in agricultural professions. Patients with 10 or more years of occupational pesticide exposure had a significantly elevated risk of mortality (HR = 2.81, 95% CI [1.17, 6.73], p = 0.02), in contrast to patients with fewer than 10 years of exposure. CONCLUSION: In addition to providing a broad overview of the socioeconomic breakdown of a contemporary cohort of patients with PD in South America, this study implicates occupational pesticide exposure as an independent risk factor for poor motor function and mortality among patients with PD when controlling for disease-specific and socioeconomic confounding factors. This is especially important in the Brazilian market, and perhaps in other developing countries, where new pesticides continue to be introduced without the corresponding research output necessary to understand the impact on human health.Item Leptospirosis Risk Perception and Associated Behavior in a Region of High Seroprevalence in Iquitos, Peru(2016-04-01) Gutierrez, Carolina Paola; Higashi, Robin T.; Niwagaba, Lilian; Southern, PaulBACKGROUND: Iquitos has an ideal environment for Leptospira transmission leading up to endemic leptospirosis. Studies in Belen, an urban slum in Iquitos, indicate seroprevalence as high as 28% with rates higher in flooding and non-flooding areas, and pathogenic Leptospira in floodwater. Public health education efforts to date have failed to reduce prevalence and transmission rates. OBJECTIVE: Assess the community environment, residents' beliefs and behaviors, and social networks for information exchange to identify opportunities for enhancing public health strategies. METHODS: The primary researcher collected qualitative data from site observation (approximately 12 hours), 51 interviews, and 4 focus group interviews (n=27). All audio recordings were transcribed verbatim, translated to English, then analyzed and interpreted using NVivo 9.0 (QSR Australia). RESULTS: Roughly half (47%) of participants were familiar with the term "Leptospirosis" or "la enfermedad de la rata" (the rat's disease), but few could report on disease presentation or prevention. Although limited knowledge uptake has hampered prevention efforts, results also demonstrate that high-risk behaviors are closely aligned with environmental conditions, daily living practices, and cultural values, beliefs, and priorities. CONCLUSION: Complex and interconnected social, economical, and cultural conditions make Belen an ideal environment for transmission of leptospirosis. Public health strategies and funding to reduce transmission should target community trash disposal techniques, knowledge of water-borne illness, and modification of education modalities and distribution to leverage community-oriented values and priorities.Item [News](1982-03-30) Harrell, AnnItem [UT News](1986-12-12) Rutherford, Susan