ContexteDe nombreux facteurs influencent l’exposition des agriculteurs aux produits phytopharmaceutiques (PP) : facteurs techniques (matériel de pulvérisation, forme et type des PP employés), agronomiques (pression parasitaire, doses employées, type de culture) et humains. La perception d'un risque est un facteur déterminant du comportement humain face à celui-ci. La perception du risque phytosanitaire chez les agriculteurs et ses conséquences sur l'exposition aux substances actives des utilisateurs sont peu étudiées.ObjectifL’objectif de ce travail est d’évaluer comment la perception du risque influe sur les pratiques des agriculteurs. Il vise aussi à décrire et évaluer les déterminants de cette perception, et leurs impacts sur le risque sanitaire des utilisateurs de PP. Méthode.Des entretiens individuels sont menés pour évaluer la perception du risque auprès d’utilisateurs de PP. Des mesures et modélisations d’exposition complètent ces observations. Les mesures se focalisent sur les paramètres influencés par la perception du risque décrits lors des entretiens. Les résultats des mesures d’exposition sont comparés aux pratiques observées et servent à qualifier et quantifier l’impact de la perception sur le risque sanitaire.RésultatsCe travail montre que la perception des agriculteurs du risque liés aux PP est empirique et se base sur des critères tels que l'odeur, le type, la forme ou l'efficacité des produits pour estimer le risque. Les comportements des agriculteurs pour réduire leur exposition sont corrélés à leur perception des produits employés. L'utilisation des équipements de protection individuelle (EPI) est le marqueur le plus fort de la perception. Plus le risque est perçu comme important, plus l'utilisation d'EPI est élevée. Mais les pratiques de réduction du risque ne sont pas toujours efficaces pour réduire l'exposition. En effet, les mesures d'exposition réalisées montrent que les opérateurs, même utilisateurs d'EPI, n'ont pas conscience des phénomènes de contaminations indirectes (cabine des tracteurs, environnement de travail). Combinés à un mauvais usage fréquent des EPI (réutilisation d'EPI à usage unique, utilisation partielle ou inadaptée), ces défauts de perception jouent sur l'exposition aux PP.Les modélisations et mesure d’exposition en fonction des pratiques observées ont permis de quantifier les conséquences sanitaires de ces comportements. Il ressort que le risque sanitaire lors de l'utilisation des PP dans le cadre des bonnes pratiques est acceptable. Cependant ces bonnes pratique sont théoriques et les observations montrent que les opérateurs ont des comportements qui s'éloignent des bonnes pratiques et les exposent aux PP, mais ces comportements ne sont pas perçus comme tels. Le risque sanitaire associé aux pratiques est très individuel et difficilement généralisable. Cependant, ce travail exploratoire a permis de mettre à jour des profils de risque et de décrire les déterminants forts de la perception. La sensation de maîtrise du risque est le déterminant clef dans l'acceptation du risque par les agriculteurs. ConclusionCe travail montre que la perception du risque joue un rôle décisif dans l'exposition totale des agriculteurs aux PP. Le risque sanitaire est sensiblement dépendant de la perception du risque. Les politiques de prévention des risques doivent s'appuyer sur cet aspect afin d'adapter les messages et d'éduquer les opérateurs aux pratiques exposantes telles que la contamination indirecte ou le mauvais usage des EPI, aujourd'hui peu pris en compte par les utilisateurs de pesticides. / IntroductionMany factors influence the exposure of farmers to pesticides. Technical (spraying equipment, type of pesticides used), agronomic (type of crop, doses used, frequency) and human factors. The perception of risk is a determinant key of human behavior and how human faces to risk. Pest risk perception among farmers and the consequences of exposure to active substances of farmers have not been clearly studied.AimsThe objective of this study is to evaluate how risk perception affects farmers' practices. It also aims to describe and assess the determinants of this perception, and their impact on the health risk of pesticides users.Individual interviews are conducted to describe the perception of risk of pesticides' users. Measurements and modeling of exposure complement these observations. The measures focus on the parameters influenced by the perception of risk described in the interviews. The results of exposure measurements are compared to practices observed and used to qualify and quantify the impact of perception on health risk.ResultsThis work shows that farmers' perceptions of risk related to pesticides used is empirical and based on criteria such as smell, type, form or effectiveness of products to estimate the risk. Farmers' behavior to reduce exposure is correlated with their perception of the products used. The use of personal protective equipment (PPE) is the strongest marker of perception. The higher the risk perceived, the greater the use of PPE is high. But the practical risk reductions are not always effective in reducing exposure. Indeed, exposure measurements show that operators, even in users of PPE, are unaware of indirect contamination (cab tractors, work environment). Combined with frequent misuse of PPE (reuse of disposable PPE, partial or improper use), these defects perception are increase exposure to pesticides.Modeling and exposure’s measurement based on observed practices are used to quantify the health consequences of these behaviors. It appears that the health risk of pesticides is acceptable when used as recommended. However, recommended practices are theoretical and observations show that operators have behaviors that deviate from recommended practices depending on pesticides used. But these behaviors are not perceived as risky. The health risks associated with individual practice is very difficult to generalize. However, this work highlights profiles of risk and describes strong determinants of perception. The risk-control feeling is the key determinant in risk acceptance by farmers.ConclusionThis work shows that the perception of risk plays a decisive role in the exposure to pesticide of farmers. The health risk is substantially dependent on the perception of risk. The risk prevention policies must support this risk perception to adapt messages and educate the operators to not adapted practices such as indirect contamination or improper use of PPE, few considered by some pesticides users.

The increase in global population witnessed over recent years poses major threats to the quality of the air we breathe. Coupled with population growth in many developed countries, often driven by immigration, there have been substantial increases in the populations of developing countries. At the same time, an increasing number of individuals live in urban environments. In order to assess risk of exposure to hazardous air pollutants (air toxics) in the inner city, where a susceptible population resides, data obtained from high school students in the New York and Los Angeles TEACH (Toxic Exposure Assessment: A Columbia-Harvard Study) studies, were analyzed, with the three main objectives to: 1). Assess, characterize, quantify and compare directly-measured personal air toxics exposures from New York and Los Angeles; 2). Assess, quantify and compare the concentrations and temporal and spatial variability of air toxics measured in the outdoor urban microenvironments of these two cities; 3). Determine if personal air toxics exposures could be modeled using available time-activity information, coupled with measured microenvironmental air pollution inputs. The main findings of this research revealed substantial differences between New York and Los Angeles in the quantity and quality of particle-associated personal air toxics exposures in these two cities. Students across cities exhibited similar levels of personal exposure to particulate matter (PM 2.5) and to high levels of sulfates (greater in Los Angeles than New York; both likely of vehicular traffic origin). Different patterns of exposure to particle-associated air toxics was observed in the two cities and across seasons. In New York, students demonstrated substantially higher exposures to iron, cobalt, and manganese, likely of subway origin, than their counterparts in Los Angeles, who exhibited higher exposures to calcium, aluminum, magnesium (likely of crustal origin). Across seasons, within cities, differences were also detected, with higher levels of air toxics exposures shown in New York in the winter than in the summer for nearly 80% of the analytes, similar to the general pattern (winter vs. fall) in Los Angeles. With respect to outdoor air toxics concentrations, in general terms, crustal sources of air toxics were detected in both cities, though in Los Angeles these levels tended to be higher than in New York, often significantly. Anthropogenic sources were evident in each of the cities to varying degrees. Sulfates were detected at comparable high levels across both cities, though the levels tended to be higher and variability of concentrations of this air pollutant was greater Los Angeles than New York, likely reflecting differences both in patterns of traffic and built environment. Various approaches taken to model spatial and temporal variability of outdoor air toxics concentrations using mixed procedures showed city-specific, spatial and temporal variance patterns of air toxics. Using location and time (day) inputs, in New York, Zn, Pt, and Sn were among the elements with highest spatial variability in the summer, whereas in the winter, Co and La (possibly of subway origin) showed high spatial-temporal variance. In Los Angeles on the other hand, highest spatial to temporal variance ratios were noted for Cs, Ni and K in the fall and Ni, As and Mg in the winter. Each city also revealed different patterns of temporally dominant air toxics, consistent with variable-in-time excursions in air toxics reflecting remote, upwind sources. Using regression modeling that accounted for the distribution of measured personal air toxics, coupled with available time-activity diary data from TEACH and assignment of those activities to specific measured microenvironments, modeling of personal exposures yielded generally strong coefficients of determination, explanatory power and could be cross-validated. Important findings included the role of the indoor environment in predicting personal exposures and the degree to which a small percentage of time spent in the transit environment could affect exposures to trace elements from this source. Although the majority of elements could be predicted in large part by indoor exposures, not simply as a reflection of outdoor air toxics concentrations, the inclusion of other microenvironments, in many cases substantially increased the predictive power of the models generated. The research pursued in this thesis project further details and underscores the risk of air toxics exposures of young residents of the inner city, which, unlike workplace and environmental standards that traditionally may have been based on single exposures, are characterized by exposures to low level complex mixtures of air toxics. In aggregate, these mixtures may have different health consequences than more intense single pollutant exposures. Data generated here may help to inform planning of air quality monitoring approaches in the inner city, as well as provide one template for predictive modeling of human exposures to air toxics in that complex environment, to reduce the need for direct personal measurements to assess exposure risk. This may ultimately contribute to approaches to mitigate air toxics exposures and its consequences for an expanding global population residing in the world's inner cities.

Thesis ( MPH.) --University of Limpopo, 2014 / The purpose of this study was to investigate the knowledge and practices among households at Ga-Mokgwathi Village regarding the disposal of mercury coated bulbs. Cross-sectional design with quantitative approach was used in this study. The study objectives were to determine the knowledge about the disposal methods of mercury coated bulbs and also to determine the practices of handling broken mercury coated bulbs among the villagers of Ga-Mokgwathi. Data collection was done using self-administered questionnaires. Cluster random sampling was used in the study where a total number of 338 households were randomly selected to participate in the study. The results indicated that 36.7 % of the households at Ga-Mokgwathi Village had knowledge of safe disposal methods of mercury coated bulbs, 7.7% were not sure and 55.6% did not have such knowledge. Furthermore, the results indicated that 51.5% of the households had improper practices regarding the handling of broken mercury coated bulbs, 6.2% were not sure and 42.3% had proper practices regarding the handling of broken mercury coated bulb. The results of the study concluded that the majority of people were lacking knowledge of proper disposal methods and the handling of mercury coated bulbs. These results necessitate education of people about the disposal methods and handling of mercury coated bulbs.

This dissertation assesses the factors that lead to the emergence of infectious diseases in children, particularly the emergence of multidrug-resistant organisms (MDROs) and diarrheal pathogens in vulnerable pediatric populations. It includes three manuscripts. The initial study is a systematic review that summarized the role of antibiotic exposure on the acquisition of MDROs in children. Twenty-nine studies met the inclusion criteria and a positive association between prior antibiotic use and subsequent colonization or infection with an MDRO was identified in most studies. There were wide variations among study sites, populations, and definitions of antibiotic use and MDROs. Therefore, limited inferences could be made on which components of antibiotic exposure have the greatest impact on MDRO development. The second analysis examines the relationship between prior stay at a pediatric long-term care (LTC) facility and infection with an MDRO among hospitalized children. This study included 2,945 infections in 258,664 pediatric admissions from 2006 through 2016. At least 1 MDRO was identified in 10% of infections. Of the 1,198 children who had previously resided in a pediatric LTC facility, only 1 child (0.08%) had an MDRO infection. However, prior receipt of pediatric LTC was associated with an increased likelihood of infection (OR 2.4, CI95 1.66 – 3.43), C. difficile infection (OR 2.57, CI95 1.26 – 5.25), days of antibiotic use (OR 1.01, CI95 1.01 – 1.02), length of stay (OR 1.01, CI95 1.01 – 1.01), and death (OR 4.38, CI95 2.93 – 6.55). The concluding study evaluates the association between animals living in or near the home and diarrheal disease in children. This research is a secondary analysis of the Global Enteric Multicenter Study case control study, which investigated the epidemiology of diarrheal illness in children <5 in sub-Saharan Africa and south Asia. Of 9,439 cases and 13,128 controls, 87% had ≥1 animal in their home. In a multivariable analysis adjusting for exclusive breastfeeding, water source, sanitation facility, number of children <5 years in the household, and wealth index, any animal on a child’s compound decreased the odds of diarrhea by 33% (aOR 0.66, CI95 0.59 – 0.74). However, children with diarrhea who had an animal present were not more likely to have a positive stool culture. Overall, the three studies provide a thorough analysis of several factors associated with the infectious disease emergence in children, particularly as related to MDROs and diarrheal disease. Environmental characteristics, including antibiotic use and interaction with animals, were shown to be important factors for emergent infectious disease across diverse settings. The development of pediatric infection prevention interventions should take into consideration environmental risk factors in order to effectively mitigate the risks posed infectious disease emergence.

In 1990, the Clean Air Act (CAA) Amendments authorized the regulation of 188 hazardous air pollutants (HAP). Exposure to HAPs at sufficient concentrations and durations can increase both cancer and serious adverse non-carcinogenic effects. The purpose of this study was to conduct a human health risk assessment using data of 43 HAPs from five monitor sites in Portland, Oregon during July 1999-August 2000. HAP concentrations were compared to carcinogenic and non-carcinogenic (health) benchmark concentrations; and emission sources were determined for HAPs that exceeded health benchmark concentrations. Additionally, cancer risks were determined for subpopulations and compared to cancer risks generated for the general population. Results of this study indicate that 20 HAPs exceeded carcinogenic benchmark concentrations (corresponding to a risk level of 1 x 10������) in at least one location. Chromium compounds posed the highest cancer risk (3.5 x 10������). Seventeen HAPs exceeded carcinogenic benchmark concentrations at all five sites. Seventy-five percent (%) of the total cumulative cancer risk was contributed by chromium compounds, 1,3-butadiene, formaldehyde and 1,1,2,2-tetrachloroethane. Three HAPs, chromium compounds, acrolein, and formaldehyde, exceeded non-carcinogenic hazard ratios of 1.0. Releases from area sources accounted for the largest percentage of HAPs that exceeded health benchmark concentrations. With respect to subpopulations, asthmatics teenagers (age 11-16) and asthmatic adults (age 18-50), had slightly elevated cancer risks of 1.4 x 10������ and 1.2 x 10������. respectively, compared to the general population risk level of 1 x 10������. Results of this study indicate that several HAPs pose a potential human health concern in Portland and that efforts should be made to reduce their emissions. Additional studies are warranted to further assess potential human health risks and the extent of HAPs in Portland, Oregon. / Graduation date: 2003

The goal of the project was to develop a functional prototype of an environmental risk assessment parameter database on the World-Wide Web. The ability to develop a consolidated environmental database has become possible due to the phenomenal growth of the Internet and the World-Wide Web over the past few years. A large number of environmental resources do currently exist; however, with the large volume of information available, access, management, reliability, and retrievability have become increasingly difficult. To illustrate the prototype database, a practical environmental concern and the tools necessary to evaluate and characterize that concern were needed. Uranium (�������U) daughters leaching from abandoned mill tailing piles at three abandoned uranium mines in southwestern Colorado were chosen to demonstrate the database concept. The RESRAD environmental pathway modeling code served as the evaluation and characterization tool. Due to the size and complexity of RESRAD, a single radionuclide release rate equation was isolated as a controllable component of the code. The equation was a small part of the water pathway factor and examined the rate at which radionuclides absorbed in soil were leached by infiltrating water. This serves as the source term for groundwater contamination and directly applies to the �������U progeny leaching from mill tailing piles scenario. Parameters selected from the equation dealt with the background data that directly influenced the mobility of contaminates in the environment. Environmental data for the three Colorado sites were gathered and interpreted. Probability Density Functions (PDFs) were developed for input parameters and the results were then incorporated into the web site. / Graduation date: 1998

Quantitative soil ingestion studies employing a mass balance tracer approach have been used to determine soil ingestion rate for use in human health risk assessments (HHRAs). Past studies have focused on soil ingestion in populations living in urban/suburban environments and the results have been highly variable. Moreover, there is a paucity of reliable quantitative soil ingestion data to support human health risk assessments of other lifestyles that may be predisposed to ingesting soil, such as indigenous populations following traditional lifestyles. Thus, the primary objective of the research was to determine if populations following lifestyles typical of traditional land use practices in rural or wilderness areas ingest more soil than populations living in urban or suburban environments. Further, the research investigated the use of alternative mass balance tracers, specifically isotopes of the 238U and 232Th decay series, to reduce soil ingestion estimate variability. Mass balance tracer methods were developed and validated in a pilot canine study, and methods using isotope tracers were adapted to permit quantification of sediment ingestion in the benthic fish Moxostoma macrolepidotum (Shorthead Redhorse Sucker). A pilot human soil ingestion study of 7 subjects from an Aboriginal community in British Columbia was conducted over a 3-week period. The mean soil ingestion rate calculated using the daily means of the 4 elemental tracers with the lowest food-to-soil ratios (i.e., Al, Ce, La, Si) was observed to be approximately 74 mg d-1 (standard deviation 91 mg d-1), The median soil ingestion rate was 60 mg d-1, and the 90th percentile was 196 mg d-1. These soil ingestion rate estimates are higher than those currently recommended for HHRAs of adults, and higher than those obtained in most previous studies of adults. However, the estimates are much lower than the earlier qualitative assessments for subsistence lifestyles (i.e., 330-400 mg d-1). The study results also demonstrated that isotopes of the 238U and 232Th decay series radionuclide are not reliable mass balance tracers for estimating soil ingestion in humans; however, they may be useful for quantifying soil and sediment ingestion in wildlife.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Quantitative soil ingestion studies employing a mass balance tracer approach have been used to determine soil ingestion rate for use in human health risk assessments (HHRAs). Past studies have focused on soil ingestion in populations living in urban/suburban environments and the results have been highly variable. Moreover, there is a paucity of reliable quantitative soil ingestion data to support human health risk assessments of other lifestyles that may be predisposed to ingesting soil, such as indigenous populations following traditional lifestyles. Thus, the primary objective of the research was to determine if populations following lifestyles typical of traditional land use practices in rural or wilderness areas ingest more soil than populations living in urban or suburban environments. Further, the research investigated the use of alternative mass balance tracers, specifically isotopes of the 238U and 232Th decay series, to reduce soil ingestion estimate variability. Mass balance tracer methods were developed and validated in a pilot canine study, and methods using isotope tracers were adapted to permit quantification of sediment ingestion in the benthic fish Moxostoma macrolepidotum (Shorthead Redhorse Sucker). A pilot human soil ingestion study of 7 subjects from an Aboriginal community in British Columbia was conducted over a 3-week period. The mean soil ingestion rate calculated using the daily means of the 4 elemental tracers with the lowest food-to-soil ratios (i.e., Al, Ce, La, Si) was observed to be approximately 74 mg d-1 (standard deviation 91 mg d-1), The median soil ingestion rate was 60 mg d-1, and the 90th percentile was 196 mg d-1. These soil ingestion rate estimates are higher than those currently recommended for HHRAs of adults, and higher than those obtained in most previous studies of adults. However, the estimates are much lower than the earlier qualitative assessments for subsistence lifestyles (i.e., 330-400 mg d-1). The study results also demonstrated that isotopes of the 238U and 232Th decay series radionuclide are not reliable mass balance tracers for estimating soil ingestion in humans; however, they may be useful for quantifying soil and sediment ingestion in wildlife.