The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

This review covers the toxicology of mercury and its compounds. Special attention is paid to those forms of mercury of current public health concern. Human exposure to the vapor of metallic mercury dates back to antiquity but continues today in occupational settings and from dental amalgam. Health risks from methylmercury in edible tissues of fish have been the subject of several large epidemiological investigations and continue to be the subject of intense debate. Ethylmercury in the form of a preservative, thimerosal, added to certain vaccines, is the most recent form of mercury that has become a public health concern. The review leads to general discussion of evolutionary aspects of mercury, protective and toxic mechanisms, and ends on a note that mercury is still an "element of mystery."

The Toxicology of Mercury and Its Chemical Compounds

Water quality issues are a major challenge that humanity is facing in the twenty-first century. Here, we review the main groups of aquatic contaminants, their effects on human health, and approaches to mitigate pollution of freshwater resources. Emphasis is placed on chemical pollution, particularly on inorganic and organic micropollutants including toxic metals and metalloids as well as a large variety of synthetic organic chemicals. Some aspects of waterborne diseases and the urgent need for improved sanitation in developing countries are also discussed. The review addresses current scientific advances to cope with the great diversity of pollutants. It is organized along the different temporal and spatial scales of global water pollution. Persistent organic pollutants (POPs) have affected water systems on a global scale for more than five decades; during that time geogenic pollutants, mining operations, and hazardous waste sites have been the most relevant sources of long-term regional and local water pollution. Agricultural chemicals and wastewater sources exert shorter-term effects on regional to local scales.

https://www.annualreviews.org/doi/pdf/10.1146/annurev-environ-100809-125342

Global Water Pollution and Human Health

Neurodevelopmental disabilities, including autism, attention-defi cit hyperactivity disorder, dyslexia, and other cognitive impairments, aff ect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence. In 2006, we did a systematic review and identifi ed fi ve industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants—manganese, fl uoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered. To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy. Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity. To coordinate these eff orts and to accelerate translation of science into prevention, we propose the urgent formation of a new international clearinghouse.

/pdf/neurobehavioural-effects-of-developmental-toxicity-40atxxdh1g.pdf

Neurobehavioural effects of developmental toxicity

The industrialization of the agricultural sector has increased the chemical burden on natural ecosystems. Pesticides are agrochemicals used in agricultural lands, public health programs and urban green areas in order to protect plants and humans from various diseases. However, due to their known ability to cause a large number of negative health and environmental effects, their side effects can be an important environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, among them agriculture reforms and food production implementing sustainable practice evolving to food sovereignty. It is more obvious than ever that the society needs the implementation of a new agricultural concept regarding food production which is safer for man and the environment, and to this end, steps such as the declaration of Nyeleni have been taken.

/pdf/chemical-pesticides-and-human-health-the-urgent-need-for-a-4k913yglgk.pdf

Chemical Pesticides and Human Health: The Urgent Need for a New Concept in Agriculture.

Introduction Agrochemicals, short from agricultural chemicals, is a term used for various chemical products which are commonly used in agriculture. The most famous representative example of agrochemicals are pesticides, but it may also include fertilizers, hormones or similar chemical growth agents, as well as raw animal manure. Even as an active substance is authorized in European Union, and products containing this active substance are authorized and marketed, there is still a need for risk assessment to communicate and to manage risk with regard to the different risk groups, workers and the general population as a whole. Overall Goal The goal of this effort is the creation of Exposure and Risk Profiles, as a reliable, scientifically based way to forecast pesticide exposure and workers’ risk in typical scenarios from a minimum set of available information, aimed at performing a preliminary risk assessment even without the need of “in field” measurements. Methodology To reach our goal we have conducted a wide published literature search to define the process of pesticide application and the most common exposure determinants. Then we conducted two real-life field studies on exposure to pesticide in different use scenarios in the vineyards of the Region of Lombardy (one study in the framework of the ACROPOLIS project of the European Union, and another financed by INAIL). We collected field information in the form of a structured questionnaire, with a goal to record the variables previously identified as important modifiers of pesticide exposure. Also we collected exposure measurements, using two methodologies: skin pads and whole-body method, following in principle the OECD guidelines. Finally, we used the results from the field to develop a method that allows for a re-use of field data in risk assessment, by creating a Risk Assessment Scheme which can be used to assess risk in the field, without doing any measurements. Results We report the main phases of pesticide work and variables, together with their influence, as a result of our wide literature search. Also we report the results of two field studies, first on 7 workers applying Tebuconazole on 12 work-days, and second on 28 workers applying Mancozeb on 38 work-days. Finally, we show a proposed approach to using field measurements from our study in the Region of Lombardy to perform future riskassessment in one defined scenario of closed and filtered tractors. Discussion and Conclusions Our work has tackled the problem of risk assessment for pesticide exposure in agriculture, which has been unfairly neglected in the past years. Through the use of literature data, field studies and computational modelling, we have managed to analyze and summarize the characteristics of pesticide application in agriculture, explore the real-life field conditions during pesticide application in vineyards in Italy, collect the field measurements necessary to do exposure and risk assessment, and to develop a method to use the data collected to produce a Risk Assessment Scheme. The study results and the above mentioned tool represent a step forward towards rapid, simple and scientifically based risk assessment in real-life conditions of pesticide application in agriculture. Novel Approaches to Pesticide Risk Assessment by Stefan Mandić-Rajčević

Exposure and risk profiles for a safe pesticide use in agriculture

Nodulo del mungitore da parapox virus : un case report

Introduction Agriculture is one of the most hazardous industries in Europe, measured by work-related injuries, diseases, disabilities and deaths. Statistics and studies show great differences in national injury and occupational disease rates, as well as approaches and support for prevention of these adverse outcomes. This EU-COST action explores reasons why agriculture lags behind other sectors, and why some countries have been more successful than others in reducing agricultural injuries and diseases. Methods Evaluation of health and safety programmes and approaches on the national level identification of knowledge, attitudes, behaviors and priorities among farmers regarding safety, health and risk management identification of effective measures for training and integrating vulnerable populations (including refugees) into the agricultural workforce development of indicators for monitoring progress and evaluating the impact of interventions on occupational injuries and diseases in agriculture. Results Benchmarked and evidence-based recommendations will be developed to inform and guide national initiatives and efforts. Results will be disseminated to stakeholders and the agricultural community. Discussion This action is in progress; previous Cooperation in Science and Technology (COST) Actions, like Monitoring Occupational Diseases and tracing New and Emerging Risks in a Network (MODERNET) show that such multidisciplinary, international focused exchange programmes are effective to trigger awareness raising and preventive actions.

https://oem.bmj.com/content/oemed/75/Suppl_2/A462.2.full.pdf

1768 Safety culture and risk management in agriculture (sacurima)

The pharmacokinetics of pentachlorophenol (PCP) excretion in urine was examined in four workers exposed to the biocide in the tannery and wood industries. PCP concentration in urine was significantly higher in morning samples than in afternoon or evening samples. This excretion pattern was observed during an exposure of several shifts and following a four-week holiday period. The estimated half-life for PCP urine excretion was 10 days. Biological monitoring of occupational exposure to PCP should be carried out by measuring the concentration of the compound in urine collected in the morning or before the workshift

Urine excretion of pentachlorophenol (PCP) in occupational exposure

Occupational logging activities expose workers to a wide range of risk factors, such as lifting heavy loads, prolonged, awkward positioning of the lower back, repetitive movements, and insufficient work pauses. Body posture has an important impact on the level of physiological load. The present study involved a group of 40 loggers in the province of Enna (Sicily, Italy) with the aim of defining the impact of logging activities on the workers’ physiological strain during the three primary work tasks of felling, delimbing, and bucking. The Zephyr Bioharness measurement system was used to record trunk posture and heart rate data during work tasks. The NASA TLX questionnaire was used to explore workers’ effort perception of the work tasks. Based on our results, the most demanding work task was tree felling, which requires a higher level of cardiac cost and longer periods spent in awkward trunk postures. The perceived physiological workload was consistently underestimated, especially by the more experienced loggers. Lastly, as the weight of the chainsaw increased, the cardiac load increased.

/pdf/assessing-the-impact-of-work-activities-on-the-physiological-27duame3.pdf

Claudio Colosio

Papers

Exposure and risk profiles for a safe pesticide use in agriculture

Nodulo del mungitore da parapox virus : un case report

1768 Safety culture and risk management in agriculture (sacurima)

Urine excretion of pentachlorophenol (PCP) in occupational exposure

Assessing the Impact of Work Activities on the Physiological Load in a Sample of Loggers in Sicily (Italy)