Magnitude of behavioral deficits varies with job-related chlorpyrifos exposure levels among Egyptian pesticide workers.

Chronic occupational exposure to organophosphorus pesticides (OPs) is consistently associated with deficits on behavioral tests when compared to unexposed comparison groups. However, a dose-response relationship has yet to be established, leading some to doubt an association between occupational OP exposure and behavioral deficits. Pesticide application teams in Egypt who are primarily exposed to one OP, chlorpyrifos (CPF), were recruited into a field assessment. Trail Making A and the more challenging Trail Making B tests were administered to 54 engineers (who supervise the pesticide application process, usually from the side of the field), 59 technicians (who guide the pesticide applicators in the field), 31 applicators (who mix and apply pesticides using knapsack sprayers), and 150 controls (who did not work in the fields) at two different times during the OP application season as well as immediately after applications had ended and 1.5 months later. All participants were males since only males work on pesticide application teams in Egypt. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of CPF, confirmed the pattern of lower to higher CPF exposures from engineers to technicians to applicators, and these were all greater than urinary metabolite levels in controls. A consistent relationship between job title and performance speed on the behavioral task was observed: Controls had the best (fastest) performance on Trail Making A and B tests throughout the application season, and applicators had significantly slower performance than engineers on Trail Making A (p = 0.015) and B (p = 0.003). However, individual urinary TCPy, blood acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) levels did not predict individual performance. This study identifies a dose-related effect based on job title, which serves as a surrogate for chronic exposure in that differing job titles exhibit varying group exposure levels. The results establish that chronic occupational exposure to chlorpyrifos is neurotoxic and suggest that the classic biomarkers of recent CPF exposure are not predictive of chronic exposure effects.

Information and communication technologies in primary healthcare facilities in Egypt.

BACKGROUND: The health sector has always relied on technologies. According to World Health Organization, they form the backbone of the services to prevent, diagnose, and treat illness and disease. It is increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. Aim of the study This was to assess the current situation of information and communication technologies (ICTs) in primary healthcare in the terms of describing and classifying the existing work, identify gaps and exploring the personal experiences and the challenges of ICTs application in the primary healthcare. Subjects and methods A mixed research method in the form of sequential explanatory design was applied. In the quantitative phase a cross-sectional study was conducted among 172 family physicians using a predesigned questionnaire. Followed by qualitative data collection among 35 participants through focused group discussions. RESULTS: Nearly half of the physicians have ICTs in their work and they were trained on it. None of them developed a community-based research using ICTs technology. Training on ICTs showed a statistically significant difference regarding the availability and the type of ICTs present in the workplace (P<0.05). Focused group discussion revealed that the majority of the participants believe that there is poor commitment of policymaker toward ICTs utilization in the primary care. Nearly 97% thinks that there is insufficient budget allocated for ICTs utilization in the workplace. Almost 88% of the participants demanded more incentives for ICTs users than non-user at the workplace. CONCLUSIONS: ICTs resources are underutilized by health information professionals. Lack of funds, risk of instability of the electric supply and lack of incentives for ICTs users were the most common barriers to ICTs implementation thus a steady steps toward budget allocation and continuous training is needed.

Opportunities and barriers to enhance research capacity and outputs among academic family physicians in the Arab world.

AIM: To explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation. BACKGROUND: Research is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries. METHODS: An online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region. FINDINGS: Seventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research. CONCLUSION: Although many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

Experimental strategy for translational studies of organophosphorus pesticide neurotoxicity based on real-world occupational exposures to chlorpyrifos.

Translational research is needed to understand and predict the neurotoxic consequences associated with repeated occupational exposures to organophosphorus pesticides (OPs). In this report, we describe a research strategy for identifying biomarkers of OP neurotoxicity, and we characterize pesticide application workers in Egypt's Menoufia Governorate who serve as our anchor human population for developing a parallel animal model with similar exposures and behavioral deficits and for examining the influence of human polymorphisms in cytochrome P450 (CYP) and paraoxonase 1 (PON1) enzymes on OP metabolism and toxicity. This population has previously been shown to have high occupational exposures and to exhibit a broad range of neurobehavioral deficits. In addition to observational studies of work practices in the field, questionnaires on demographics, lifestyle and work practices were administered to 146 Egyptian pesticide application workers applying pesticides to the cotton crop. Survey results indicated that the application workforce uses standard operating procedures and standardized equipment provided by Egypt's Ministry of Agriculture, which provides a workforce with a stable work history. We also found that few workers report using personal protective equipment (PPE), which likely contributes to the relatively high exposures reported in these application workers. In summary, this population provides a unique opportunity for identifying biomarkers of OP-induced neurotoxicity associated with occupational exposure.

Prevalence and risk factors of hearing impairment among primary-school children in Shebin El-kom District, Egypt.

PURPOSE: This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students. METHOD: A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools. RESULTS: The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice. CONCLUSIONS: The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Chlorpyrifos exposures in Egyptian cotton field workers.

Neurobehavioral deficits have been reported in Egyptian pesticide application teams using organophosphorus (OP) pesticides, but whether these effects are related to OP pesticide exposures has yet to be established. In preparation for a comprehensive study of the relationship between OP pesticide dose and neurobehavioral deficits, we assessed exposure within this population. We conducted occupational surveys and workplace observations, and collected air, dermal patch and biological samples from applicators, technicians and engineers involved in chlorpyrifos applications during cotton production to test the hypotheses that: (1) dermal exposure was an important contributor to internal dose and varied across body regions; and (2) substantial differences would be seen across the three job categories. Applicators were substantially younger and had shorter exposure histories than did technicians and engineers. Applicators and technicians were observed to have relatively high levels of skin or clothing contact with pesticide-treated foliage as they walked through the fields. Both dermal patch loadings of chlorpyrifos and measurements of a chlorpyrifos-specific metabolite (TCPy) in urine confirmed substantial exposure to and skin absorption of chlorpyrifos that varied according to job category; and dermal patch loading was significantly higher on the thighs than on the forearms. These findings support our hypotheses and support the need for research to examine neurobehavioral performance and exposures in this population. More importantly, the exposures reported here are sufficiently high to recommend urgent changes in work practices amongst these workers.