Modelo de desenvolvimento, agrotóxicos e saúde: prioridades para uma agenda de pesquisa e ação Translated title: Development model, pesticides, and health: priorities for research and action agenda

In the spring and summer of 2001, 47 fathers, 48 mothers and 117 children of Iowa farm and non-farm households were recruited to participate in a study investigating take-home pesticide exposure. On two occasions approximately 1 month apart, urine samples from each participant and dust samples from various rooms were collected from each household and were analyzed for atrazine, metolachlor, glyphosate and chlorpyrifos or their metabolites. The adjusted geometric mean (GM) level of the urine metabolite of atrazine was significantly higher in fathers, mothers and children from farm households compared with those from non-farm households (P < or = 0.0001). Urine metabolites of chlorpyrifos were significantly higher in farm fathers (P = 0.02) and marginally higher in farm mothers (P = 0.05) when compared with non-farm fathers and mothers, but metolachlor and glyphosate levels were similar between the two groups. GM levels of the urinary metabolites for chlorpyrifos, metolachlor and glyphosate were not significantly different between farm children and non-farm children. Farm children had significantly higher urinary atrazine and chlorpyrifos levels (P = 0.03 and P = 0.03 respectively) when these pesticides were applied by their fathers prior to sample collection than those of farm children where these pesticides were not recently applied. Urinary metabolite concentration was positively associated with pesticide dust concentration in the homes for all pesticides except atrazine in farm mothers; however, the associations were generally not significant. There were generally good correlations for urinary metabolite levels among members of the same family.

Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide. Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems. Previous research has demonstrated wide variability in incidence rates for APP. This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems. This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world. It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases. Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention. By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.

Organophosphorus esters have the potential to produce several forms of toxicity. Most produce acute intoxication as a result of inhibition of acetylcholinesterase and, if severe, this can have longer lasting secondary consequences such as intermediate syndrome, or even permanent disability. Some esters produce a very specific syndrome of delayed peripheral neuropathy. This neuropathy is always preceded by severe acute intoxication, except in the case of a few specific agents such as tri-o-cresyl phosphate. All of these effects are reasonably well understood and show a dose threshold. Chronic low level exposure in non-poisoned subjects has been associated with impaired neurobehavioral performance in some, but not all, epidemiological studies. The mechanisms involved are not well understood, but if organophosphates do play a causal role, this will not necessarily be via acetylcholinesterase inhibition. Doses too low to produce cholinergic signs have been shown to produce a variety of effects in experimental animals ranging from enhanced maze learning to slowed nerve conduction. It is likely that other, more sensitive, brain proteins are the targets for such actions. Effects mediated via such target proteins would be expected to show very different structure-activity relationships to acute toxicity mediated by acetylcholinesterase. Hence epidemiological studies expecting similar (class) effects from low-dose exposure to different organophosphorus esters may produce variable results or false negatives.