This study estimated the level of underreporting of acute pesticide poisonings (APP) in the pesticide surveillance system in Nicaragua in 2000. Data on pesticide exposure and health effects were assessed in a nationally representative cross-sectional survey of 3,169 persons aged 15 years and older. The authors found 1,369 cases of APP in the official register for 2000. Responses to questionnaires revealed 22 cases of APP in which individuals sought medical attention. Most of these cases involved agricultural workers who spray organophosphate pesticides, mostly class I. In 68 percent of cases, the mean out-of-pocket cost for treatment of one APP episode was $41, almost equivalent to one month's salary. Only 1 of the 22 cases (< 5%) in which the individual sought medical attention was reported to the national register. The authors estimate that, nationally, about 30,000 pesticide poisoning cases receiving medical treatment were not reported. Characterization of APP based only on official figures, without considering the underreported cases, leads to a constant inability to interpret and report acute pesticide health effects in a manner useful to policymakers. The pesticide surveillance system must be strengthened to improve registration routines, analysis and interpretation of data, health personnel training, and participation of private providers.

Background A considerable fraction of newly constructed buildings have indoor air problelns associated with health effects, usually of the nonspecific sick building syndrome variety. Specific health effects such as asthma, rhinitis, and allergic alveolitis can also occur. Case On 1 September 1988 a school teacher showed symptoms of an acute respiratory illness, which was first interpreted as pulmonary embolism and then later as atypical sarcoidosis. The illness slowly progressed over six years, at which time the diagnosis was revised to chronic allergic alveolitis, related to her school environment. The school had had indoor-air quality problems off and on for several years. C O~C~U S~O~S The case illustrates the difficulties of diagnosing cases of chronic allergic alveolitis, especially when it appears in environments where it is not generally encountered. It also raises questions regarding a possible relation between environments associated with the sick building syndrome and the occurrence of building-associated illnesses.

With the aim of exploring possible reasons for dangerous work practices among small-scale farmers in the Pacific plain of Nicaragua, a qualitative study was performed. Four focus groups were involved. The information gathered was analyzed with an emphasis on the farmers' relationships to and perspectives on their crops, the economy, pests, and pesticide hazards. Factors that had been anticipated, such as poverty, inadequacy of protective devices, and environmental factors, were found to lead to dangerous work practices. Cultural factors also affected the farmers' attitudes in ways that favored hazardous work procedures. This finding, which had not been anticipated, has important practical implications. It suggests that, to be effective, education and training courses on occupational health should assure that their design, language, materials, and execution are culturally relevant and appropriate.

No abstract

Objectives-To determine mortality and cancer incidence relative to exposure to phenoxy herbicides. Methods-A cohort of Swedish lumberjacks of which 261 were exposed to phenoxy herbicides, and 250 were unexposed, was followed up for mortality from 1954 to 1994, and for cancer incidence from 1958 to 1992. The number of days of exposure to phenoxy herbicides was determined from pay slips. With the county population as a reference, standardised mortality ratios and cancer incidence ratios (SMR and SIR) were calculated. Results-Mortality and cancer incidence were low with two exceptions; a small but highly exposed group of foremen showed an increased cancer incidence (SIR 274, 95% confidence interval (95% CI) 100 to 596), and over all mortality (SMR 141, 95% CI 68 to 260). Of three cases of nonHodgkin's lymphoma, two were found among the most exposed workers. Conclusions-The results provide some support to claims of previous studies that exposure to phenoxy herbicides might be related to non-Hodgkin's lymphoma and to an increased overall cancer risk. (Occup Environ Med 2000;57:718-720)