Health problems from pesticide exposure and personal protective measures among women cotton workers in southern Pakistan

Occupational Exposure to Pesticides, Personal Protection, and Willingness to Reduce Chemical Sprayings Among Iranian Greenhouse Farmers

OBJECTIVES

The level of greenhouse farmers' personal protection in pesticide use and the possibility of environmental protection through farmers' willingness to reduce chemical sprayings were assessed in Khuzestan Province, Iran.

METHODS

A survey of 80 active greenhouse vegetable growers was carried out in 2021 with face-to-face interviews. Willingness to reduce chemical sprayings was examined with the theory of planned behavior (TPB) model.

RESULTS

Several intoxication symptoms were reported, with the most common symptom of pesticide intoxication being dizziness. Farmers showed unsafe or rather unsafe use of personal protective equipment (PPE) during pesticide handling. The maximum use of PPE pertained to the use of mask, spray clothing, and long-sleeved shirts. On a scale from 1 (= totally disagree) to 5 (= totally agree), the respondents showed negative attitudes towards reducing chemical sprayings (mean = 2.30), rather low levels of subjective norms (mean = 2.67), and rather low levels of perceived behavioral control over reduction of chemical sprayings (mean = 2.76). The TPB variables accounted for 73% of the variance in farmers' behavioral intention. Overall, farmers' behavioral intention to reduce chemical sprayings was almost neutral.

CONCLUSION

Increasing knowledge of the adverse effects of pesticides on health is necessary to promote safety behavior of farmers in the greenhouse.

Insecticide exposure and associated acute health effects in farmers in a rice growing district of India

This study investigated insecticide usage and associated acute health hazards in rice farming in Odisha, India. A retrospective cross-sectional study design was used to collect data from 139 participants, in the post-monsoon period, 2023. The participants were overwhelmingly male, mostly aged 30 and over, with basic literacy and a range of educational attainment, three-quarters ceasing education by 10th grade and a significant number never attending school. Most farmers/farmworkers used low or moderately toxic insecticides in low doses, typically 3 times/year. However, uptake of appropriate PPE was poor when mixing and applying insecticides. Almost two-thirds (63.4%) of participants reported discomfort/illness after insecticide exposure. Over 90% reported up to 3 symptoms, most experiencing skin irritation. The reported health symptoms were significantly higher among those who ate and drank during insecticide application, compared to those who did not. The number of symptoms reported was also significantly higher in participants who had seen or heard of community insecticide poisoning cases in the previous 12 months, compared with those who had not. Further research is needed on barriers to using effective PPE and on information and training on risks and controls of insecticide exposure that are appropriate for rice farmers in Odisha, India.

Current status and future trends of microbial and nematode-based biopesticides for biocontrol of crop pathogens

The increasing public demand to avoid the use of synthetic pesticides and fertilizers in agricultural production systems, causing serious environmental damages, has challenged industry to develop new and effective solutions to manage and control phytopathogens. Biopesticides, particularly microbial-based biopesticides, are a promising new alternative with high biodegradability, specificity, suitability for incorporation into integrated pest management practices, low likelihood of resistance development, and practically no known human health risks. However: expensive production methods, narrow action spectra, susceptibility to environmental conditions, short shelf life, poor storage stability, legislation registry constraints, and general lack of knowledge are slowing down their adoption. In addition to regulatory framework revisions and improved training initiatives, improved preservation methods, thoughtfully designed formulations, and field test validations are needed to offer new microbial- and nematode-based biopesticides with improved efficacy and increased shelf-life. During the last several years, substantial advancements in biopesticide production have been developed. The novelty part of this review written in 2023 is to summarize (i) mechanisms of action of beneficial microorganisms used to increase crop performance and (ii) successful formulation including commercial products for the biological control of phytopathogens based on microorganisms, nematode and/or metabolites.

Omics-Based Approaches in Research on Textile Dye Microbial Decolorization

The development of the textile industry has negative effects on the natural environment. Cotton cultivation, dyeing fabrics, washing, and finishing require a lot of water and energy and use many chemicals. One of the most dangerous pollutants generated by the textile industry is dyes. Most of them are characterized by a complex chemical structure and an unfavorable impact on the environment. Especially azo dyes, whose decomposition by bacteria may lead to the formation of carcinogenic aromatic amines and raise a lot of concern. Using the metabolic potential of microorganisms that biodegrade dyes seems to be a promising solution for their elimination from contaminated environments. The development of omics sciences such as genomics, transcriptomics, proteomics, and metabolomics has allowed for a comprehensive approach to the processes occurring in cells. Especially multi-omics, which combines data from different biomolecular levels, providing an integrative understanding of the whole biodegradation process. Thanks to this, it is possible to elucidate the molecular basis of the mechanisms of dye biodegradation and to develop effective methods of bioremediation of dye-contaminated environments.

The Environment and Headache: a Narrative Review

PURPOSE OF REVIEW

In this narrative review, we summarize the peer-reviewed literature published between 2017 and 2022 that evaluated ambient environmental risk factors for primary headache disorders, which affect more than half of the population globally. Primary headache disorders include migraine, tension-type headache (TTH), and trigeminal and autonomic cephalalgias (TAC).

RECENT FINDINGS

We identified 17 articles that met the inclusion criteria via PubMed or Google Scholar. Seven studies (41%) relied on data from US populations. The remaining studies were conducted in China, Taiwan, Germany, Ghana, Japan, the Netherlands, South Korea, and Turkey. Air pollution was the most frequently assessed environmental risk factor. Most studies were cross-sectional and focused on all-cause or migraine headaches; one study included TTH, and none included TAC. Short-term exposure to fine particulate matter (PM2.5) was not consistently associated with headache endpoints, but long-term exposure to PM2.5 was associated with migraine headache prevalence and severity across multiple studies. Elevated ambient temperature, changes in weather, oil and gas well exposure, and less natural greenspace, but not noise pollution, were also associated with headache. No studies considered water pollution, metal exposure, ultrafine particulate matter, or wildfire smoke exposure. There is a need for ongoing research focused on headache and the environment. Study designs with the greatest explanatory power may include longitudinal studies that capture the episodic nature of headache and case-crossover analysis, which control for time-invariant individual-level confounders by design. There is also a clear need for research that considers comorbid psychiatric illness and socioeconomic position as powerful modifiers of the effect of the environment on headache.

Factors affecting safe pesticide-use behaviors among farm plant agriculturists in northeastern Thailand

BACKGROUND

Pesticide poisoning is a major public health problem in Thailand and is the result of intensive inappropriate and unsafe use of pesticides. This analytical cross-sectional study aimed to determine the factors affecting safe pesticide-use behaviors among farm plant agriculturists in northeastern Thailand.

METHODS

The study sample included 427 farm plant agriculturists in Loei Province, northeastern Thailand. Individuals were randomly selected by a multistage random sampling technique. The following data were collected via a self-administered questionnaire consisting of 8 parts: (1) sociodemographic characteristics, (2) knowledge about pesticide use, (3) perceived severity of impact from pesticide use among farm plant agriculturists, (4) perceived susceptibility to pesticide use, (5) perceived self-efficacy in the modification of safe pesticide-use behaviors, (6) perceived outcome of the modification of safe pesticide-use behaviors, (7) social support, and (8) safe pesticide-use behaviors. Frequencies, percentages, means, standard deviations, and multiple regression analyses were employed for data analysis.

RESULTS

The majority of participants (79.4%) had high scores for safe pesticide-use behaviors among farm plant agriculturists (scores of 112-150). Factors that significantly affected safe pesticide-use behaviors included knowledge about pesticide use (β = 0.282), social support (β = 0.217), reading information from pesticide labels before pesticide use (β = 0.207), perceived self-efficacy (β = 0.186), female sex (β = -0.140), rice farmer status (β = 0.129), corn farmer status (β = 0.127), perceived susceptibility (β = 0.126), having received information from the internet (β = -0.124), and perceived severity (β = -0.098). Together, these 10 factors were found to explain 32.5% of the safe pesticide-use behaviors among farm plant agriculturists.

CONCLUSIONS

Our findings indicate that there is a need to increase the number of promotional activities related to the safe use of pesticides through social support and training, with the aim of increasing the overall level of knowledge, perceived self-efficacy, perceived susceptibility, and modification of the perceived impact severity of pesticide use. Thus, relevant agencies should promote and support the safe use of pesticides by farm plant agriculturists. This study revealed that the factors affecting safe pesticide-use behaviors among farm plant agriculturists included knowledge about pesticide use, social support, reading pesticide container labels, perceived self-efficacy in the modification of pesticide-use behaviors, sex, rice farmer status, corn farmer status, perceived susceptibility to pesticide use, having received information from the internet, and perceived severity of impact from pesticide use.

A systematic review of work-related health problems of factory workers in the textile and fashion industry

OBJECTIVES

The purpose of this study was to present a systematic review of the health-related problems of factory workers in the textile and fashion industry. These workers endure long sitting postures, poor workspace conditions, and long working hours to complete their overload of tasks. This situation results in several health problems that affect the productivity, mental health, and well-being of the workers.

METHODS

The relevant data (21 article publications) were obtained from the Scopus database. Analysis of the 21 articles was grouped under 3 research themes based on the critical reading of the content and abstracts: respiratory problems, musculoskeletal disorders, and psychological stressors and other health issues.

RESULTS

The findings show that factory workers are exposed to dust particles of cotton and other raw materials, fumes, and chemicals from manufacturing processes. This prolonged exposure without the use of personal protective equipment (PPE) leads to respiratory diseases like byssinosis that affect the workers' health. Additionally, working in a particular posture due to the workstation design for prolonged hours causes musculoskeletal disorders or pains. Workers also suffer from anxiety, depression, and stress from workload and pressure, hence making them unstable with reduced productivity.

CONCLUSIONS

The findings of the study reinforce the need for a safe workspace and spacious work environment, provision of PPE, training in occupational hazards, frequent health checks, and ergonomic assessment of workstations to reduce prolonged work postures. Stakeholders, employers, policymakers, and governments should collaborate to safeguard and protect the well-being and health of the workers at these factories.

Recent Development and Applications of Stretchable SERS Substrates

Surface-enhanced Raman scattering (SERS) is a cutting-edge technique for highly sensitive analysis of chemicals and molecules. Traditional SERS-active nanostructures are constructed on rigid substrates where the nanogaps providing hot-spots of Raman signals are fixed, and sample loading is unsatisfactory due to the unconformable attachment of substrates on irregular sample surfaces. A flexible SERS substrate enables conformable sample loading and, thus, highly sensitive Raman detection but still with limited detection capabilities. Stretchable SERS substrates with flexible sample loading structures and controllable hot-spot size provide a new strategy for improving the sample loading efficiency and SERS detection sensitivity. This review summarizes and discusses recent development and applications of the newly conceptual stretchable SERS substrates. A roadmap of the development of SERS substrates is reviewed, and fabrication techniques of stretchable SERS substrates are summarized, followed by an exhibition of the applications of these stretchable SERS substrates. Finally, challenges and perspectives of the stretchable SERS substrates are presented. This review provides an overview of the development of SERS substrates and sheds light on the design, fabrication, and application of stretchable SERS systems.

Eco-friendly approaches of zinc oxide and silver nitrate nanoparticles along with plant extracts against Spodoptera litura (Fabricius) under laboratory conditions

The tobacco cutworm (Spodoptera litura) is a widespread pest that inflicts severe damage on various crops, including cotton, tobacco, and vegetables, with a particular preference for solanaceous plants. Traditional control methods often rely heavily on synthetic insecticides, leading to adverse effects on the environment, human health, and the development of insecticide resistance. In light of these challenges, this study explores the potential of nanotechnology as an innovative and sustainable approach to combat this notorious pest. Bioassays were conducted using laboratory-reared 3rd instar S. litura larvae. Eight different plant extracts coated with zinc oxide and silver nitrate nanoparticles were tested, with concentrations in both distilled water and ethanol at 3, 5, and 7 ml. Data were collected at 24, 48, and 72-h intervals. The results revealed that the highest larval mortality, reaching 98%, was observed in the group treated with silver nitrate nanoparticles derived from Cymbopogon citratus. In comparison, the group treated with zinc oxide nanoparticles dissolved in ethanol exhibited a larval mortality rate of 90%. Ethanol is a polar solvent that is widely used in the synthesis of nanocomposites. It is capable of forming strong hydrogen bonds with oxygen atoms, making it a good dispersant for zinc oxide nanoparticles. Additionally, ethanol has a low boiling point and a non-toxic nature, which makes it a safe and effective option for the dispersion of nanoparticles. Notably, the study concluded that silver nanoparticles combined with ethanol exhibited prolonged and more potent toxic effects against S. litura when compared to zinc oxide nanoparticles. Overall, this research underscores the potential of nanotechnology as a valuable component of Integrated Pest Management (IPM) strategies. By integrating nanotechnology into pest management practices, we can promote sustainable and environmentally friendly approaches that benefit both farmers and the ecosystem.

Hydrophobic-action-driven removal of six organophosphorus pesticides from tea infusion by modified carbonized bacterial cellulose

The abuse of organophosphorus pesticides (OPPs) in tea planting makes it easy to transfer from tea into its infusion, bringing potential health risks to consumers. Thus, it is essential to adopt reliable techniques to remove OPPs from tea infusion. In this study, three treatment methods were used to modify carbonized bacterial cellulose (CBC) to improve its adsorption performance. Among them, CBC treated by hydrazine hydrate (N-CBC) had the best adsorption effect, whose removal rate for dicrotophos is 13 times that of CBC. The in-depth study of adsorption mechanism proved that hydrophobic interaction dominated the adsorption of OPPs onto N-CBC. The pseudo-second-order kinetic model and Langmuir isotherm model were more suitable to describe the process. Additionally, there were no significant changes in tea infusion quality after N-CBC treatment. This work clarifies that N-CBC benefitted from simple preparation method, excellent adsorption performance and unique adsorption mechanism has potential applications in tea infusion.

Pesticide Use Practice and Associated Factors Among Rural Community of Malga District, Sidama Regional State, South Ethiopia

In Ethiopia, like that of the other developing countries, pesticides are widely used for a variety of purposes, but their unsafe use causes a major environmental and health hazard. The aim of this study was to assess pesticide use practice and its associated factors among the rural community of Malga district, Sidama region, southern Ethiopia. A community based cross-sectional study was conducted from February to March 2021 at Malga District. Data were collected from 549 farmers by a structured and pretested interviewer-administered questionnaire. Binary and multivariable logistic regression was used for the data analysis. Adjusted odds ratios and their 95% confidence intervals (CIs) were calculated to determine the association between safe practices of pesticide use and several related factors. Safe practice of pesticide use was observed in 193 (35.2%). The participants who had primary education [AOR = 5.605, 95% CI: 3.309, 9.495], secondary education and above [AOR = 9.847, 95% CI: 5.007, 19.368], used pesticide for 10 years and above [AOR = 6.790, 95% CI: 3.589, 12.843], used pesticide between 6 and 10 years [AOR = 1.913, 95% CI: 1.166, 3.141] pesticide bought from any shop [AOR = 2.320, 95% CI: 1.364, 3.947], agricultural office [AOR = 7.187, 95% CI: 3.654, 14.137] were associated with safe use of pesticides. The safe practice of pesticide use was low in the study area. Continuous training programs should be implemented on the safe practice of pesticide use to the local farmers.

Aging in Rural Communities

Purpose of Review

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent Findings

The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary

Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

The dual impacts of specialized agricultural services on pesticide application intensity: Evidence from China

BACKGROUND

Specialized agricultural services are a new trend in agricultural production around the world, especially in developing countries. However, the growing impacts of specialized agricultural services on pesticide application intensity are unclear. In regions facing pesticide overuse, do specialized agricultural services exacerbate or mitigate the problem?

RESULTS

Based on province-level panel data from China from 2004 to 2018, this study examines the impact of specialized agricultural services on pesticide application intensity, considering both direct and indirect (i.e. spatial spillover) effects. The dual impacts of specialized agricultural services on pesticide application intensity in China are identified. First, specialized agricultural services directly increase pesticide application intensity, likely due to increased cultivation and specialized management of land that was previously abandoned or marginally managed. Second, there is a negative indirect or spatial spillover effect of specialized agricultural services on pesticide application intensity, likely due to technology and efficiency diffusion enabled by the cross-regional provision of specialized agricultural services. The net impact of specialized agricultural services on pesticide application intensity is negative.

CONCLUSION

Crop protection services are regarded as the core force to promote the reduction of pesticide application intensity. Steps should be taken to promote the research and development, demonstration, and promotion of new technologies and equipment for crop protection services, particularly the development of crop protection by drones. © 2022 Society of Chemical Industry.

Pesticide use safety practices and associated factors among farmers in Fogera district wetland areas, south Gondar zone, Northwest Ethiopia

BACKGROUND

Farmers in developing countries, including Ethiopia, are exposed to agricultural pesticides, including pesticides that are restricted or banned in developed countries. There is little information available on pesticide use safety practices and associated factors among Ethiopian farmers, particularly in the study area.

OBJECTIVE

To assess pesticide use safety practices and associated factors among farmers in Fogera district wetland area, Amhara region, Northwest Ethiopia.

METHODS

A community-based cross-sectional study design that employs quantitative and qualitative methods was used from August 25 to September 30, 2021. Four hundred thirty participants were included by using a stratified random sampling technique. Pre-tested interview questionnaires, observational checklists, and key informant and in-depth interview guides were used to collect data. The quantitative data were collected by face-to-face interviews of farmers, whereas the qualitative data were collected by in-depth interviews of selected farmers and key informant interviews of responsible stalk holders. The data were entered into Epi data version 4.6 and analyzed using SPSS version 21. Bi-variable logistic regression was used to identify factors associated with the dependent variable. A p-value of less than 0.05 was used as a cut-off point to declare a statistically significant association between factors and outcome variables. The odds ratio and 95% CI were calculated to describe the strength of the association between factors and outcome variables. The qualitative study included 35 respondents from various backgrounds and levels of expertise, which were analyzed using thematic analysis by open-code 4.03 version software.

RESULT

The proportion of good pesticide use safety practices in the study area was 24.4% (95% CI: 21.4%-29.3%). Educational status (adjusted odds ratio (AOR): 3.19, 95% CI: 1.44-6.71), experience of pesticide spraying (AOR: 6.85. 95% CI: 2.426-9.35), knowledge of pesticide usage (AOR: 3.40, 95% CI: 1.459-7.855), access to safety materials (AOR: 2.06, 95% CI: 1.198-3.536), and ever having received training (AOR: 4.93, 95% CI: 2.88-8.59) were factors associated with good safety practice in pesticide use. Qualitatively, limited material access, lack of government attention, insufficient training opportunities, absence of media coverage, weak enforcement of laws, and limited guideline access barred good safety practices for pesticide use.

CONCLUSION

The study revealed that good safety practices were low in the study area. Being educated, having experience with pesticide spraying, having good knowledge of pesticide usage, having access to safety materials, and having received pesticide use training all increased the likelihood of good pesticide use practice. Insufficient training opportunities and material access, weak law enforcement, limited access to guidelines, and a shortage of media coverage were challenges identified qualitatively.

Occupational and environmental pesticide exposure and associated health risks among pesticide applicators and non-applicator residents in rural Ethiopia

Intensive pesticide use increased concern about the potential acute and chronic health effects of pesticides in general and among applicators in particular. This study aims to explore occupational and environmental pesticide exposure and health risks among pesticide applicators and residents. A community-based cross-sectional study was conducted involving 1,073 individuals. We examined the health effects potentially attributable to pesticide exposure using regression to estimate prevalence ratios (PR). A higher proportion of good knowledge of pesticides [75 vs. 14%; APR = 1.542 (1.358-1.752), p < 0.001] and a higher mean score of perceived health risk of pesticide use [4.21 vs. 3.90; APR = 1.079 (1.004-1.159), p < 0.05] were observed among applicators than residents. A significantly higher proportion of applicators experienced health effects presumably related to pesticide exposure among themselves (36%) than residents (16%), and a higher proportion of them used prescribed drugs in the past 12 months [51 vs. 32%; APR = 1.140 (1.003-1.295), p < 0.05]. Skin irritation, shortness of breath, cough, and dizziness were more likely reported by applicators than residents. Perceived toxicity of currently applied pesticide products, mix pesticides without gloves, regularly maintain and wash sprayer tank after application, occurrence of an incidental splash during mixing and application, and using home-based care after experiencing a symptom presumably due to pesticide exposure were significantly associated with health effects among applicators. Use of face mask and visiting health facility when experiencing a symptom presumably due to pesticide exposure were significantly positively correlated with attending training on the health risks and use of pesticides. A substantial proportion of applicators reported improper use of preventive measures and methods of pesticide waste disposal. These observations point out that applicators can face high health risks of occupational pesticide exposure in Ethiopia. Even trained applicators pursued poor preventive practices; hence, comprehensive practice-oriented in-depth training focusing on safety precautions and proper use of personal protective equipment, and provision of adequate pesticide waste disposal means are crucial interventions.

Occupational exposure to pesticides and its association with telomere length - A systematic review and meta-analysis

BACKGROUND

Telomere length is a common biomarker for the cumulative effect of environmental factors on aging-related diseases, therefore an association has been hypothesized between occupational exposure to pesticides and shorter telomere length.

OBJECTIVE

This study is a systematic review and meta-analysis aiming to examine the association between telomere length and occupational exposure to pesticides.

METHODS

We systematically searched in SciELO, PubMed, Scopus, Embase, Cochrane, Lilacs, Science Direct, and Web of Science databases for all observational studies containing measurements of telomere length on groups occupationally exposed to pesticides. Data were synthesized through qualitative synthesis and meta-analysis. We estimated the associations between exposed and non-exposed groups by using the natural log of the response ratio (lnRR). Heterogeneity was quantified using the Cochran Q test and I² statistics.

RESULTS

Six studies were included in the qualitative synthesis and meta-analysis, with a total of 480 participants exposed to pesticides. The time of exposure evaluated 391 participants that had a range of 5 to >30 years of occupational exposure. Most studies presented shorter telomere length in the occupationally exposed group. From the six studies included in the meta-analysis, three presented telomere length measurement as a single copy gene (T/S), and three presented telomere length measurement as base pairs (bp). The statistical analysis pooled estimates (log ratio of means) of the telomere length in both measurements (T/S and bp) showed a shortening of telomere length in the exposed group when compared with the non-exposed (control) group. Two of six studies reported longer telomere length in the group exposed to pesticides.

DISCUSSION

Our findings suggest an association between occupational exposure to pesticides and shorter telomere length. However, we found a small number of studies to include in our meta-analysis, being required more high-quality studies to strengthen our findings and conclusions.

Impact of organization decision making styles and safety accountability on occupational health and safety implementation: The moderating role of mimetic motives

The agriculture sector is a traditional economic pillar of many emerging economies. However, it is facing greater occupational health and safety (OHS) challenges in Pakistan, and its performance is continuously decreasing. An effective OHS implementation provides better control over OHS challenges and may help to restore its former glory. Therefore, this study aims to explore different organizational decision-making styles and safety accountability to put OHS into practice in this sector. Based on institutional theory, a theoretical framework was developed. Two hundred and eighty-seven agriculture farms in Punjab, Pakistan were surveyed and analyzed using SmartPLS 3.3.7. The findings revealed that implementation styles (rational and incremental) and safety accountability positively impact OHS implementation. Similarly, the moderating role of mimetic motives was found positively significant in the relationship between rational style and OHS implementation, and negatively significant in the relationship between incremental style and OHS implementation. While no moderating effect of mimetic motive was found between safety accountability and OHS implementation. This study suggested that OHS implementation should not be viewed as a social or technical issue alone. Strategic arrangements should be made at the organizational level to gain better control over OHS challenges by considering the institutional environment in which the organization operates.

Intensivmedizinische Versorgung von Patienten mit akuter Intoxikation in Deutschland – ein Rückblick über 20 Jahre

Hintergrund

Die vorliegende Studie präsentiert ein Kollektiv akut intoxikierter Patienten, die in den letzten 2 Jahrzehnten auf eine medizinische Intensivstation eines tertiären Versorgungszentrums in Deutschland aufgenommen wurden.

Ziel der Arbeit

Das Ziel der Studie bestand darin, einen Überblick zur akuten Intoxikation als relevantes intensivmedizinisches Krankheitsbild und hiermit assoziierte klinische Charakteristika sowie die Prognose der betroffenen Patienten zu bieten.

Material und Methoden

Die Studienkohorte umfasst 1030 Patienten, die in den Jahren1999–2019 aufgrund einer akuten Vergiftung auf die medizinische Intensivstation der Uniklinik RWTH Aachen aufgenommen wurden. Demographische und klinische Merkmale sowie das klinische Management wurden detailliert analysiert und zwischen alters- und geschlechtsspezifischen Untergruppen verglichen.

Ergebnisse

Suizidversuche stellten die häufigste Ursache für die intensivmedizinische Aufnahme intoxikierter Patienten dar. Insbesondere führten Medikamente, v. a. Antidepressiva, zu einer akuten Vergiftung. Die Substanzen variierten hierbei je nach Geschlecht und Alter der betroffenen Patienten. In der Subgruppe der älteren Patienten stellten Benzodiazepine die am häufigsten verwendeten Substanzen dar. 286 Patienten (28 %) entwickelten ≥ 1 Organversagen. Die Gesamtmortalität betrug 2,6 %. Im Vergleich der ersten (1999–2009) mit der zweiten Dekade (2010–2019) des Beobachtungszeitraums zeigte sich ein Trend zu einer häufigeren Einnahme von Antidepressiva und Alkohol, während die Verwendung von Benzodiazepinen rückläufig war.

Diskussion

Obwohl die Gesamtmortalität im beobachteten Kollektiv gering ist, repräsentieren akut vergiftete Patienten fast 10 % aller Einweisungen auf die Intensivstation und beanspruchen insbesondere in Zeiten begrenzter Intensivkapazitäten wertvolle Ressourcen.

Attitudinal behaviour of agriculturalists towards pesticide use in Pir Panjal Range of Kashmir Himalayas

BACKGROUND

Attainment of safety during pesticide spraying relies on the farmer's knowledge of pesticide use, attitude and sense of safety. However, such investigations are insufficient in the current study area.

METHODS

The study is based on a primary survey of 384 orchardists about the myriad of aspects affecting the use of pesticides and their subsequent effects.

RESULTS

The study revealed that knowledge, attitude, and perception had a weighted average index (WAI) and a standard deviation (SD) of 2.85 ± 1.17, 3.55 ± 1.34, and 3.81 ± 0.98 correspondingly. The findings reflect the farmers have a low to moderate level of knowledge, a moderate attitude toward pesticides, and a favourable perception on their utilization. Thus, for farmer personal protective equipment (PPE) use, it scored 2.77 ± 0.90 on the WAI scale, indicating that most farmers use PPEs 'rarely to occasionally' and that none use full protective gear. Furthermore, attitude and PPE usage exhibited a negative relationship with age, as younger people use PPE more than older ones. The findings were consistent for both farming experience and PPE usage. Moreover, there exists a positive association between age with perception and farming experience, knowledge with perception and PPE use, and attitude with perception.

CONCLUSIONS

The coefficient of determination (R²) shows that 67.2% of the variability in farmers' PPE use was attributed to factors including knowledge, attitude, perception, and education. A favorable behavioral shift in pesticide usage may be achieved by enhancing farmers' knowledge, attitudes and perceptions, and adequate PPE usage.

Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis

Purpose

As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics.

Methods

A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews.

Results

One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes.

Conclusions

To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.

Prenatal organophosphate exposure can cause adverse birth outcomes to humans

Organophosphate (OP) pesticides may accumulate in pregnant agricultural workers, resulting in adverse effects on the growth and development of the fetus and neonates. This study aims to evaluate a possible association between prenatal urinary OP metabolite levels among pregnant agricultural workers and birth outcomes of infants. This study also investigated the factors associated with urinary OP metabolites among pregnant agricultural workers. The spot urine samples were collected and analyzed for six OP metabolite levels. Birth outcomes data were abstracted from medical records. Multiple regression analysis found that gestational age at childbirth was negatively associated with diethylphosphate (DEP) levels (β = -0.073; 95% CI, -0.121, -0.024). Apgar score at 1 and 5 min after birth were negatively associated with diethyldithiophosphate (DEDTP) levels (β = -0.036; 95% CI, -0.069, -0.003; and β = -0.034, 95% CI, -0.057, -0.011, respectively). In addition, DEDTP levels were negatively associated with maternal age (β = -0.181; 95% CI, -0.339, -0.023), and dimethylphosphate (DMP) levels were positively associated with frequency of agricultural work during pregnancy (β = 31.554; 95% CI, 0.194, 62.914). Our results indicate that prenatal OP exposure can cause adverse birth outcomes in babies. Therefore, it is necessary to develop an effective strategy for reducing prenatal exposure to OP pesticides.

Occupational hazards, health costs, and pesticide handling practices among vegetable growers in Pakistan

Disregarding protective measures when handling pesticides in agricultural production imposes increased health risks and health costs on farmers as well as degrades the natural ecosystem. In Pakistan, where agriculture is the prime occupation in rural communities, there is overwhelming evidence of indiscriminate use of hazardous pesticides by farmers without taking adequate precautions. Using cross-sectional data, we examined personal protection and health costs to vegetable growers due to pesticide exposure and determinants of farmers' pesticide handling practices. The theory of averting behavior was used, and the possible factors affecting farmers' adoption of safety equipment and of disposal methods for pesticide containers were estimated using a logit model. Health effects (P < 0.05) and farmers' protection and health costs (P < 0.01) are found as important determinants of farmers' adoption of safety equipment and of disposal methods for pesticide containers. The mean protection and health cost of pesticide exposure per farmer per vegetable season in 2019 was US $3.60. Analytical outcomes indicate that safe and recommended pesticide handling practices are needed to be introduced through adequate integrated pest management (IPM) training programs and by improving farmers' formal education. Thus, creating awareness through IPM training programs among vegetable growers and enhancing formal education to encourage the adoption of precautionary measures and safe disposal methods for pesticide containers may reduce health risks and health costs. Findings imply that adoption of adequate pesticide handling practices would further help reduce occupational hazards and promote sustainable agriculture in Pakistan.

The changing epidemiology of hemorrhagic fever with renal syndrome in Southeastern China during 1963-2020: A retrospective analysis of surveillance data

Background

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by hantavirus which was endemic Zhejiang Province, China. In this study, we aim to explore the changing epidemiology of HFRS in Zhejiang, identify high-risk areas and populations, and evaluate relevant policies and interventions to better improve HFRS control and prevention.

Methods

Surveillance data on HFRS during 1963–2020 in Zhejiang Province were extracted from Zhejiang Provincial Center for Disease Control and Prevention archives and the Chinese Notifiable Disease Reporting System. The changing epidemiological characteristics of HFRS including seasonal distribution, geographical distribution, and demographic features, were analyzed using joinpoint regression, autoregressive integrated moving average model, descriptive statistical methods, and Spatio-temporal cluster analysis.

Results

From 1963 to 2020, 114 071 HFRS cases and 1269 deaths were reported in Zhejiang Province. The incidence increased sharply from 1973 and peaked in 1986, then decreased steadily and maintained a stable incidence from 2004. HFRS cases were reported in all 11 prefecture-level cities of Zhejiang Province from 1963 to 2020. The joint region (Shengzhou, Xinchang, Tiantai, and surrounding areas), and Kaihua County are the most seriously affected regions throughout time. After 1990, the first HFRS incidence peak was in May-June, with another one from November to January. Most HFRS cases occurred in 21- (26.48%) and 30- years group (24.25%) from 1991 to 2004, but 41- (25.75%) and 51-years (23.30%) had the highest proportion from 2005 to 2020. Farmers accounted for most cases (78.10%), and cases are predominantly males with a male-to-female ratio of 2.6:1. It was found that the median time from onset to diagnosis was 6.5 days (IQR 3.75–10.42), and the time from diagnosis to disease report was significantly shortened after 2011.

Conclusions

We observed dynamic changes in the seasonal distribution, geographical distribution, and demographic features of HFRS, which should be well considered in the development of control and prevention strategies in future. Additional researches are warranted to elucidate the environmental, meteorological, and social factors associated with HFRS incidence in different decades.

This study conducted a long-term and systematic study on the epidemiological characteristics of HFRS in Zhejiang Province from 1963 to 2020 through a combination of time and space analysis and epidemiology, aiming to analyze the distribution characteristics of HFRS and explore the high incidence of epidemics in Zhejiang Province Regional influence. From 1963 to 2020, all 11 prefecture-level cities in Zhejiang Province reported HFRS cases, and the morbidity and mortality rates decreased significantly. However, the geographical distribution of endemic areas has been expanding to eastern Zhejiang Province. Moreover, the age of high-risk groups increases over time. Although the incidence rate has declined in recent years, HFRS is still a huge threat to people’s health. As the incidence rate changes, some epidemiological characteristics have also changed. Comprehensive interventions should also be adjusted, including rodent control in endemic areas, health education, vaccination, and improved detection and diagnosis capabilities for HFRS epidemiological changes.

Assessment of respiratory exposure to cypermethrin among farmers and farm workers of Shiraz, Iran

Cypermethrin, a member of the synthetic pyrethroids group, is a popular insecticide used to eliminate a broad range of common bugs in agricultural lands and households. However, studies of farmers' exposure to this insecticide are limited. The present study aimed to measure the respiratory exposure to cypermethrin among farmers and farm workers of Shiraz, as one of the biggest cities in Fars province, Iran. Totally, nine target regions were selected, where 42 individual samples were taken using XAD-2 sorbents and were analyzed by gas chromatography-electron capture detector (GC-ECD). This is the first study on farmers' exposure to insecticides during spraying in Iran. The average concentration of cypermethrin vapor in farmers' respiratory area during spraying was 0.982 ± 0.421 mg/m³, which was lower than the permitted threshold value for cypermethrin recommended by the Occupational Safety and Health Administration (OSHA). The mean time-weighted average (TWA) was also evaluated in two distinct occupational groups (tree operators and field operators). The exposure was significantly higher in tree operators than in field operators. A direct correlation was also found between the height of the workers and the amount of cypermethrin (Spearman's r = 0.555). Findings support that farm workers' respiratory exposure to cypermethrin was within the permissible range, but this situation cannot guarantee workers' safety. Total respiratory exposure and skin exposure studies are recommended in future research.

Oxidative stress and DNA damage in agricultural workers after exposure to pesticides

BACKGROUND

Recent epidemiological studies on workers describe that exposure to pesticides can induce oxidative stress by increased production of free radicals that can accumulate in the cell and damage biological macromolecules, for example, RNA, DNA, DNA repair proteins and other proteins and/or modify antioxidant defense mechanisms, as well as detoxification and scavenger enzymes. This study aimed to assess oxidative stress and DNA damage among workers exposed to pesticides.

METHODS

For this purpose, 52 pesticide exposed workers and 52 organic farmers were enrolled. They were assessed: the pesticide exposure, thiobarbituric acid reactive substances (TBARS), total glutathione (TG), oxidized glutathione levels (GSSG), and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), levels.

RESULTS

Correlation between pesticide exposure was positively associated with high TBARS and 8-oxodG levels (p <  0.001). A negative association was founded with TG and GSSG and pesticide exposure.

CONCLUSIONS

The present investigation results seem to indicate a mild augment in oxidative stress associated with pesticide exposure, followed by an adaptive response to increase the antioxidant defenses to prevent sustained oxidative adverse effects stress.

Oxidative stress and DNA damage in agricultural workers after exposure to pesticides

BACKGROUND

Recent epidemiological studies on workers describe that exposure to pesticides can induce oxidative stress by increased production of free radicals that can accumulate in the cell and damage biological macromolecules, for example, RNA, DNA, DNA repair proteins and other proteins and/or modify antioxidant defense mechanisms, as well as detoxification and scavenger enzymes. This study aimed to assess oxidative stress and DNA damage among workers exposed to pesticides.

METHODS

For this purpose, 52 pesticide exposed workers and 52 organic farmers were enrolled. They were assessed: the pesticide exposure, thiobarbituric acid reactive substances (TBARS), total glutathione (TG), oxidized glutathione levels (GSSG), and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), levels.

RESULTS

Correlation between pesticide exposure was positively associated with high TBARS and 8-oxodG levels (p <  0.001). A negative association was founded with TG and GSSG and pesticide exposure.

CONCLUSIONS

The present investigation results seem to indicate a mild augment in oxidative stress associated with pesticide exposure, followed by an adaptive response to increase the antioxidant defenses to prevent sustained oxidative adverse effects stress.

Emerging nanobiotechnology in agriculture for the management of pesticide residues

Utilization of pesticides is often necessary for meeting commercial requirements for crop quality and yield. However, incessant global pesticide use poses potential risks to human and ecosystem health. This situation increases the urgency of developing nano-biotechnology-assisted pesticide formulations that have high efficacy and low risk of side effects. The risks associated with both conventional and nanopesticides are summarized in this review. Moreover, the management of residual pesticides is still a global challenge. The contamination of soil and water resources with pesticides has adverse impact over agricultural productivity and food security; ultimately posing threats to living organisms. Pesticide residues in the eco-system may be treated via several biological and physicochemical processes, such as microbe-based degradation and advanced oxidation processes. With these issues in mind, we present a review that explores both existing and emerging techniques for management of pesticide residues and environmental risks. These techniques can offer a sustainable solution to revitalize the tarnished water/soil resources. Further, state-of-the-art research approaches to investigate biotechnological alternatives to conventional pesticides are discussed along with future prospects and mitigation techniques are recommended.

Impact of better cotton initiative on health cost and pesticide exposure of women cotton pickers in Punjab, Pakistan

Cotton picking is an exclusive work that is performed only by women in Pakistan. They are directly exposed to pesticide as cotton picking is usually done without protective measures which cause destructive effects on their health. Better cotton standard system involves trainings of cotton pickers to use precautionary measures and avoid pesticide exposure. The current study has been conducted to explore the health cost of women cotton pickers in conventional versus better cotton in Punjab, Pakistan. Primary data were collected from 600 cotton pickers through an organized questionnaire from three districts (Layyah, Toba Tek Singh, and Bahawalnagar). Ordinary least square method was used to find the pesticide exposure and socioeconomic factors affecting the health cost of women cotton pickers. The study shows that total cost per person, cost of medication, productivity loss, cost of accompanied person, and dietary expenses in better cotton are significantly less than those in the conventional cotton. Cost of precautionary measures in better cotton is significantly higher than conventional cotton as better cotton pickers are trained to use precautionary measures. Moreover, education, distance from hospital, and precautionary measures affect health cost significantly. Results suggest that education should be improved in rural areas. Better cotton standard system should be promoted in Pakistan through education and other training programs. Women cotton pickers should be encouraged to use protective measures.

Pesticide exposure and adverse health effects associated with farmwork in Northern Thailand

OBJECTIVES

To assess pesticide exposure and understand the resultant health effects of agricultural workers in Northern Thailand.

METHODS

This was a cross-sectional study. We quantified exposure to pesticides, including chlorpyrifos, methomyl, and metalaxyl, by air sampling and liquid chromatography/mass spectrometry. We estimated differences in self-reported health outcomes, complete blood counts, cholinesterase activity, and serum/urine calcium and creatinine concentrations at baseline between farmworkers and comparison workers, and after pesticide spraying in farmworkers only.

RESULTS

This study included 97 men between the ages of 22 and 76 years; 70 were conventional farmworkers; and 27 did not report any prior farmwork or pesticide spraying. None of the farmworkers wore standardized personal protective equipment (PPE) for the concentrated chemicals they were working with. Methomyl (8.4-13 481.9 ng/m3 ), ethyl chlorpyrifos (11.6-67 759 ng/m3 ), and metalaxyl (13.9-41 191.3 ng/m3 ) were detected via personal air sampling. When it came to reporting confidence in the ability to handle personal problems, only 43% of farmworkers reported feeling confident, which reflects higher stress levels in comparison to 78% of comparison workers (P = .028). Farmworkers also had significantly lower monocyte counts (P = .01), serum calcium (P = .01), red blood count (P = .01), white blood cell count (P = .04), and butyrylcholinesterase activity (P < .0001), relative to comparison workers. After adjusting for body mass index (BMI), age, and smoking, methomyl air concentrations were associated with a decrease in farmworker acetylcholinesterase activity (beta = -0.327, P = .016).

CONCLUSIONS

This population of farmworkers had significant alterations in stress measures and clinical biomarkers, including decreased blood cell counts and cholinesterase activity, relative to matched controls. These changes are potentially linked to occupational pesticide exposures. Improving PPE use presents a likely route for preventive intervention in this population.

The level of Cry1Ac endotoxin and its efficacy against H. armigera in Bt cotton at large scale in Pakistan

A biophysical survey was conducted in 15 cotton-growing districts of Pakistan. Four hundred cotton growers were approached and inquired about the production technology of Bt cotton. Further, 25 strip tests using combo strips (Cry1Ac, Cry2Ab, Vip3Aa and Cp4, EPSPS gene) were performed at each farmer’s field. Out of 10,000 total-tested samples, farmers claimed 9682 samples as Bt and 318 samples as non-Bt. After performing a strip test, 1009 and 87 samples were found false negative and false positive, respectively. Only 53 samples were found positive for Cry2Ab, 214 for EPSPS and none for Vip3Aa gene. Quantification of Cry endotoxin and bioassay studies were performed by taking leaves from upper, middle, and lower canopies, and fruiting parts at approximately 80 days after sowing from 89 varieties. Expression was highly variable among different canopies and fruiting parts. Moreover, Cry endotoxin expression and insect mortality varied significantly among varieties from 0.26 µg g⁻¹ to 3.54 µg g⁻¹ with mortality ranging from 28 to 97%, respectively. Highest Cry1Ac expression (3.54 µg g⁻¹) and insect mortality (97%) were observed for variety FH-142 from DG Khan. Cry endotoxin expression varied significantly across various plant parts, i.e., IUB-13 variety from upper canopy documented 0.34 µg g⁻¹ expression with 37% insect mortality in Layyah to 3.42 µg g⁻¹ expression and 96% insect mortality from DG Khan. Lethal dose, LD95 (2.20 µg g⁻¹) of Cry1Ac endotoxin was optimized for effective control of H. armigera. Our results provided evidence of practical resistance in H. armigera and way forward.

Assessing and Prioritizing the Climate Change Policy Objectives for Sustainable Development in Pakistan

The world is facing the observable and direct impacts of climate change in the shape of extreme weather events, irregular precipitation, glacial melt, sea-level rise, an asymmetric average temperature trends, higher oceanic temperatures, damage to natural ecosystems, and biodiversity. In 2015, collective wisdom stirred the global community to agree upon two unprecedented milestones in recent human history—the Paris agreement and sustainable development goals (SDGs). The twin global agreements set a platform for collective efforts to secure socio-economic and climatic sustainability. Pakistan also joined the board to put forth policy interventions for the mitigation and adaption of climate change risks to maintain symmetry between the environmental quality and economic development. The government of Pakistan (GOP) formulated the National Climate Change Policy (NCCP (2012)) and passed the Pakistan Climate Change Act (PCCA (2017)) to provide an impetus for the implementation of the NCCP. Yet, an appropriate assessment and prioritization of the objectives of the NCCP are indispensable for productive and effective policies to achieve the targets. This study serves this purpose by prioritizing the climate change policy objectives (CCPOs) based on symmetric principles, i.e., energy, transport, urban and town planning, industry, and agriculture as criteria, with 17 sub-criteria in total. The fuzzy analytical hierarchy process (AHP) results show that the energy sector is the most pivotal while implementing the NCCP. Energy production is the most critical area that needs mitigation policy intervention for shifting the energy mix of the economy from high-carbon to low-carbon energy. The fuzzy AHP analysis further revealed the railway, population and urbanization, air pollution, crop growing practices and techniques as the most important related to transport, urban planning, industry, and agriculture sub-criteria, respectively. The fuzzy VIseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) analysis showed the ranking of the CCPOs from high to low through the integration of policies, institutional capacity building, water security, natural resource management, natural disaster management, environmental financial structure development, and social sector development. The findings of the present research would be helpful for experts and policymakers to re-examine the NCCP and put forth action plans to achieve sustainable climate and SDGs.

Factors affecting use of personal protective equipment and pesticide safety practices: A systematic review

An evidence-based understanding of factors influencing PPE use and pesticide safety practices has the benefit of facilitating the design of interventions to minimize exposure to pesticides and the promotion of the utilization of PPE and safety practices among agricultural pesticide handlers. The aim of this study, therefore, is to review the available literature on the use of PPE in agricultural pesticide handlers in world regions, and also the factors associated with the use of PPE and pesticide safety practices in farmers and farm workers. Full-text articles published on PubMed, Scopus, and ISI databases between 1999 and 2019 were reviewed and the scientific evidence was evaluated. One hundred and twenty-one articles were eligible for inclusion in this quantitative synthesis: 110 evaluated PPE use in agricultural pesticide handlers, and 23 focused on factors affecting PPE use and pesticide safety practices. Considerable evidence was found to show that the most basic PPE worn among pesticide handlers in all world regions was a long sleeve shirt (66.1%), long sleeve trousers (71.1%), and a hat (47.3%). The lowest basic PPE worn was an apron (8.6%), goggles (24.3%), gloves (40.5%), boots (42.3%), and mask (43.2%). The PPE worn (except for an apron) was proportionally higher in farmers than in farm workers. There is considerable evidence to suggest that the significant determinants associated with PPE use and pesticide safety practices are as follows: (1) demographic factors (i.e. education/literacy level, experience of illness, income); (2) farm structure factors (i.e. farm size); (3) behavioral and psychosocial factors (i.e. contact with pesticides, perceptions, attitudes, awareness, norms and beliefs); and (4) environmental factors (i.e. information about pesticides, access to extension services, training program, and farm organization). Therefore, there is a recognizable need for a life-long education program with training to change the perception and behavior of pesticide handlers sustainably.

Transgenic cotton and farmers' health in Pakistan

Despite substantial research on the economic effects of transgenic insect-resistant Bacillus thuringiensis (Bt) cotton, there is still limited work on this technology’s impacts on human health. Due to the inbuilt insect resistance, Bt cotton requires fewer pesticide sprays than conventional cotton, which is not only advantageous from economic and environmental perspectives, but may also result in health benefits for farmers. Using socioeconomic and biophysical data from Pakistan, we provide the first evidence of a direct association between Bt gene expression in the plant and health benefits. A key feature of this study is that Bt cotton cultivation in Pakistan occurs in a poorly regulated market: farmers are often mistaken in their beliefs about whether they have planted Bt cotton or conventional cotton, which may affect their pesticide-use strategies and thus their pesticide exposure. We employ a cost-of-illness approach and variations in the measurement of Bt adoption to estimate the relationship between Bt cotton and farmers’ health. Bt adoption based on farmers’ beliefs does not reduce the pesticide-induced cost of illness. However, adoption based on measuring Bt gene expression is associated with significant health cost savings. Extrapolating the estimates for true Bt seeds to Pakistan’s entire Bt cotton area results in annual health cost savings of around US$ 7 million. These findings have important implications for the regulation of seed markets in Pakistan and beyond: improved regulations that ensure claimed crop traits are really expressed can increase the benefits for farmers and society at large.