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Objectives: There is an epidemic of Mesoamerican Nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes have been proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN, was conducted with the aim of characterizing the associations between urinary concentrations of metals, pesticides and mycotoxins, and decline in kidney function. Methods: Urine samples collected at baseline (pre-sugarcane harvest) and at the first 6-month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (Al, total As, Cd, Co, Cr, Cu, Hg, Mn, Pb, Se, Si and Sr) were analysed by inductively-coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-D, 3-PBA, 4F3PBA, CFCA, DCCA, ETU, glyphosate, MCPA, OH-PYM, 5-OH-TBZ, TEB-OH and TCP), and two mycotoxins (OTA and CIT), were analysed by liquid chromatography coupled to mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable versus declining kidney function over a 2-year follow-up period) were examined. Results: Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. Conclusions: These findings provide evidence against the tested metals, metalloids, pesticides and mycotoxins as the primary cause(s) of MeN in Nicaragua. N/A

The associations between childhood acute lymphoblastic leukemia (ALL) and several factors related to early stimulation of the immune system, that is, farm residence and regular contacts with farm animals (livestock, poultry) or pets in early childhood, were investigated using data from 13 case–control studies participating in the Childhood Leukemia International Consortium. The sample included 7847 ALL cases and 11,667 controls aged 1–14 years. In all studies, the data were obtained from case and control parents using standardized questionnaires. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Contact with livestock in the first year of life was inversely associated with ALL (OR = 0.65, 95% CI: 0.50, 0.85). Inverse associations were also observed for contact with dogs (OR = 0.92, 95% CI: 0.86, 0.99) and cats (OR = 0.87, 95% CI: 0.80, 0.94) in the first year of life. There was no evidence of a significant association with farm residence in the first year of life. The findings of these large pooled and meta-analyses add additional evidence to the hypothesis that regular contact with animals in early childhood is inversely associated with childhood ALL occurrence which is consistent with Greaves’ delayed infection hypothesis. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PURPOSE OF REVIEW: There are many opportunities and challenges for conducting occupational epidemiologic studies today. In this paper, we summarize the discussion of a symposium held at the Epidemiology in Occupational Health (EPICOH) conference, Chicago 2014, on challenges for occupational epidemiology in the twenty-first century. RECENT FINDINGS: The increasing number of publications and attendance at our conferences suggests that worldwide interest in occupational epidemiology has been growing. There are clearly abundant opportunities for new research in occupational epidemiology. Areas ripe for further work include developing improved methods for exposure assessment, statistical analysis, studying migrant workers and other vulnerable populations, the use of biomarkers, and new hazards. Several major challenges are also discussed such as the rapidly changing nature and location of work, lack of funding, and political/legal conflicts. As long as work exists there will be occupational diseases that demand our attention, and a need for epidemiologic studies designed to characterize these risks and to support the development of preventive strategies. Despite the challenges and given the important past contribution in this field, we are optimistic about the importance and continued vitality of the research field of occupational epidemiology.

We present an interface for eliciting sets of acceptable gambles on a three-outcome possibility space, discuss an experiment conducted for testing this interface, and present the results of this experiment. Sets of acceptable gambles form a representation for imprecise probabilities that is close to human behavior and eliciting them directly may improve the quality of the resulting uncertaintymodel. The experiment consisted of a betting competition for the 2014 FIFA World Cup: For each match bets were assigned based on the sets of acceptable gambles elicited from the participants. A new algorithm was designed for generating fair bets for assignment. Participant feedback indicated that improving the usability and transparency of the interface would ease the elicitation procedure. The experiment’s results underlined that imprecision is an essential aspect of real-life uncertainty modeling.

Background: Results from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery. Methods: We pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis. Findings: The studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]). Interpretation: Our results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism. Funding: National Cancer Institute. © 2016 Elsevier Ltd.

Pesticides are an extensively documented occupational and environmental hazard in Central America. Yet, severe problems persist. Toxic pesticide use in the Region increased during 1985-1999. High exposure levels and ineffectiveness of personal protective equipment evidence the difficulties for risk reduction. Acute poisonings remain a severe problem. Delayed and/or long-lasting health effects include dermatoses, cancer, and genotoxic, neurotoxic, and respiratory effects. The use of hazardous pesticides persists through deficiencies in government-driven assessment and risk management; excessive focus on regional harmonization; short-term economic interests; strong links between industry and governments; aggressive marketing; weak trade unions; and failure of universities to reach decision makers. Regulation based on local data is lacking. An agreement of the Ministries of Health for restricting the most toxic pesticides in Central America has potential for progress. The most effective way to reduce risk is to greatly reduce pesticide use. Actions needed include development of multidisciplinary strategies for local studies on health and environmental impact of pesticides; development of sustainable nonchemical agricultural technologies; evaluation of interventions; extending and sharing of expertise within the Region; strengthening of unions and communities; and redefining the role of industry toward development of safer products, with responsible marketing and reliable information.

Background: Maternal prenatal supplementation with folic acid and other vitamins has been inconsistently associated with a reduced risk of childhood acute lymphoblastic leukemia (ALL). Little is known regarding the association with acute myeloid leukemia (AML), a rarer subtype. Methods: We obtained original data on prenatal use of folic acid and vitamins from 12 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2012), including 6,963 cases of ALL, 585 cases of AML, and 11,635 controls. Logistic regression was used to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for child's age, sex, ethnicity, parental education, and study center. Results: Maternal supplements taken any time before conception or during pregnancy were associated with a reduced risk of childhood ALL; odds ratios were 0.85 (95% CI = 0.78-0.92) for vitamin use and 0.80 (0.71-0.89) for folic acid use. The reduced risk was more pronounced in children whose parents' education was below the highest category. The analyses for AML led to somewhat unstable estimates; ORs were 0.92 (0.75-1.14) and 0.68 (0.48-0.96) for prenatal vitamins and folic acid, respectively. There was no strong evidence that risks of either types of leukemia varied by period of supplementation (preconception, pregnancy, or trimester). Conclusions: Our results, based on the largest number of childhood leukemia cases to date, suggest that maternal prenatal use of vitamins and folic acid reduces the risk of both ALL and AML and that the observed association with ALL varied by parental education, a surrogate for lifestyle and sociodemographic characteristics. Copyright © 2014 by Lippincott Williams & Wilkins.

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Eine gemeinsame Entwicklung der OSRAM GmbH in Berlin und dem Fraunhofer-Institut für Werkzeugmaschinen und Umformtechnik in Chemnitz zeigt, dass Aluminiumschaum hervorragend zum Fügen unterschiedlicher und vor allem im Betrieb thermisch beanspruchter Werkstoffe geeignet ist. Der Nachweis wurde an einer Hochdruckentladungslampe erbracht. Die Eignung des Aluminiumschaums resultiert unter anderem aus der großen Volumenzunahme im Schäumprozess und damit dem Vermögen, große Spalten überbrücken zu können.

This paper summarizes experiences from long-term ongoing cooperation between Swedish research institutions and institutions at the National Universities in Nicaragua and Costa Rica. 24 researchers and teachers from the Central American institutions and ten Swedish research students have been trained. In addition to three full doctoral and three licentiate (two-year PhD program) theses, the two programs have so far published 15 articles in English-language, international, refereed journals and about three times as many abstracts for conferences in more than ten countries. A "sandwich" model for training is recommended, where the southern researchers come to the wealthier partner for collaborative analyses and write-ups of the publications, while spending 50-75% of their time in their home countries for data collection. Such collaboration should be planned for a time span of at least eight years and include substantial numbers of researchers and students. Means to minimize the risk of brain drain are suggested. The collaboration has been important for the globalization of the research cultures at the participating institutions and has trained international experts.