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Research Uncovers Risk Factors for Mysterious Kidney Disease in Farm Workers

Researchers from the Center for Health, Work & Environment at the Colorado School of Public Health (ColoradoSPH) on the University of Colorado Anschutz Medical Campus have identified new risk factors for a mysterious kidney illness affecting tens of thousands of farm workers worldwide. Their findings have been published in the Journal of Occupational and Environmental Medicine.

Partnering with Pantaleon, one of the largest sugar producers in Central America, ColoradoSPH researchers examined 330 sugarcane cutters in Guatemala over the course of a six-month harvest season. More than one-third of the workers showed a decline in kidney function over the course of the harvest, while the other two-thirds of the workers’ kidney function remained the same or improved. The researchers discovered that factors including smoking, living in the local community, and low kidney function before employment were associated with a decline in kidney function. The researchers found no association with other health conditions, the amount of water workers drank, sugary drink consumption, or home use of pesticides.

Following worker protection guidelines for rest and hydration set forth by the World Health Organization (WHO), Pantaleon already provides rest breaks, shade, water and electrolyte solutions similar to sports drinks to their employees. Based on the findings of this study, these preventive measures are not sufficient to protect all workers from kidney injury.

Previous studies have identified an illness called “Mesoamerican Nephropathy,” also referred to as Chronic Kidney Disease of Unknown Origin (CKDu). Notably, this new study shows that when a workforce has access to water, rest, and shade, the rates of CKDu onset and kidney injury are lower, and the injury is less severe than that seen in previous studies.

Hydration, rest, shade ‘probably not enough’

“Water, rest and shade are important for anyone doing heavy labor in hot climates. It’s vitally important that employers continue to focus on that. But our study shows that hydration, rest and shade are probably not enough to stop the global epidemic of kidney disease,” explained Dr. Jaime Butler-Dawson, lead author of the study and researcher at the Center for Health, Work & Environment. “We now have a better idea of some strategies to help keep workers safe and healthy,” she said.

Pantaleon has long prided itself on its commitment to worker health and sustainability. The company initially sought the input of Dr. Lee Newman, director of the Center for Health, Work & Environment in 2016 to conduct a rigorous third-party evaluation of their workplace health programs. The partnership has grown since and they have launched multiple studies. The goals of the collaboration are to evaluate Pantaleon’s progress towards achieving its sustainability goals and to help identify and eliminate the health risks of agricultural workers.

Researchers at the Center for Health, Work & Environment see these findings as part of a larger picture of evolving science in the field of Total Worker Health®, an integrated approach to workplace health and safety coined by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention.

Requires more holistic approach

“What we are seeing in our research is that protecting workers from hazards and supporting their health requires a more holistic approach, what NIOSH refers to as Total Worker Health. That is why we are examining work-related factors and personal risk factors. Both need to be addressed together,” said Butler-Dawson.

Dr. Butler-Dawson and her team are focusing future research on delving deeper into understanding the factors that contribute to declining kidney function, such as why workers who live closer to the sugarcane field are more likely to have impaired kidney function at the end of the harvest season. They are also examining why two-thirds of the workers in this study maintained healthy kidney function or improved their kidney function. Her team is collaborating with researchers in the Colorado School of Public Health’s Center for Global Health to design and test ways to improve the health of sugarcane workers and other agricultural workers in the region.

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Researchers to study neurological effects of Zika virus in young children

Researchers at the University of  Colorado Anschutz Medical Campus and the Baylor College of Medicine will join with Guatemalan investigators in a major study examining the clinical outcomes of children infected with the Zika virus after being born, focusing on long-term brain development.

“We now know the severe effects of Zika in the fetus and the unborn child if the mother gets the infection during pregnancy,” said Edwin Asturias, MD, co-principal investigator of the study and director of Latin American Projects at the Center for Global Health at the Colorado School of Public Health. “But if the virus is able to affect the developing brain of an infant or a child, this will have enormous consequences to a generation of children in areas where the virus has spread.”

Dr. Edwin Asturias of the Center for Global Health at the Colorado School of Public Health.

 

The study, funded by the National Institutes of Health, has been approved by the Ministry of Health in Guatemala and will take place in the rural southwestern coast of that country. Along with the Zika virus, the region is also endemic for the dengue and chikungunya virus transmitted by the same mosquito that carries Zika.

“We are enrolling infants in the first year of life and children up to 5 years of age who will be followed over one year to see if they become infected with Zika virus, and then we will be looking at the effects of the infection in the infants’ and children’s neurodevelopment,” said Dr. Flor M. Muñoz, associate professor of pediatrics in the section of infectious diseases at Baylor and principal investigator of the study. “We will look for neurologic or neurodevelopmental effects specifically, including effects on hearing and eye problems, because we know that the virus has the potential to cause central nervous manifestations.”

Zika virus has been known to affect babies in utero when the mother is infected during pregnancy, but little is known about what happens when infants are infected in early life, Muñoz said.

“Our concern is that a developing brain in early life can be impacted significantly,” she said. “It’s an important question to address not just for children that live in the endemic areas, but also for children who travel to these areas.”

Recruitment for the study will take place through a clinic created by the University of Colorado’s Center for Global Health in Guatemala. The goal is to follow 500 infants and their mothers for one year to determine if they become infected by the Zika virus. Neurologic exams and age-appropriate neurodevelopmental testing will be run for the duration of the study to identify changes in children infected with Zika virus.

Researchers will also be enrolling 700 children between the ages of 1 and 5 years, including 300 children known to have been exposed to dengue or Zika viruses while participating in a previous dengue study, and 400 who are siblings of the infants in this study. They will be tested periodically and evaluated for symptoms of flavivirus-like illness to determine if they have been infected by Zika, dengue or chikungunya viruses. Investigators will monitor serial neurologic examinations and developmental milestones in the children to determine if the Zika virus infection is associated with any neurologic or developmental changes.

Dr. Edwin Asturias examining children in Guatemalan clinic.
Dr. Edwin Asturias examining a child in Guatemalan clinic.

Muñoz and Asturias will collaborate with colleagues from the Fundacion para la Salud Integral de los Guatemaltecos (FUNSALUD) clinic in Guatemala. The clinic, affiliated with the Colorado School of Public Health and Children’s Hospital Colorado, is led by Dr. Antonio Bolaños. It has a full complement of local investigators, nurses and laboratory technicians along with Emory University’s Vaccine Treatment and Evaluation Unit (VTEU) research laboratory led by Dr. Mark Mulligan.

Neurodevelopmental testing will be conducted by three local psychologists under the leadership of Dr. Amy Connery of Children’s Hospital Colorado in Aurora, Colo. The study will last three years and results will be reported throughout the study. More information can be found at the NIH Zika website.

 

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Guatemala partnership aids farm worker health

lee-newman
Lee Newman, MD, director of the Center for Work, Health and Environment and professor at the Colorado School of Public Health at CU Anschutz.

The Center for Health, Work & Environment and the Center for Global Health at the Colorado School of Public Health announced a new partnership with Pantaleon, one of the largest sugar producers in Central America, to further understand the health risks of sugar cane workers and improve prevention efforts.

The study will evaluate Pantaleon’s health promotion program in Guatemala and researchers will offer recommendations to the company based on their findings. The team is initially focusing on improving current health and safety practices and understanding how to reduce the risk of chronic kidney disease, an illness commonly found in workers performing strenuous labor in hot climates.

With growing international concerns about the impact of heat stress and climate change on farm workers, researchers from the Colorado School of Public Health hope the findings of this investigation will help protect not only Pantaleon’s nearly 30,000 workers but potentially millions of workers worldwide.

“Agricultural workers have always had an unacceptably high risk for work-related injuries and illness. Now the stakes are even higher because of rising global temperatures and increasing rates of chronic illness,” said Dr. Lee Newman, director of the Center for Work, Health and Environment and professor at the Colorado School of Public Health at CU Anschutz. “We are excited to work with companies like Pantaleon that show a commitment to improving worker safety, health, and well-being. What we learn here has the potential to help workers back in the U.S. and abroad,” he added.

Pantaleon agricultural worker harvesting sugarcane (Pantaleon)
Pantaleon agricultural worker harvesting sugarcane (Pantaleon)

Over the last 15 years, Pantaleon has prioritized worker health as part of their sustainability goals and has adjusted its policies and practices overtime in response to calls from clients, stakeholders, and the public. Pantaleon’s health promotion program began in 2002 and in November of last year, the group sought out assistance from experts at the Colorado School of Public Health to evaluate and further improve their worker health and safety program.

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Collaboration brings new lodging facility to Guatemala clinic

In July, several leaders from Children’s Hospital Colorado, the University of Colorado School of Medicine, the Skaggs School of Pharmacy and Pharmaceutical Sciences and the Colorado School of Public Health, the Center for Global Health, and the Centers for Disease Control traveled to Guatemala to celebrate the opening of the new lodging facility at the Trifinio Center for Human Development.

The facility was made possible in part thanks to the efforts of deans and chairs from the various schools and departments at CU Anschutz who were instrumental in raising the $100,000 needed to complete the project. As a result, up to 25 visiting students, residents, faculty members, pharmacists, nurses and community health workers now have a comfortable and safe place to stay while working on site in the community at the family medical clinic, the dental clinic or at the soon-to-be-opened birthing clinic.

Steve Berman of CU School of Medicine

Steve Berman, MD, FAAP, Professor of Pediatrics and Epidemiology at the CU Anschutz and Director, Center for Global Health, stands with community nurses at the Center for Human Development in Guatemala.

Several attendees expressed how impressed and inspired they were by the collaboration between AgroAmerica, the supporting hospitals and schools and the Trifinio Center for improving the lives of the children and families of those working in the banana and palm oil plantations AgroAmerica runs. Further, the quality of equipment and capabilities, including the pharmacy, made several attendees excited about how much this clinic facility can offer.

“It is exciting to think of the possibilities we have at Trifinio to improve the health not just of our community but also to create an innovative health model that can be replicated around the world,” said Stephen Daniels, MD, PhD, Professor and Chair of Pediatrics, School of Medicine at the University of Colorado Anschutz Medical Campus and Pediatrician-in-Chief L. Joseph Butterfield Chair in Pediatrics at Children’s Hospital Colorado.

But it was the degree to which the local community members were involved with the direction and planning for the clinic and its programming that struck Jodie Malhotra, PharmD, International Affairs Coordinator and Assistant Professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences. “I was able to truly witness the community’s support and engagement in the clinic. It was also very clear that the community leaders are very supportive of the clinic,” Dr. Malhotra shared. “We even had the opportunity to accompany the community nurses on a visit with a new mother at her home to see how they work with the mother and baby. Their means of assessing the baby and educating the mother were very inspiring.”

Spacious new lodging facility in Guatemala

The new lodging facility at the Trifino Center for Human Development will house students and medical professionals when they volunteer at the clinic.

Also during the trip, the Colorado contingent met four students from the CU Anschutz Medical Campus who were working in the clinic this summer. It was easy to see the effect that the experience would have not only on their careers, but also their professions. “This clinic provides a life-changing opportunity for health students to benefit from service learning,” said David Goff, MD, PhD, dean of the Colorado School of Public Health. “It was clear that we have at least as much to gain as we have to offer in this unique collaboration with the Trifinio community.”

Look for more news in the coming months celebrating the opening of the birthing center – a key step toward improving the area’s population health.

In addition to Drs. Daniels, Malhotra and Goff, attendees included:

  • Edwin Asturias, MD, Associate Professor of Pediatric Infectious Diseases and Epidemiology at CU Anschutz and Director of Latin American Projects, Center for Global Health
  • Steve Berman, MD, FAAP, Professor of Pediatrics and Epidemiology at the CU Anschutz and Director, Center for Global Health
  • Richard Johnston, MD, Emeritus Professor of Pediatrics, School of Medicine at the CU Anschutz
  • Jerrod Milton, Vice President of Operations, Children’s Hospital Colorado
  • Reina Turcios-Ruiz, MD, FIDSA, Director of the Central America Regional Office, Centers for Disease Control

Contributed by the Center for Global Health.

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