J Douwes

Massey University, Palmerston North City, Manawatu-Wanganui, New Zealand

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Publications (153)437.42 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To provide a detailed assessment of the extent and industrial distribution of workplace carcinogens in New Zealand, and to identify key industries and key carcinogens for which intervention would result in marked reductions in occupational cancer.
    Occupational and environmental medicine. 06/2014; 71 Suppl 1:A47.
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    ABSTRACT: Significant excess risks of lung cancer and haematologic neoplasms have been observed in slaughterhouse workers in eight New Zealand studies, and numerous studies conducted elsewhere. No specific causal agents have been identified, although a biological aetiology is suggested as the risk is highest in those areas where workers are exposed to live animals or to biological material containing animal urine, faeces or blood. This study aimed to assess the airborne bacterial microflora in the slaughterhouse environment in order to develop exposure categories for reanalysis of a meat workers' cohort.
    Occupational and environmental medicine. 06/2014; 71 Suppl 1:A21.
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    ABSTRACT: Polybrominated diphenyl ethers (PBDEs) are present in many consumer goods. There is evidence that PBDEs are toxic to humans, particular young children. The purpose of this study was to assess indoor dust as an exposure source for PBDEs. Concentrations of 16 PBDEs were determined in dust samples from 33 households in New Zealand, and in breast milk samples from 33 mothers living in these households. Associations between dust and breast milk PBDE concentrations were assessed, and children's PBDE intake from breast milk and dust estimated. Influences of household and demographic factors on PBDE concentrations in dust were investigated. Indoor dust concentrations ranged from 0.1ng/g for BDE17 to 2500ng/g for BDE209. Breast milk concentrations were positively correlated (p<0.05) with mattress dust concentrations for BDE47, BDE153, BDE154, and BDE209 and with floor dust for BDE47, BDE183, BDE206, and BDE209. The correlation for BDE209 between dust and breast milk is a novel finding. PBDE concentrations in floor dust were lower from households with new carpets. The estimated children's daily intake of PBDEs from dust and breast milk was below U.S. EPA Reference Dose values. The study shows that dust is an important human exposure source for common PBDE formulations in New Zealand.
    Environment international 07/2013; 59C:255-261. · 6.25 Impact Factor
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    ABSTRACT: Background and objectiveIncreased sputum neutrophilia has been observed in asthma, but also during normal ageing in asthmatics and non-asthmatics. It remains unclear what constitutes ‘normal’ neutrophil levels in different age groups. Methods We assessed the relationship between age and airway neutrophils of 194 asthmatics and 243 non-asthmatics (age range: 6–80 years). Regression analyses were used to assess this relationship adjusted for confounders including asthma status, atopy, gender, smoking and current use of inhaled corticosteroids (ICS). Age-corrected reference values for different age groups were determined using the 95th percentile of non-asthmatic participants. ResultsAge was positively associated with sputum neutrophils in both asthmatic and non-asthmatic adults (0.46% neutrophil increase/year (95% confidence interval (CI) 0.18, 0.73) and 0.44%/year (0.25, 0.64, respectively), but no association was found in the <20-year age category. Individuals with high sputum neutrophil counts (>95th percentile of non-asthmatic counts for any given age group) were significantly more likely to be asthmatic (odds ratio = 2.5; 95% CI: 1.3, 5.0), with the greatest effect observed in the older age group. Other factors that independently associated with increased sputum neutrophil levels included atopy in non-asthmatic adults, male gender and current use of ICS in asthmatic adults. Age-specific reference values for neutrophil percentage were under 20 years-76%, 20–40 years-62%, 40–60 years-63% and over 60 years-67%. Conclusions Airway neutrophilia is related to age in adults, with a neutrophilic asthma phenotype present in older adults. The use of appropriate age-specific reference values is recommended for future studies aimed at elucidating the role of neutrophils in asthma.
    Respirology 07/2013; 18(5). · 2.78 Impact Factor
  • Neil Pearce, Jeroen Douwes
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    ABSTRACT: Epidemiology is currently undergoing changes in its underlying philosophy and approach, as a result of the rapid global changes which are transforming the world in which epidemiologists live and work. This necessitates a multidisciplinary "population approach" involving "multilevel thinking" about the determinants of disease. These issues are of relevance to the interface between human and animal epidemiology, which has received considerable attention in recent years, particularly as a result of the arrival of H1N1 influenza, and the increasingly obvious need for coordinated systems of surveillance for human and animal infectious diseases. However, the need for coordination between human and veterinary epidemiology is broader than that, and there is no need to restrict the "one world one health" concept to communicable disease. In the current paper we will therefore consider the interface between human and animal health for the study of non-communicable disease, particularly those involving occupational and environmental risk factors. These issues are illustrated with two examples: one involving environmental health (asthma); and one involving occupational health (cancer). We will also discuss the potential to use animal health data as indicators for human environmental health risks.
    Preventive Veterinary Medicine 06/2013; · 2.39 Impact Factor
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    ABSTRACT: Breast milk samples of 39 first time mothers aged 20-30 were collected in 2007-2010 from rural and urban areas of New Zealand, following the fourth World Health Organization coordinated survey protocol. Samples were individually analysed for persistent organic pollutants (POPs) including dioxins and furans (PCDD/Fs), polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and polybrominated diphenyl ethers (PBDEs). The lipid adjusted concentrations of PCDD/Fs (mean toxic equivalent (TEQ): 3.54pg/g) and PCBs (mean TEQ 1.29pg/g) were low in comparison to those reported for other countries, and concentrations of dieldrin (10ng/g) and p,p'-DDE (379ng/g) and PBDEs were in the mid-range. Breast milk concentrations of PCDD/F-TEQ, PCB-TEQ, dieldrin and p,p'-DDE were significantly higher in rural compared to urban areas (+23%, 33%, 59%, and 44% respectively), while concentrations of several PBDEs and lindane were higher in urban areas. Concentrations of PCDD/Fs, PCBs and OCPs, but not PBDEs, increased with age, and higher body mass index was associated with lower concentrations of PCBs. Despite New Zealand's low body burdens of many chlorinated POPs in comparison to other countries, breast milk concentrations continued to decrease over time, with a decrease by half over the last 10years for PCDD/F-TEQ (-40%), PCB-TEQ (-54%) and OCPs -34 to -90%), indicating that regulatory measures continue to have beneficial effects. Continued monitoring is needed particularly for the brominated POPs for which little New Zealand specific data is available.
    Science of The Total Environment 05/2013; 458-460C:399-407. · 3.26 Impact Factor
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    ABSTRACT: Environmental levels of β-(1,3)-glucan, an inflammatory fungal cell wall component, have been suggested to be related to respiratory symptoms. However there is currently little data comparing β-(1,3)-glucan detection methods and/or results obtained in different laboratories. The aim of this study was to compare levels of β-(1,3)-glucans detected in household dust samples (n=40) using different extraction/detection methods (Limulus amebocyte assay (LAL), inhibition enzyme immunoassay (EIA) and sandwich EIA) in five different laboratories. Dust sample aliquots were sent to participating centres, extracted and analysed for β-(1,3)-glucan according to standard in-house procedures. Significant differences in the levels of β-(1,3)-glucan were observed between all laboratories geometric mean levels ranging from 15.42g/g to 47542g/g dust; p<0.0001) with the exception of those using a similar LAL method. The inhibition EIA used in laboratory D produced mean β-(1,3)-glucan measurements 80-100 times higher than the LAL assays, 4 times higher than the sandwich EIA in the same lab, 17.6 times those obtained with the EIA in lab E and 363 times those obtained in the EIA in laboratory C. Pearson’s correlations generally showed significant associations between methods and laboratories, particularly those using similar methodology (R ranging from 0.5 to 0.8; p<0.001), although some poor and even inverse correlations were observed. Bland-Altman analyses showed moderate to good agreement between most assays, although clear absolute differences were observed. In conclusion, although results obtained with different methods were significantly correlated and therefore comparable in relative terms, direct comparison of results between laboratories and assays may be inappropriate.
    Environmental Science: Processes and Impacts. 02/2013; 15:405-411.
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    ABSTRACT: BACKGROUND: Airway inflammation is commonly assessed by sputum induction followed by a differential cell count (DCC) using light microscopy. This method is prone to intercounter variability and poor reproducibility. We aimed to develop a more objective method using flow cytometry (FCM). METHODS: Fifty-six sputum inductions were conducted in 41 adults (23 asthmatics). Sputum was processed, a cytospin prepared for DCC, and the remainder immunolabeled for FCM using CD45, CD14, and CD16-specific antibodies to distinguish major leukocyte populations. Aliquots of 15 samples were frozen at -80°C to assess the effects of cryostorage. DCC and FCM were compared, and viability of individual cell populations was determined by FCM. RESULTS: FCM and DCC, and fresh and frozen samples, were significantly correlated, R = 0.54-0.87; all P < 0.0001, and R = 0.57 to 1; P < 0.005, respectively. There was a significant neutrophil loss after cryostorage (from median 30.5-17.4% of total leukocytes; P < 0.0001). Cell viability was higher for lymphocytes compared to granulocytes or macrophages (P < 0.001). With the exception of the expected higher levels of eosinophils (P < 0.005), no significant difference in cell differentials or viability was observed between asthmatics and nonasthmatics using either DCC or FCM. CONCLUSIONS: FCM is a suitable means of assessing leukocyte populations in induced sputum. Sample storage at -80°C prior to FCM is feasible, but may be detrimental to neutrophils, although good correlations were still observed between fresh and frozen samples. Large differences in viability were found between individual cell populations suggesting that viability dye use may be necessary. © 2013 International Clinical Cytometry Society.
    Cytometry Part B Clinical Cytometry 01/2013; · 2.23 Impact Factor
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    ABSTRACT: Background. Asthma and depression are important public-health concerns worldwide. While some epidemiologic studies have shown asthma and wheezing to be associated with depression and anxiety, the patterns are unclear at the multinational level due to the lack of cross-study comparability. Our study examined the associations of self-reported asthma diagnosis and current wheezing with self-reported depression diagnosis and 30-day anxiety using an international survey. Methods. Using the 2002 World Health Survey, a standardized international survey conducted by the WHO, we estimated the associations between diagnosed asthma and current wheezing with diagnosed depression and 30-day anxiety via multiple logistic regressions for 54 countries worldwide. Results. Diagnosed depression and 30-day anxiety were associated with diagnosed asthma in 65% and 40% of the countries, respectively. Diagnosed depression and 30-day anxiety were associated with current wheezing in 83% and 82% of the countries, respectively. Conclusions. The association between asthma and depression was generally seen at the global level. These results indicated the importance of addressing the asthma-depression comorbidity as public-health and clinical management priorities, in order to improve the overall health of the countries.
    Pulmonary medicine. 01/2013; 2013:929028.
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    ABSTRACT: Published studies have shown that workers in animal slaughterhouses are at a higher risk of lung cancers as compared to the general population. No specific causal agents have been identified, and exposures to several chemicals have been examined and found to be unrelated. Evidence suggests a biological aetiology as the risk is highest for workers who are exposed to live animals or to biological material containing animal faeces, urine or blood. To investigate possible biological exposures in animal slaughterhouses, we used a metagenomic approach to characterise the profile of organisms present within an aerosol sample. An assessment of aerosol exposures for individual workers was achieved by the collection of personal samples that represent the inhalable fraction of dust/bioaerosol in workplace air in both cattle and sheep slaughterhouses. Two sets of nine personal aerosol samples were pooled for the cattle processing and sheep processing areas respectively, with a total of 332,677,346 sequence reads and 250,144,492 sequence reads of 85 bp in length produced for each. Eukaryotic genome sequence was found in both sampling locations, and bovine, ovine and human sequences were common. Sequences from WU polyomavirus and human papillomavirus 120 were detected in the metagenomic dataset from the cattle processing area, and these sequences were confirmed as being present in the original personal aerosol samples. This study presents the first metagenomic description of personal aerosol exposure and this methodology could be applied to a variety of environments. Also, the detection of two candidate viruses warrants further investigation in the setting of occupational exposures in animal slaughterhouses.
    PLoS ONE 01/2013; 8(8):e72226. · 3.73 Impact Factor
  • Collin Brooks, Neil Pearce, Jeroen Douwes
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    ABSTRACT: PURPOSE OF REVIEW: It has been hypothesized that increased cleanliness, reduced family size, and subsequent decreased microbial exposure could explain the increases in global asthma prevalence. This review considers the recent evidence for and against the 'hygiene hypothesis'. RECENT FINDINGS: Recent evidence does not provide unequivocal support for the hygiene hypothesis: the hygiene hypothesis specifically relates to atopic asthma, but some of the protective effects (e.g. farm exposures) appear to apply to both atopic and nonatopic asthma; asthma prevalence has begun to decline in some western countries, but there is little evidence that they have become less clean; Latin American countries with high infection rates have high asthma prevalence and the hygiene hypothesis relates to early-life exposures, but exposures throughout life may be important. SUMMARY: There is a considerable body of evidence which warrants scepticism about the hygiene hypothesis. However, these anomalies contradict the 'narrow' version of it in which microbial pressure early in life protects against atopic asthma by suppressing T-helper 2 immune responses. It is possible that a more general version of the hygiene hypothesis is still valid, but the aetiologic mechanisms involved are currently unclear.
    Current Opinion in Allergy and Clinical Immunology 10/2012; · 3.40 Impact Factor
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    ABSTRACT: The literature was reviewed to assess the relationship between the lipid adjusted concentration in human serum and breast milk (expressed as the serum/milk ratio) of a broad range of POPs in paired samples. Thirteen studies were identified, including seven studies that reported serum/milk ratios for polychlorinated dibenzo-dioxins and -furans (PCDD/Fs), ten for polychlorinated biphenyls (PCBs), five for polybrominated diphenyl ethers (PBDEs), and five for organochlorine pesticides (OCPs). Mean serum/milk ratios ranged between 0.7 and 25 depending on the compound and congener. For PCDD/Fs, PCBs and PBDEs, a clear trend of increasing mean serum/milk ratio by increasing molar volume, hydrophobicity and number of halogen substitutes was observed. The mean serum/milk ratios reported by the 13 studies summarized here will aid comparison between human POPs exposure studies using either serum or milk samples. More studies are needed to allow a valid comparison between data obtained from analysis of breast milk and serum samples for a broader range of POPs. Furthermore such studies may shed light on compound specific factors as well as other determinants that may affect the partitioning and partition kinetics of POPs between serum and breast milk.
    Chemosphere 08/2012; 89(8):911-8. · 3.14 Impact Factor
  • Neil Pearce, Jeroen Douwes
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    ABSTRACT: In recent decades there have been marked increases in asthma prevalence in Western countries. More recently, asthma prevalence has peaked, or even begun to decline, in Western countries, but many low and middle income countries are now beginning to experience increases in prevalence (although there is no evidence of increases in prevalence in India to date). "Established" risk factors for asthma cannot account for the global prevalence increases, or the international patterns that have been observed, or the recent declines in prevalence in some Western countries. It seems that as a result of the "package" of changes in the intrauterine and infant environment that are occurring with "Westernization", we are seeing an increased susceptibility to the development of asthma and/or allergy. There are a number of elements of this "package" including changes in maternal diet, increased fetal growth, smaller family size, reduced infant infections and increased use of antibiotics and paracetamol, and immunization, all of which have been (inconsistently) associated with an increased risk of childhood asthma, but none of which can alone explain the increases in prevalence. It is likely that the "package" is more than the sum of its parts, and that these social and environmental changes are all pushing the infants' immune systems towards an increased risk of asthma.
    The Indian Journal of Pediatrics 05/2012; · 0.72 Impact Factor
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    ABSTRACT: Due to worldwide restrictions on polybrominated diphenyl ethers (PBDEs), the demand for alternative flame retardants (AFRs), such as organophosphate flame retardants (OPFRs), novel brominated FRs (NBFRs) and hexabromocyclododecanes (HBCDs), has recently increased. Little is known about human exposure to NBFRs and OPFRs and that their levels in dust have been scarcely evaluated worldwide. To increase the knowledge regarding these chemicals, we measured concentrations of five major NBFRs, ten OPFRs and three HBCD isomers in indoor dust from New Zealand homes. Dust samples were taken from living room floors (n=34) and from mattresses of the same houses (n=16). Concentrations (ngg(-1)) of NBFRs were: 1,2-bis(2,4,6-tribromophenoxy)ethane (BTBPE) (<2-175), decabromodiphenyl ethane (DBDPE) (<5-1430), 2-ethylhexyl-2,3,4,5-tetrabromobenzoate (TBB) (<2-2285) and bis(2-ethylhexyl)-3,4,5,6-tetrabromophthalate (TBPH) (<2-640). For OPFRs, concentrations (ngg(-1)) ranged between: tri-ethyl-phosphate (TEP) (<10-235), tri-n-butyl-phosphate (TnBP) (<20-7545), tris-(2-chloroethyl)-phosphate (TCEP) (<20-7605), tris-(1-chloro-2-propyl) phosphate (TCPP) (20-7615), tri-(2-butoxyethyl)-phosphate (TBEP) (50-27325), tris-(2,3-dichloropropyl)-phosphate (TDCPP) (20-16560), tri-phenyl-phosphate (TPhP) (20-35190), and tri-cresyl-phosphate (TCP) (<50-3760). HBCD concentrations fell in the range <2-4100ngg(-1). BTBPE, DBDPE, TBPH, TBEP, and TnBP showed significant positive correlation (p<0.05) between their concentrations in mattresses and the corresponding floor dust (n=16). These data were used to derive a range of plausible exposure scenarios. Although the estimated exposure is well below the corresponding reference doses (RfDs), caution is needed given the likely future increase in use of these FRs and the currently unknown contribution to human exposure by other pathways such as inhalation and diet.
    Chemosphere 04/2012; 88(11):1276-82. · 3.14 Impact Factor
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    ABSTRACT: We assessed the association between work-related stress and asthma in a cross-sectional workforce survey in New Zealand. Men and women randomly selected from the Electoral Roll were invited to take part in a telephonic interview, which collected information on current workplace exposures and respiratory symptoms. Participants rated how stressful they found their current job on a five-point scale. We conducted unconditional logistic regression to calculate prevalence odds ratios (OR) and 95% confidence intervals (CI) for job stress and both current and adult-onset asthma, adjusting for age, sex, smoking, and deprivation. Analyses were also stratified by sex, smoking status, body mass index, and age group. Results were based on 2903 interviews. Participants with very or extremely stressful jobs were twice as likely to have current asthma (OR = 1.98; 95% CI = 1.52-2.58) and 50% more likely to have adult-onset asthma (OR = 1.50; 95% CI = 1.05-2.15) compared to those with not at all or mildly stressful jobs. This association was evident for both sexes and was not explained by either occupation, age, body mass index, or smoking, although the results did differ by smoking status. Our study adds to the sparse evidence on the relationship between work-related stress and asthma in adult working populations.
    Journal of Asthma 08/2011; 48(8):783-9. · 1.85 Impact Factor
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    ABSTRACT: There has been a global epidemic of asthma during the past half-century. More recently, the prevalence has leveled off or declined in many Western countries, whereas the prevalence in less affluent nations is still increasing. The reasons for this and the different geographical patterns of asthma prevalence remain unclear. This paper provides an epidemiologic perspective on whether allergen exposure and allergies can explain these trends. In particular, the paper discusses 1) geographical and temporal trends in asthma and the role of allergens and allergy, 2) the importance of nonallergic mechanisms, 3) nonallergenic exposures that may modify the risk of allergies and asthma, and 4) new and emerging risk and protective factors. Although allergy and asthma are closely related, allergen exposure and allergy alone cannot explain current time trends and geographical patterns of asthma. Population-based studies focusing on recently identified risk and protective factors may provide further insight.
    Current Allergy and Asthma Reports 07/2011; 11(5):434-44. · 2.75 Impact Factor
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    ABSTRACT: Although musculoskeletal symptoms (MSS) are common worldwide, little is known about its prevalence amongst the working population in relation to gender, age, and occupational/industrial group. This paper describes the prevalence of MSS in a sample of 3003 men and women aged 20e64 randomly selected from the New Zealand Electoral Roll. MSS experienced during the previous 12 months in 10 body regions was assessed in telephone interviews using a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). MSS prevalence was 92% (for any body region). The highest prevalence was for low back (54%), neck (43%), and shoulders (42%). Females reported a statistically significantly higher prevalence of MSS in the neck, shoulders, wrist/hands, upper back and hips/thighs/buttocks regions compared to males while males reported more symptoms of the elbows, low back and knees. There were no statistically significant differences in prevalence among age groups. In general, participants with heavy physical workloads had significantly higher prevalence of symptoms in most body regions than those with light physical workloads although women with light physical workloads reported more neck symptoms. The study indicates that the New Zealand working population has a high prevalence of MSS and that exposure in the workplace plays a role. Relevance to industry: The findings of this study imply that efforts to reduce MSS in the workplace should focus on females and employees with high physical workloads.
    International Journal of Industrial Ergonomics 07/2011; 41(5):561-572. · 1.21 Impact Factor
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    ABSTRACT: Study the determinants of non-response and the potential for non-response bias in a New Zealand survey of occupational exposures and health. A random sample of 10,000 New Zealanders aged 20-64 years were invited by mail to take part in a telephone survey. Multiple logistic regression was used to study the determinants of non-response. Whether occupational exposure, lifestyle and health indicators were associated with non-response was studied by standardising their prevalence towards the demographic distribution of the source population, and comparing early with late responders. The response rate was 37%. Younger age, Māori descent, highest and lowest deprivation groups and being a student, unemployed, or retired were determinants of non-contact. Refusal was associated with older age and being a housewife. Prevalence of key survey variables were unchanged after standardising to the demographic distribution of the source population. Following up the non-responders to the mailed invitations with telephone calls more than doubled the response rate and improved the representativeness of the sample. Although the response rate was low, we found no evidence of major non-response bias. Judgement regarding the validity of a survey should not be based on its response rate.
    Australian and New Zealand Journal of Public Health 06/2011; 35(3):256-63. · 1.64 Impact Factor
  • J Douwes, C Brooks, N Pearce
    European Respiratory Journal 05/2011; 37(5):986-90. · 6.36 Impact Factor
  • Source
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    ABSTRACT: AGRICOH is a recently formed consortium of agricultural cohort studies involving 22 cohorts from nine countries in five continents: South Africa (1), Canada (3), Costa Rica (2), USA (6), Republic of Korea (1), New Zealand (2), Denmark (1), France (3) and Norway (3). The aim of AGRICOH, initiated by the US National Cancer Institute (NCI) and coordinated by the International Agency for Research on Cancer (IARC), is to promote and sustain collaboration and pooling of data to investigate the association between a wide range of agricultural exposures and a wide range of health outcomes, with a particular focus on associations that cannot easily be addressed in individual studies because of rare exposures (e.g., use of infrequently applied chemicals) or relatively rare outcomes (e.g., certain types of cancer, neurologic and auto-immune diseases). To facilitate future projects the need for data harmonization of selected variables is required and is underway. Altogether, AGRICOH provides excellent opportunities for studying cancer, respiratory, neurologic, and auto-immune diseases as well as reproductive and allergic disorders, injuries and overall mortality in association with a wide array of exposures, prominent among these the application of pesticides.
    International Journal of Environmental Research and Public Health 05/2011; 8(5):1341-57. · 2.00 Impact Factor

Publication Stats

4k Citations
437.42 Total Impact Points

Institutions

  • 2000–2014
    • Massey University
      • Centre for Public Health Research
      Palmerston North City, Manawatu-Wanganui, New Zealand
    • University of Iowa
      • Department of Occupational and Environmental Health
      Iowa City, Iowa, United States
  • 2012
    • London School of Hygiene and Tropical Medicine
      Londinium, England, United Kingdom
  • 2011
    • California Department of Public Health
      • Environmental Health Laboratory Branch (EHLB)
      California City, CA, United States
  • 2009
    • University of Newcastle
      • Sub-discipline of Respiratory and Sleep Medicine
      Newcastle, New South Wales, Australia
    • University of Birmingham
      • School of Geography, Earth and Environmental Sciences
      Birmingham, ENG, United Kingdom
  • 2004–2009
    • National Institute of Occupational Health (STAMI)
      • Department of Chemical and Biological Work Environment
      Oslo, Oslo, Norway
  • 2001–2009
    • Universiteit Utrecht
      • Institute for Risk Assessment Sciences (IRAS)
      Utrecht, Provincie Utrecht, Netherlands
    • Columbia University
      • Department of Environmental Health Sciences
      New York City, NY, United States
  • 2006
    • The Chinese University of Hong Kong
      • Department of Paediatrics
      Hong Kong, Hong Kong
  • 2003
    • Friedrich-Schiller-University Jena
      • Institute of Immunology
      Jena, Thuringia, Germany
  • 2001–2003
    • University of Otago
      • Welllington Cardiovascular Research Group
      Dunedin, Otago, New Zealand
  • 1993–2000
    • Wageningen University
      Wageningen, Gelderland, Netherlands
  • 1996
    • University of Amsterdam
      • Department of Molecular Cell Biology
      Amsterdamo, North Holland, Netherlands