■使用农药作为自杀手段故意自我中毒是低收入和中等收入国家的一个重要公共卫生问题。三种剧毒农药乐果,fenthion,和百草枯-在2008年至2011年间从斯里兰卡的市场上被移除。2015年,毒性较低的农药(毒死蜱,草甘膦,克百威,和西维因)受到限制。随后的结果没有得到很好的描述。
■探讨农药禁令与农药自我中毒和住院死亡的关系。
■在这项具有中断时间序列设计的横截面研究中,我们前瞻性收集了2002年3月31日至2019年12月31日期间在斯里兰卡10家医院就诊的所有故意自我中毒患者的数据,并按中毒的汇总类型进行了分析.农药禁令的相关性是在农药组中和其他物质组中的自我中毒估计的。数据分析在2002年4月1日至2019年12月31日之间进行。
■实施2套农药禁令。
■主要结果是使用分段泊松回归测量的与农药自我中毒相关的医院介绍和院内死亡的变化。
■共有79780名患者(中位[IQR]年龄,24[18-34]岁;50.1%的男性)因各种原因发生自我中毒而被送往研究医院,农药中毒29389例(36.8%)。共有2859名患者死亡,2084人(72.9%)摄入了农药。第一个针对剧毒的限制,高度危险的农药与农药中毒比例的突然和持续下降有关(比率[RR],0.85;95%CI,0.78-0.92)在研究期间,药物中毒增加(RR,1.11;95%CI,1.02-1.21)和家用和工业化学品(RR,1.20;95%CI,1.05-1.36)。农药的总病死率显着降低(RR,0.33;95%CI,0.26-0.42)在实施了2008年至2011年的高危害性农药限制后。根据2015年低毒农药的限制,住院情况没有改变,死亡人数增加(RR,1.98;95%CI,1.39-2.83)。
这些研究结果支持在资源贫乏的国家限制使用剧毒农药,以帮助减少因故意自我中毒而导致的住院和死亡,并警告不要任意禁止毒性较低的农药,而毒性更大的农药仍然可用。
UNASSIGNED: Deliberate self-
poisoning using pesticides as a means of suicide is an important public health problem in low- and middle-income countries. Three highly toxic pesticides-dimethoate, fenthion, and paraquat-were removed from the market in Sri Lanka between 2008 and 2011. In 2015, less toxic pesticides (chlorpyrifos, glyphosate, carbofuran, and carbaryl) were restricted. Subsequent outcomes have not been well described.
UNASSIGNED: To explore the association of pesticide bans with pesticide self-poisonings and in-hospital deaths.
UNASSIGNED: In this cross-sectional study with an interrupted time series design, data were prospectively collected on all patients with deliberate self-poisonings presenting to 10 Sri Lankan hospitals between March 31, 2002, and December 31, 2019, and analyzed by aggregated types of
poisoning. The correlates of pesticide bans were estimated within the pesticide group and on self-poisonings within other substance groups. The data analysis was performed between April 1, 2002, and December 31, 2019.
UNASSIGNED: Implementation of 2 sets of pesticide bans.
UNASSIGNED: The main outcomes were changes in hospital presentations and in-hospital deaths related to pesticide self-
poisoning as measured using segmented Poisson regression.
UNASSIGNED: A total of 79 780 patients (median [IQR] age, 24 [18-34] years; 50.1% male) with self-
poisoning from all causes were admitted to the study hospitals, with 29 389 poisonings (36.8%) due to pesticides. A total of 2859 patients died, 2084 (72.9%) of whom had ingested a pesticide. The first restrictions that targeted acutely toxic, highly hazardous pesticides were associated with an abrupt and sustained decline of the proportion of poisonings with pesticides (rate ratio [RR], 0.85; 95% CI, 0.78-0.92) over the study period and increases in poisonings with medications (RR, 1.11; 95% CI, 1.02-1.21) and household and industrial chemicals (RR, 1.20; 95% CI, 1.05-1.36). The overall case fatality of pesticides significantly decreased (RR, 0.33; 95% CI, 0.26-0.42) following the implementation of the 2008 to 2011 restrictions of highly hazardous pesticides. Following the 2015 restrictions of low-toxicity pesticides, hospitalizations were unchanged, and the number of deaths increased (RR, 1.98; 95% CI, 1.39-2.83).
UNASSIGNED: These findings support the restriction of acutely toxic pesticides in resource-poor countries to help reduce hospitalization for and deaths from deliberate self-poisonings and caution against arbitrary bans of less toxic pesticides while more toxic pesticides remain available.