Childhood pesticide poisoning in Zhejiang, China: a retrospective analysis from 2006 to 2015

Organophosphate pesticide residue impact on water quality and changes in macroinvertebrate community in an Afrotropical stream flowing through farmlands

River Chanchaga has experienced significant agricultural practices around its catchment, which involved the indiscriminate use of pesticides. However, residents of the study area are not well aware of the negative impact of pesticides on water quality and macroinvertebrates. In this study, the first report on the influence of organophosphate pesticide contamination on the abundance of the macroinvertebrate community was provided. Sampling for the determination of organophosphate pesticide residues was carried out during the peak of the two seasons, while macroinvertebrates and physicochemical variables were observed for 6 months. We examined 11 organophosphate pesticide residues using gas chromatography coupled with mass spectrometry, 12 water quality variables, and 625 macroinvertebrate individuals. The concentration of recorded organophosphate pesticide residues ranged from 0.01 to 0.52 μg/L. From the Canonical Correspondence Analysis plot, malathion, chlorine, and paraffin show a positive correlation with Unima sp., Hydrocanthus sp., Chironomus sp., and Potadoma sp. At station 3, depth shows a positive correlation with Biomphalaria sp. and Zyxomma sp., indicating poor water quality as most of these macroinvertebrates are indicators of water pollution. Diuron and carbofuran show a negative correlation with Lestes sp. and Pseudocloeon sp., and these are pollution-sensitive macroinvertebrates. The total mean concentration of organophosphate pesticide residues was above international drinking water standards set by the World Health Organization except for paraffin, chlorpyrifos, and diuron. In conclusion, the observations recorded from this research are useful in managing pesticide applications around the river catchment.

Clinical analysis of acute poisoning in children

OBJECTIVE

The clinical characteristics of hospitalized children with acute poisoning were analyzed to provide a reference for preventing poisoning and seeking effective prevention and treatment.

METHODS

The clinical data of 112 children with acute poisoning admitted to Qilu Hospital of Shandong University from January 1, 2018, to December 31, 2021, were collected and analyzed from different perspectives.

RESULTS

The majority of acute poisoning cases that occurred in children were in early childhood and preschool age (89 cases, accounting for 79.4%). The most common types of poisoning were pesticide poisoning and drug poisoning, and the main ways of poisoning were accidental administration via the digestive tract and accidental ingestion. Poisoning occurred slightly more in spring and summer all year round, and most children had a good prognosis after timely treatment.

CONCLUSION

Acute poisoning often occurs in children. Parental education and intensified child supervision are needed to prevent the incidence of unintentional poisoning.

A more than four-fold sex-specific difference of autism spectrum disorders and the possible contribution of pesticide usage in China 1990-2030

Autism spectrum disorders (ASDs) are prevalent in children and adolescents and disproportionately affect males, and the main contributing factors underlying male vulnerability remain widely unknown. Pesticide use is widely reported to be associated with ASD risk, and the cases of pesticide poisoning incidence in rural areas are remarkably higher than those in the urban areas while the prevalence of ASDs in rural areas was higher than that in urban areas and the rate of male pesticide poisoning was significantly higher than female. Thus, pesticide usage may be an important contributing factor for causing sex-specific differences of ASD incidence. ASD burden was analyzed by using the data of ASD number, ASD rate (ASD cases per 100,000 persons) and disability-adjusted life years (DALYs) from 1990 to 2019. The changes from 1990 to 2030 were predicted using autoregressive integrated moving average (ARIMA) in time series forecasting based on the small values of Akaike information criterion and Bayesian information criterion. Finally, the relationship between ASD rate and pesticide usage risk index (PURI) was analyzed via Pearson's correlation coefficient. ASD number, ASD rate and DALYs will be reduced by 45.5% ± 8.2% (t = 9.100 and p = 0.0119), 56.6% ± 10.2% (t = 9.111 and p = 0.0118), and 44.9% ± 7.0% (t = 20.90 and p = 0.0023) from 1990 to 2030 in China. PURI has a strong relationship with ASD rate (rho = 0.953 to 0.988 and p < 0.0001). Pesticide poisoning incidence in males is up to 2-fold higher than that in females. ASD number and DALYs in males are 4-fold higher than those in females. Furthermore, there is growing evidence supporting that males are more susceptible than females to pesticides with sex differences in neurotoxicogenetics. Therefore, pesticide poisoning may be a contributing factor for causing the sex differences of ASD. Much work still needs to be done to confirm that.

Impact of the COVID-19 Outbreak on Disease Spectrum of Pediatric Intensive Care Units

Purpose

We aimed to analyze the changes in the disease spectrum data of a pediatric intensive care unit (PICU) in Nanjing, China, during the COVID-19 outbreak and explore a feasible plan for the treatment of critically ill children.

Methods

This retrospective study used data from our PICU from 1 January 2018 to 31 December 2020. Patient demographics, distribution of disease spectrum, results of etiological examinations, and the PICU length of stay (LOS) were compared during the COVID-19 period (2020) and the previous years (2018 and 2019).

Results

In 2020, the number of PICU admissions was 46.8 and 47.8% lower than that in 2018 and 2019, respectively. There were significant differences in the number of patients in PICU among different age groups, and these differences were mainly found in children aged <4 years and older than 14 years. The percentage of the number of patients in PICU with respiratory diseases decreased significantly, while those with hematological diseases, poisoning, and rare diseases increased significantly. Moreover, the number of patients with rare diseases increased significantly, while the number of patients with mitochondrial diseases exceeded that of those with autoimmune encephalitis. The PICU LOS in 2020 was higher than that observed in 2018 and 2019, indicating that the changes in the PICU disease spectrum did not directly affect the PICU LOS. Etiological examinations revealed that during the COVID-19 period, the number of patients in PICU with bacterial infections increased, and those with viral infections decreased, although not statistically significant.

Conclusions

A striking decrease in the number of PICU admissions was observed during the COVID-19 outbreak, which caused a significant change in the PICU disease spectrum. Changes in the number and characteristics of patients admitted to PICUs should be considered for facilitating the effective working of PICUs during the COVID-19 pandemic.

Evaluation of accidental and intentional pediatric poisoning: Retrospective analysis in an emergency Department of Turkey

INTRODUCTION

Childhood poisoning is one of the leading causes of applications to ED and is a preventable cause of morbidity and mortality. The characteristics of poisoning may differ by geographic region, season, and the sociocultural aspects of the community and age groups.

METHOD

Poisoned patients age ≤ 18 years admitted to the ED January 2018-December 2019, were evaluated retrospectively.

RESULTS

Of 170 cases, mean age was 7.48 ± 5.54 years. Of the cases, 0-5 years (44.1%), 6-12 years (24.7%), and 13-18 years (31.2%); most were female (58.2%). Causes were accidental (72.9%), intentional (24.1%), and substance use (2.9%). Accidental cases were all patients age 0-5 years, 31.8% of age 6-12 years, and 24.5% of age 13-18 years. Drugs caused 72.9% of cases, primarily analgesics (22.4%), among which nonsteroidal anti-inflammatory drugs were most common (12.4%). Intentional poisoning by repeated drug intake caused 5.9% of cases. Rat poison caused 7.1% of non-drug cases. Treatment was gastric lavage (52.4%) and oral activated charcoal (45.9%).

CONCLUSION

As a result of the study, it was determined that accidental drug intake was the most common reason for children to apply to the ED due to acute poisoning in our region. Childhood poisoning can be prevented by measures to be taken by the environment, family, and healthcare professionals.

PRACTICE IMPLICATIONS

The fact that children's acute poisoning cases are mostly accidental in our region shows that it is important to raise the awareness of parents to reduce acute poisoning and alleviate its negative consequences.

Do pesticides promote or hinder sustainability in agriculture? The challenge of sustainable use of pesticides in modern agriculture

Sustainable agriculture aims to meet the food needs of the growing world population while ensuring minimal impact on the environment and humans as well as productivity. Although pesticides represent the backbone of the agri-food sector in its endeavor to secure food production their application is perceived by many as an obstacle towards the achievement of sustainability; the main concerns are linked with their adverse effects on human health and the environment. Τhis review aims to present the status of chemical plant protection and provide insights into the use of pesticides within the context of sustainable agriculture. It mainly focuses on the strengthened legislation frameworks, which especially in the European Union and the United States of America ensure the placement in the market of pesticides with acceptable toxicological and environmental profiles without compromising crop production. Furthermore, the implementation of Integrated Pest Management principles plays a key role in the sustainable use of pesticides. The stringent regulatory requirements have resulted in the dramatic increase of the associated effort and costs in pesticide research and development (R&D) of improved products. Nevertheless, the investment of leading agrochemical companies in the R&D of new pesticides remains high. All the above set the ground for the sustainable use of pesticides in crop production while their successful application remains a challenge.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

BACKGROUND

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.

AIMS

Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.

METHOD

We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.

RESULTS

Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.

CONCLUSIONS

Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

The Role of Suspension Array Technology in Rapid Detection of Foodborne Pollutants: Applications and Future Challenges

Food safety is an important livelihood issue, which has always been focused attention by countries and governments all over the world. As food supply chains are becoming global, food quality control is essential for consumer protection as well as for the food industry. In recent years, a great part of food analysis is carried out using new techniques for rapid detection. As the first biochip technology that has been approved by the Food and Drug Administration (FDA), there is an increasing interest in suspension array technology (SAT) for food and environmental analysis with advantages of rapidity, high accuracy, sensitivity, and throughput. Therefore, it is important for researchers to understand the development and application of this technology in food industry. Herein, we summarized the principle and composition of SAT and its application in food safety monitoring. The utility of SAT in detection of foodborne microorganisms, residues of agricultural and veterinary drugs, genetically modified food and allergens in recent years is elaborated, and the further development direction of SAT is envisaged.

Exploring the external exposome using wearable passive samplers - The China BAPE study

Environmental exposures are one of the greatest threats to human health, yet we lack tools to answer simple questions about our exposures: what are our personal exposure profiles and how do they change overtime (external exposome), how toxic are these chemicals, and what are the sources of these exposures? To capture variation in personal exposures to airborne chemicals in the gas and particulate phases and identify exposures which pose the greatest health risk, wearable exposure monitors can be deployed. In this study, we deployed passive air sampler wristbands with 84 healthy participants (aged 60-69 years) as part of the Biomarkers for Air Pollutants Exposure (China BAPE) study. Participants wore the wristband samplers for 3 days each month for five consecutive months. Passive samplers were analyzed using a novel gas chromatography high resolution mass spectrometry data-processing workflow to overcome the bottleneck of processing large datasets and improve confidence in the resulting identified features. The toxicity of chemicals observed frequently in personal exposures were predicted to identify exposures of potential concern via inhalation route or other routes of airborne contaminant exposure. Three exposures were highlighted based on elevated toxicity: dichlorvos from insecticides (mosquito/malaria control), naphthalene partly from mothballs, and 183 polyaromatic hydrocarbons from multiple sources. Other exposures explored in this study are linked to diet and personal care products, cigarette smoke, sunscreen, and antimicrobial soaps. We highlight the potential for this workflow employing wearable passive samplers for prioritizing chemicals of concern at both the community and individual level, and characterizing sources of exposures for follow up interventions.

Sociodemographic characteristics and exposure patterns of pesticide-related cases reported to a poison service center in Brazil between 2012 and 2016

Pesticide poisoning is a significant public health problem responsible for an estimated three million poisoning cases per year and more than 250,000 deaths, most of which occur in underdeveloped countries. We evaluated pesticide exposure cases reported to a toxicological service center in Brazil, between 2012 and 2016. There were 3211 cases of pesticide exposure, with a high prevalence in adults aged 20-39 years (41.2%). Attempted suicide was the leading cause of pesticide cases (48%). Occupational exposure to pesticides of agricultural use was more frequently observed among men. Accidental exposure and attempted suicide were more frequently observed in urban areas while occupational exposure was more prevalent in rural areas. A higher exposure rate was observed among men in counties with higher agricultural activities. Establishing prevalence and cause of pesticide exposure is important to provide subsidy for evidence-based interventions in the field.

Presence and Health Risks of Obsolete and Emerging Pesticides in Paddy Rice and Soil from Thailand and China

Organochlorine (OCPs) and organophosphorus pesticides (OPPs) have been intensively applied in rice paddy field farming to control pest infestation and increase the yield. In this study, we investigated the presence of organochlorine and organophosphorus pesticides in paddy rice and soil from rice plantations in Thailand and China. According to concentration and distribution of OCPs, the most abundant OCPs residues in rice and soil from Thailand and China were dichlorodiphenyltrichloroethane and hexachlorocyclohexanes. The OPPs of methidathion, carbophenothion, chlorpyrifos, and diazinon were common to Thailand and China in both types of samples. The detection frequency of multiple types of these pesticides was greater than 50% of total samples. The relative concentration of some OPPs residues in rice and soil from Thailand and China were significantly different from each other (p < 0.0083), whereas, no significant difference was observed for the relative concentration of OCPs residues in rice and soil from both countries, except for HCHs (p < 0.05). Bioaccumulation factors of OCPs between rice and soil samples indicated that OCPs and OPPs in soil could accumulate in rice. The carcinogenic and non- carcinogenic risks of OCPs and OPPs seem to be in the safe range as recommended by the European Union.

Extracorporeal treatment in children with acute severe poisoning

Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons.We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded.The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died.ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.

Epidemiological and sociocultural assessment of childhood poisonings

Objectives

Poisoning occurring in childhood still continues to be an important public health issue. The aim of the study is to socio-demographically and clinically examine poisoning cases consulted to emergency department.

Methods

The findings of 121 patients between the ages of 1 month and 17 years consulting to the pediatric emergency department with the suspicion of poisoning were examined retrospectively in the study.

Results

The mean age of the patients was 6.60 ± 5.70 (min-max: 0–17) years and 49.6% of the patients were male and 50.4% were female. The most common causes of poisoning were corrosive chemicals in 35 patients (28.9%), poisonous animals in 24 patient's (19.8%) and prescription medications in 24 patients (19.8%). While 103 (85.1%) of the cases were exposed to the factor accidently, 18 of the cases (14.9%) had attempted suicide. The mean monthly family income levels of accidently poisoned cases were significantly higher than those who attempted suicide (p < 0.001). The father's education level was lower in cases who were poisoned by suicide attempt than in those who were accidently poisoned (p < 0.001).

Conclusion

Poisoning rates in childhood and varieties of factors differentiate among the regions. The rate of poisoning cases due to poisonous animals was found to be quite high in the region where this study was carried out. In addition, the study showed that poisoning rates due to suicide attempt in children of families with low income level and/or father's education level have increased.

Epidemiological characteristics of pesticide poisoning in Jiangsu Province, China, from 2007 to 2016

To investigate the characteristics of pesticide poisoning in Jiangsu province and provide a scientific basis for measures for the prevention of pesticide poisoning. Information from pesticide poisoning report cards from 2007 to 2016 was derived from the Occupational Disease and Occupational Health Information Monitoring System, and the characteristics of pesticide poisoning patients were assessed via descriptive analysis. A total of 30,789 pesticide poisoning cases were reported in Jiangsu Province. Of these cases, 23,557 were non-occupational poisonings, accounting for 76.5% of the reported cases. There were 1705 deaths from pesticide poisoning, and the fatality rate was 5.5%. Numerous cases occurred in northeast Jiangsu. Pesticide poisoning cases were primarily concentrated in individuals 36-60 years of age. Pesticide poisoning primarily occurred in the summer. The top types of pesticides causing poisoning were organophosphates. The fatality rate of intentional pesticide poisoning was the lowest among the age group of 0 to 14 years, while the highest was noted among people over 61 years. Therefore, pesticide poisoning is a major problem in Jiangsu Province. We need to strengthen the management of highly toxic pesticides and implement effective health education on the use of pesticides.

Poisoning deaths in China, 2006-2016

Objective

To provide a comprehensive overview of poisoning mortality patterns in China.

Methods

Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately.

Results

In 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6–6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25–64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25–44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females.

Conclusion

Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.

Acute Pesticide Poisoning in Children: Hospital Review in Selected Hospitals of Tanzania

BACKGROUND

Acute pesticide poisoning (APP) is a serious problem worldwide. Because the burden of childhood APP is unknown in Tanzania, this study describes the distribution, circumstances, and patterns of APP involving children under 18 years in Tanzania.

METHODOLOGY

A 12-month prospective study was conducted in 10 Tanzanian healthcare facilities in 2006 using a data collection tool for surveillance.

RESULTS

Of 53 childhood poisoning cases identified, 56.6% were female. The most common poisoning circumstances were accidents (49.1%) and suicide (30.2%). The most vulnerable children were 16-17 years old (30.2%). Suicide was significantly more common in females (PRR females/males = 1.66; 95% CI = 1.03-2.68) and accidental cases were more common in children aged 10 years or younger. Suicide was concentrated in children over 10 years, comprising 53% of cases in this age group. Organophosphates (OPs), zinc phosphide, and endosulfan were common amongst reported poisoning agents. The annual APP incidence rate was 1.61/100,000.

CONCLUSION

APP is common among children in this region of Tanzania. Prevention of suicide in older children should address mental health issues and control access to toxic pesticides. Prevention of accidents in younger children requires safer storage and hygiene measures. Diverse interventions are needed to reduce pesticide poisoning among children in Tanzania.