Acute Human Lethal Toxicity of Agricultural Pesticides: A Prospective Cohort Study
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{"title"=>"Acute human lethal toxicity of agricultural pesticides: A prospective cohort study", "type"=>"journal", "authors"=>[{"first_name"=>"Andrew H.", "last_name"=>"Dawson", "scopus_author_id"=>"7202697676"}, {"first_name"=>"Michael", "last_name"=>"Eddleston", "scopus_author_id"=>"56730281300"}, {"first_name"=>"Lalith", "last_name"=>"Senarathna", "scopus_author_id"=>"6507019572"}, {"first_name"=>"Fahim", "last_name"=>"Mohamed", "scopus_author_id"=>"8857070400"}, {"first_name"=>"Indika", "last_name"=>"Gawarammana", "scopus_author_id"=>"6505926898"}, {"first_name"=>"Steven J.", "last_name"=>"Bowe", "scopus_author_id"=>"6603109800"}, {"first_name"=>"Gamini", "last_name"=>"Manuweera", "scopus_author_id"=>"6505942009"}, {"first_name"=>"Nicholas A.", "last_name"=>"Buckley", "scopus_author_id"=>"7102676778"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-78149397168", "sgr"=>"78149397168", "issn"=>"15491277", "arxiv"=>"arXiv:1011.1669v3", "doi"=>"10.1371/journal.pmed.1000357", "pmid"=>"21048990", "isbn"=>"1549-1277", "pui"=>"359922534"}, "id"=>"f40d6d6b-6401-3a2f-8ba3-e6b7c0f875ca", "abstract"=>"BACKGROUND: agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000-370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy. METHODS AND FINDINGS: we examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides-from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications. CONCLUSION: the human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner.", "link"=>"http://www.mendeley.com/research/acute-human-lethal-toxicity-agricultural-pesticides-prospective-cohort-study", "reader_count"=>115, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>8, "Researcher"=>19, "Student > Doctoral Student"=>8, "Student > Ph. D. Student"=>16, "Student > Postgraduate"=>11, "Student > Master"=>17, "Other"=>4, "Student > Bachelor"=>19, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>4, "Professor"=>6}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>8, "Researcher"=>19, "Student > Doctoral Student"=>8, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/409802", "https://ndownloader.figshare.com/files/409840", "https://ndownloader.figshare.com/files/409882"], "description"=>"<div><h3>Background</h3><p>Agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000–370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy.</p> <h3>Methods and Findings</h3><p>We examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides—from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications.</p> <h3>Conclusion</h3><p>The human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner.</p> <h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["acute", "lethal", "toxicity", "prospective", "cohort"], "article_id"=>140942, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.s001", "https://dx.doi.org/10.1371/journal.pmed.1000357.s002", "https://dx.doi.org/10.1371/journal.pmed.1000357.s003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Acute_Human_Lethal_Toxicity_of_Agricultural_Pesticides_A_Prospective_Cohort_Study/140942", "title"=>"Acute Human Lethal Toxicity of Agricultural Pesticides: A Prospective Cohort Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-10-26 00:15:42"}
  • {"files"=>["https://ndownloader.figshare.com/files/822180"], "description"=>"<p>Plot of case fatality for different pesticides grouped by WHO class.</p>", "links"=>[], "tags"=>["fatality", "pesticides", "grouped"], "article_id"=>492546, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Plot_of_case_fatality_for_different_pesticides_grouped_by_WHO_class_/492546", "title"=>"Plot of case fatality for different pesticides grouped by WHO class.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-10-26 00:42:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/822300"], "description"=>"a<p>Excludes unknown pesticides.</p>b<p>Substitution of glyphosate for paraquat as it is the only nonspecific herbicide. Substitution of dimethoate and fenthion with the “Other pesticides” group (using the pooled case fatality).</p>c<p>Substitution of propanil for paraquat and oxydemeton-methyl for dimethoate and fenthion. Propanil would be an unlikely substitute as it is a selective herbicide.</p>", "links"=>[], "tags"=>["paraquat", "bans", "cohort", "patients"], "article_id"=>492663, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.t004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Modeling_the_potential_effect_of_dimethoate_fenthion_and_paraquat_bans_in_an_equal_size_cohort_7_461_patients_with_known_pesticide_a_ingestion_/492663", "title"=>"Modeling the potential effect of dimethoate, fenthion, and paraquat bans in an equal size cohort (7,461 patients with known pesticide<sup>a</sup> ingestion).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-26 00:44:23"}
  • {"files"=>["https://ndownloader.figshare.com/files/822335"], "description"=>"<p>WHO classification of toxicity <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000357#pmed.1000357-WHO1\" target=\"_blank\">[18]</a>.</p>", "links"=>[], "tags"=>["classification", "toxicity"], "article_id"=>492700, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_WHO_classification_of_toxicity_18_/492700", "title"=>"WHO classification of toxicity [18].", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-26 00:45:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/822378"], "description"=>"<p>Detail of pesticides included in “Other” groupings, the number of cases in parenthesis following each pesticide.</p>a<p>Denotes one sided 97.5% CI.</p>b<p>Acephate (10), coumaphos (4), fenitrothion (2), formothion (1), monochrotophos (10), phoxim (10), terbufos (1).</p>c<p>Thiodicarb (6), methylcarb (1).</p>d<p>Cyfluthrin (5), cypermethrin (7), d-trans allethrin (4), fenvalerate (4), flumethrin (6), unspecified pyrethroid (20).</p>e<p>Azadirachtin (5), chromafenozide (1), flufenoxuron (1), tebufenozide (3), thiacloprid (1), novaluron (1).</p>f<p>Dinitroaniline (1), ethoxysulfuran (1), methyl 3,4-dichlorocarbanilate (1), dinitroaniline (1), oxadiazon (1), pendimethalin (9), propachlor (1), quinclorac (7).</p>g<p>Binapacryl (1), carbendazim (2), chlorothalonil (4), dithiocarbamate (7), ethoxysulfan (1), hexaconazole (4), isoprothioline (1), mancozeb (5), propiconazole (1), propineb (1), tebuconazole (2), thiophanate (1), triazole (1).</p><p>c., cutaneous; NC Not classified.</p>", "links"=>[], "tags"=>["fatality", "pesticide", "admissions"], "article_id"=>492742, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Case_fatality_of_any_pesticide_with_more_than_ten_admissions_or_any_death_/492742", "title"=>"Case fatality of any pesticide with more than ten admissions or any death.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-26 00:45:42"}
  • {"files"=>["https://ndownloader.figshare.com/files/822417"], "description"=>"<p>Note of caution: Large OR and wide 95% CI due to small number of deaths in subgroup.</p>a<p><i>n</i> = 419 omitted from model since no deaths occurred for some categories of pesticide.</p>", "links"=>[], "tags"=>["regression", "pesticide"], "article_id"=>492782, "categories"=>["Cancer", "Biotechnology", "Information And Computing Sciences"], "users"=>["Andrew H. Dawson", "Michael Eddleston", "Lalith Senarathna", "Fahim Mohamed", "Indika Gawarammana", "Steven J. Bowe", "Gamini Manuweera", "Nicholas A. Buckley"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000357.t003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Logistic_regression_of_odds_of_a_fatal_outcome_for_each_pesticide_before_and_after_adjustment_for_gender_and_age_/492782", "title"=>"Logistic regression of odds of a fatal outcome for each pesticide before and after adjustment for gender and age.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-26 00:46:22"}

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