Acute Human Lethal Toxicity of Agricultural Pesticides A Prospective Cohort Study 英文参考文献.docVIP

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Acute Human Lethal Toxicity of Agricultural Pesticides A Prospective Cohort Study 英文参考文献.doc

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Acute Human Lethal Toxicity of Agricultural Pesticides A Prospective Cohort Study 英文参考文献

Acute Human Lethal Toxicity ofAgricultural Pesticides: AProspective Cohort Study AndrewH.Dawson1,2,3.*,MichaelEddleston1,4,5.,LalithSenarathna1,FahimMohamed1 ,Indika Gawarammana1,StevenJ.Bowe2,GaminiManuweera6,NicholasA.Buckley1,3 1SouthAsianClinicalToxicologyResearchCollaboration,FacultyofMedicine,UniversityofPeradeniya,Peradeniya,SriLanka,2SchoolofMedicineandPublicHealth, University of Newcastle, Newcastle, Australia, 3Professorial Medicine Unit, POW Clinical School, University of New South Wales, Sydney, Australia, 4National Poisons InformationService-Edinburgh,RoyalInfirmaryofEdinburgh,Edinburgh,UnitedKingdom,5ClinicalPharmacologyUnit,CentreforCardiovascularScience,Universityof Edinburgh,Edinburgh,UnitedKingdom,6OfficeofthePesticideRegistrar,GovernmentDepartmentofAgriculture,Peradeniya,SriLanka Abstract Background: Agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000–370,000peopleeachyear.TargetedpesticiderestrictionsinSriLankaoverthelast20yearshavereducedpesticide deathsby50%withoutdecreasingagriculturaloutput.However,regulatorydecisionshavethusfarnotbeenbasedonthe humantoxicityofformulatedagriculturalpesticidesbutonthesurrogateofrattoxicityusingpureunformulatedpesticides. Weaimed todeterminetherelative humantoxicity offormulatedagricultural pesticidestoimprove theeffectiveness of regulatorypolicy. MethodsandFindings:Weexaminedthecasefatalityofdifferentagriculturalpesticidesinaprospectivecohortofpatients presentingwithpesticideself-poisoningtotwoclinicaltrialcentersfromApril2002toNovember2008.Identificationofthe pesticideingestedwasbasedonhistoryorpositiveidentificationofthecontainer.Asinglepesticidewasingestedby9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients,thehistoryofingestionwasconfirmedbylaboratoryanalysisin95%ofpatients.Therewasalargevariationincase fatalitybetweenpesticides—from0%to42%.Thismarkedvari