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      The use of self-reported symptoms as a proxy for acute organophosphate poisoning after exposure to chlorpyrifos 50% plus cypermethrin 5% among Nepali farmers: a randomized, double-blind, placebo-controlled, crossover study

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          Abstract

          Background

          Previous studies stating a high prevalence of occupational acute pesticide poisoning in developing countries have mainly relied on measurements of the rather non-specific self-reported acute pesticide poisoning symptoms. Only a few studies have measured the biomarker plasma cholinesterase (PchE) activity, in addition to the symptoms, when assessing occupational acute pesticide poisoning. This study evaluated self-reported symptoms as a proxy for acute organophosphate poisoning among Nepali farmers by examining self-reported acute organophosphate poisoning symptoms and PchE activity in response to occupational acute organophosphate exposure.

          Methods

          We performed a randomized, double-blind, placebo-controlled, crossover trial among 42 Nepali commercial vegetable farmers. The farmers were randomly assigned (ratio 1:1) to a 2-h organophosphate (chlorpyrifos 50% plus cypermethrin 5%: moderately hazardous) spray session or a 2-h placebo spray session, and after 7 days’ washout, the farmers were assigned to the other spray session. Before and after each spray session farmers were interviewed about acute organophosphate poisoning symptoms and PchE activity was measured. Analyses were conducted with a Two Sample T-test and Mann Whitney U-test.

          Results

          We found no difference in the symptom sum or PchE activity from baseline to follow up among farmers spraying with organophosphate (symptom sum difference −1, p = 0.737; PchE mean difference 0.02 U/mL, p = 0.220), placebo (symptom sum difference 9, p = 0.394; PchE mean difference 0.02 U/mL, p = 0.133), or when comparing organophosphate to placebo (symptom p = 0.378; PchE p = 0.775). However, a high percentage of the farmers reported having one or more symptoms both at baseline and at follow up in the organophosphate spray session (baseline 47.6%, follow up 45.2%) and placebo spray session (baseline 35.7%, follow up 50.0%), and 14.3% of the farmers reported three or more symptoms after the organophosphate spray session as well as after the placebo spray session.

          Conclusion

          We found a general presence of acute organophosphate symptoms among the farmers regardless of organophosphate exposure or poisoning. Thus, self-reported acute organophosphate symptoms seem to be a poor proxy for acute organophosphate poisoning as the occurrence of these symptoms is not necessarily associated with acute organophosphate poisoning.

          Trial registration

          ClinicalTrials.gov, NCT02838303. Registered 19 July 2016. Retrospectively registered.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12940-016-0205-1) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          Acute pesticide poisoning: a major global health problem.

          The global problem of acute pesticide poisoning has been confirmed as extensive by a variety of independent estimates. Further, it is also recognized to be a problem confined to the developing countries. Most estimates concerning the extent of acute pesticide poisoning have been based on data from hospital admissions which would include only the more serious cases. The latest estimate by a WHO task group indicates that there may be 1 million serious unintentional poisonings each year and in addition 2 million people hospitalized for suicide attempts with pesticides. This necessarily reflects only a fraction of the real problem. On the basis of a survey of self-reported minor poisoning carried out in the Asian region, it is estimated that there could be as many as 25 million agricultural workers in the developing world suffering an episode of poisoning each year. This article emphasizes the need to control the problem on a collaborative basis by all concerned, including national governments, agrochemical industries, international agencies, scientists and victims.
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            Acute pesticide poisoning: a proposed classification tool.

            Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide. Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems. Previous research has demonstrated wide variability in incidence rates for APP. This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems. This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world. It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases. Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention. By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.
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              Knowledge, attitude, practice, and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip.

              To assess knowledge, attitude, practice, and toxicity symptoms associated with pesticide use and exposure among 189 farm workers in the Gaza Strip. A cross section of agricultural farm workers in the Gaza Strip were asked to fill in a questionnaire on knowledge, attitudes, practice towards pesticide use, and associated toxicity symptoms. Farm workers reported high levels of knowledge on the health impact of pesticides (97.9%). Moderate to high levels of knowledge were recorded on toxicity symptoms related to pesticides. Most farm workers were aware of the protective measures to be used during applying pesticides. However, no one took precautions unless they knew about the measures. Burning sensation in eyes/face was the commonest symptom (64.3%). The prevalence of self reported toxicity symptoms was dependent on mixing and use of high concentrations of pesticides. The highest percentage of self reported toxicity symptoms was found among the farm workers who returned to sprayed fields within one hour of applying pesticides. Farm workers in the Gaza Strip used pesticides extensively. Despite their knowledge about the adverse health impact of the pesticides, the use of protective measures was poor. Most had self reported toxicity symptoms, particularly the younger workers. It would be useful to minimise the use of pesticides and encourage alternative measures. Prevention and intervention programmes regarding the use of protective measures and monitoring the health status of farm workers should be implemented.
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                Author and article information

                Contributors
                +45 27 14 38 34 , dea_kofod@hotmail.com
                erik.dialogos@gmail.com
                anshu.dialogos@gmail.com
                shankuk.me@gmail.com
                Jane.Froelund.Thomsen@regionh.dk
                Journal
                Environ Health
                Environ Health
                Environmental Health
                BioMed Central (London )
                1476-069X
                13 December 2016
                13 December 2016
                2016
                : 15
                : 122
                Affiliations
                [1 ]Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Entrance 20F, 2400 Copenhagen NV, Denmark
                [2 ]Department of Occupational and Environmental Medicine, Odense Hospital, University of Southern Denmark, Odense, Denmark
                [3 ]International Centre for Occupational, Environmental and Public Health (ICOEPH), Odense Hospital, University of Southern Denmark, Odense, Denmark
                [4 ]Dialogos, Noerrebrogade 52C, Copenhagen N, Denmark
                [5 ]Institute of Medicine, Tribhuvan University of Nepal, Kathmandu, Nepal
                Article
                205
                10.1186/s12940-016-0205-1
                5154153
                27964728
                8a0e3dce-3ca4-44c0-8788-82c782420d8b
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 July 2016
                : 3 December 2016
                Funding
                Funded by: Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
                Funded by: FundRef http://dx.doi.org/10.13039/501100004954, Augustinus Fonden;
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Public health
                farmers,organophosphate,acute pesticide poisoning,symptoms,plasma cholinesterase,nepal
                Public health
                farmers, organophosphate, acute pesticide poisoning, symptoms, plasma cholinesterase, nepal

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