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Objective: Data from South Asia indicate that for 15%–20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. Methods: We conducted two comparative studies in rural Sri Lanka: (1) non‐fatal shop cases (n = 50) were survivors of self‐poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non‐fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. Results: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non‐farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2–24.4 for non‐fatal shop cases, and AOR 4.0, 95% CI 1.5–10.6 for fatal shop cases. Non‐fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0–8.9), and ingesting an insecticide (AOR 4.8, CI 1.8–1.0–8.9) than non‐fatal domestic cases. Conclusion: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self‐poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals. [ABSTRACT FROM AUTHOR]

Kaohsiung City, a modern metropolis of 1.5 million persons, has been the focus of dengue virus activity in Taiwan for several decades. The aim of this study was to provide [...]

Objective To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self- poisoning, particularly from pesticides, in a single district. Methods Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were prospectively collected over a one-month period from one general hospital (2005) and five peripheral hospitals (2006) in the Anuradhapura district. Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals. The cost of the inputs in United States dollars (US$), using 2005 figures, was derived from hospital accounts. Findings The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital and maintenance costs. The average total cost of treatment was highest for self-poisoning with pesticides (US$ 49.12). The patients placed in the intensive care unit, who comprised 5% of the total, took up 75% of the overall treatment cost for all self-poisoned patients at the general hospital. The average total cost of treating self-poisoned patients at peripheral hospitals was US$ 3.33. The average patient cost per transfer was US$14.03. In 2006, the total cost of treating self-poisoned patients in the Anuradhapura district amounted to US$ 76 599, of which US$ 53 834 were comprised of pesticide self-poisonings. Based on the total treatment cost per self-poisoned patient estimated in this study, the cost of treating self-poisoned patients in all of Sri Lanka in 2004 was estimated at US$ 866 304. Conclusion The cost of treating pesticide self-poisonings may be reduced by promoting the use of less toxic pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services. Objectif Estimer le cout financier direct pour le Ministere de la sante sri lankais du traitement des cas d'auto-empoisonnement, notamment par des pesticides, dans un district particulier. Methodes Des donnees concernant le personnel soignant, les medicaments administres et les tests de laboratoire realises, ainsi que d'autres informations sur chacun des patients admis pour auto-empoisonnements ont ete collectees prealablement sur une periode de un mois aupres d'un hopital general (2005) et de cinq hopitaux peripheriques (2006) du district d'Anuradhapura. Des donnees concernant les transferts de patients dans des etablissements de niveau secondaire ou tertiaire ont ete obtenues sur une periode de 6 mois aupres de 30 hopitaux peripheriques. Le cout des intrants precedemment mentionnes en dollars des Etats-Unis d'Amerique (US $) a ete determine a partir des comptabilites hospitalieres, en utilisant les chiffres de 2005. Resultats Le cout total moyen pour traiter un cas d'auto-empoisonnement dans un hopital general s'elevait a US $ 31,83, montant dans lequel le personnel soignant et les medicaments representaient les categories de debours les plus importantes et les couts du capital et de maintenance n'atteignaient que US $ 0,19. C'est pour les auto-empoisonnements par des pesticides que le cout moyen du traitement etait le plus eleve (US $ 49,12). Les patients places dans des unites de soins intensifs, qui representaient 5 % de l'ensemble des patients, totalisaient a eux-seuls 75 % du cout global de traitement de l'ensemble des victimes d'auto-empoisonnement dans l'hopital general. Le cout total moyen du traitement d'un cas d'auto-empoisonnement dans un hopital peripherique etait de US $ 3,33. Le cout moyen de transfert d'un patient se montait a US $14,03. En 2006, le cout total du traitement des victimes d'auto-empoisonnement dans le district d'Anuradhapura atteignait US $ 76 599, dont US $ 53 834 pour les auto-empoisonnements par des pesticides. A partir de l'estimation du cout total du traitement par victime d'auto-empoisonnement etablie dans cette etude, on a evalue a US $ 866 304 le cout du traitement des cas d'auto-empoisonnement pour l'ensemble du Sri Lanka sur l'annee 2004. Conclusion II serait possible de reduire le cout du traitement des auto-empoisonnements par des pesticides en faisant la promotion de pesticides moins toxiques et eventuellement en ameliorant la prise en charge des cas dans les etablissements de soins primaires. D'autres travaux de recherche sont necessaires pour evaluer si un renforcement des infrastructures et du personnel des hopitaux peripheriques pourrait permettre une diminution du cout global pour l'Etat, une optimisation de la prise en charge des cas et une moindre pression sur les services secondaires. Objetivo Estimar los costos financieros directos que supone para el Ministerio de Salud de Sri Lanka el tratamiento de los pacientes con intoxicacion voluntaria, en particular por plaguicidas, en un determinado distrito. Metodos En un hospital general (2005) y cinco hospitales perifericos (2006) del distrito de Anuradhapura, a lo largo de un mes se reunieron datos prospectivos sobre el personal, los medicamentos, la informacion de laboratorio y otras variables sobre todos los pacientes ingresados por intoxicacion voluntaria. Durante un periodo de seis meses se obtuvieron datos de 30 hospitales perifericos sobre los traslados de esos pacientes a centros de nivel secundario y terciario. El costo de los insumos en dolares de los Estados Unidos (US$), con cifras de 2005, se calculo a partir de las cuentas hospitalarias. Resultados En el hospital general, el costo medio total del tratamiento de los pacientes que se habian intoxicado voluntariamente fue de US$ 31,83, suma dentro de la cual el gasto mas importante correspondio al personal de sala y los medicamentos, y solo US$ 0,19 a los gastos de capital y mantenimiento. El costo total medio del tratamiento fue maximo en el caso de las intoxicaciones voluntarias por plaguicidas (US$ 49,12). Los pacientes ingresados en la unidad de cuidados intensivos, el 5% del total, representaron el 75% del costo global del tratamiento de todos los pacientes con intoxicacion voluntaria atendidos en el hospital general. El costo total medio del tratamiento de los pacientes intoxicados voluntariamente en los hospitales perifericos fue de US$ 3,33. El costo medio por traslado fue de US$14,03. En 2006, el costo total del tratamiento de esos pacientes en el distrito de Anuradhapura ascendio a US$ 76 599, de los cuales US$ 53 834 correspondian a intoxicaciones voluntarias con plaguicidas. Considerando el costo total estimado en este estudio para el tratamiento por paciente intoxicado, se calcula que el costo del tratamiento de los pacientes con intoxicacion voluntaria en todo Sri Lanka en 2004 ascendio a US$ 866 304. Conclusion El costo del tratamiento de las intoxicaciones voluntarias por plaguicidas podria reducirse promoviendo el uso de plaguicidas menos toxicos y, posiblemente, mejorando el tratamiento de los casos en los hospitales de atencion primaria. Se requeriran nuevas investigaciones para determinar si la ampliacion de la infraestructura y el personal en los hospitales perifericos permitiria reducir el costo global para la Administracion, optimizar el manejo de los casos y reducir la presion en los servicios secundarios., Une traduction en francis de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. Introduction A conservative estimate is that at [...]