Availability and storage of hazardous products in households in the metropolitan region of manaus: a population-based survey, 2015 / Disponibilidade e armazenamento de produtos perigosos em domicílios da região metropolitana de manaus: estudo de base populacional, 2015

ABSTRACT Objective: The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus. Methods: Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted. Results: A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13). Conclusions: Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.

RESUMO Objetivo: A disponibilidade de produtos perigosos em domicílios aumenta os riscos de intoxicações. Este estudo objetivou avaliar a frequência e os fatores associados à disponibilidade e armazenamento de produtos perigosos em residências da Região Metropolitana de Manaus. Métodos: Estudo transversal de base populacional realizado em 2015 com adultos selecionados por amostragem probabilística em três estágios. Os participantes foram entrevistados pessoalmente. A razão de prevalência (RP) da presença de produtos perigosos (presença de chumbinho [rodenticida anticolinesterase ilegal], produtos de limpeza artesanais e armazenamento inseguro desses produtos e de medicamentos) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson com variância robusta, ponderada pela amostragem complexa adotada. Resultados: 4.001 participantes foram incluídos, dos quais 53,0% (IC95% 51,5-54,6) reportaram a presença de produtos perigosos em seus domicílios, 36,3% (IC95% 34,8-37,8) apresentaram armazenamento inseguro, 16,2% (IC95% 15,1-17,4) possuíam produtos de limpeza artesanais e 8,2% (IC95% 7,4-9,1) possuíam chumbinho. Os domicílios com crianças menores de 5 anos apresentaram armazenamento mais seguro (RP=0,78; IC95% 0,71-0,86) e mais produtos artesanais (RP=1,30; IC95% 1,11-1,51). Presença de produtos artesanais foi maior em menores níveis de escolaridade (RP=2,20; IC95% 1,36-3,57) e menores classificações econômicas (RP=1,63; IC95% 1,25-2,13). Conclusões: Mais da metade dos domicílios da Região Metropolitana de Manaus possuía produtos perigosos; um terço os armazenava sem segurança. Produtos de limpeza artesanais e chumbinho estavam frequentemente presentes. Os domicílios com crianças apresentaram armazenamento mais seguro de produtos e fatores socioeconômicos afetaram a disponibilidade de tais produtos perigosos.

Accidental poisoning in children and adolescents admitted to a referral toxicology department of a brazilian emergency hospital / Intoxicações exógenas acidentais em crianças e adolescentes atendidos em um serviço de toxicologia de referência de um hospital de emergência brasileiro

ABSTRACT Objective: To describe the profile of children and adolescents admitted for exogenous unintentional poisoning in the emergency room and analyze factors associated with subsequent in-hospital admissions. Methods: This is a cross-sectional study based on hospital records of all subjects up to 19 years-old admitted in 2013 at a specialized toxicology service on a major public emergency hospital due to unintentional intoxication (as reported). Accidents with poisonous animals and insects were excluded. Percentages and frequencies were calculated for the qualitative variables, and measures of central tendency and dispersion for the continuous quantitative variables. Multivariate analysis was performed using binary logistic regression to identify variables associated with subsequent in-hospital admissions. Results: In 2013, 353 cases were reported. Poisonings were more frequent in children 0-4 years-old (72.5%) and in boys (55%). The vast majority was of dwellers of the Metropolitan Region of Belo Horizonte (83%), and 90% of the accidental poisonings occurred at home. 82.7% of the poisonings occurred by oral ingestion, especially of medicinal (36.5%) and cleaning products (29.4% of all poisonings). Only 12.2% of the cases resulted in hospitalization, and only one resulted in death. Residing outside Belo Horizonte (OR=5.20 [95%CI 2.37-11.44]) and poisoning by two or more products (OR=4.29 [95%CI 1.33-13.82]) were considered risk factors for hospitalization. Conclusions: Accidental poisonings occurred most frequently by ingestion of household medications and cleaning products, especially among children under 4 years-old. Preventive strategies should be primarily directed for this prevalent profile.

RESUMO Objetivo: Descrever o perfil dos atendimentos de crianças e adolescentes vítimas de intoxicações exógenas acidentais e os fatores associados às internações hospitalares. Métodos: Foi realizado um estudo transversal com base na revisão dos registros de todas as intoxicações acidentais de indivíduos com até 19 anos de idade, atendidos no setor de toxicologia de um hospital público de referência em 2013, excluídos os acidentes com animais peçonhentos e insetos. A intencionalidade da intoxicação foi baseada nos relatos. Foram calculadas percentagens e frequências para as variáveis qualitativas, e medidas de tendência central e de dispersão das variáveis quantitativas contínuas. Foi realizada análise múltipla, utilizando regressão logística binária para identificar as variáveis associadas à internação hospitalar das vítimas atendidas. Resultados: Em 2013, foram identificados 353 atendimentos em crianças e adolescentes. A faixa etária mais prevalente foi a de zero a quatro anos (72,5%), e predominaram indivíduos do sexo masculino (55%). A maioria dos atendimentos foi de pacientes residentes na região metropolitana (83%). Noventa por cento das intoxicações ocorreram nos domicílios; 82,7% se deram pela via oral, especialmente por medicamentos (36,5%) e produtos de limpeza (29,4% de todas as intoxicações). Resultaram em internações 12,2% dos casos, ocorrendo um único óbito. As variáveis associadas à internação foram: residir fora do município sede (razão de chances [OR]=5,20; intervalo de confiança de 95% [IC95%] 2,37-11,44) e o envolvimento de mais do que uma substância na intoxicação (OR=4,29; IC95% 1,33-13,82). Conclusões: O ambiente doméstico é o principal local em que ocorrem as intoxicações em crianças e adolescentes, especialmente por ingestão de medicamentos e produtos de limpeza e abaixo de quatro anos de idade. Esses achados justificam a priorização de ações preventivas direcionadas para esse perfil de acidentes.

Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños / Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCCIÓN: Los productos de aseo y cosméticos son necesarios en el diario vivir y ampliamente utilizados por la población. Sin embargo, su uso puede no estar exento de riesgos, especialmente cuando no se utilizan o almacenan según lo recomendado. Es importante caracterizar las exposiciones, ya que eso es útil para implementar estrategias para reducir la morbilidad, mortalidad y costos asociados, especialmente en la población infantil. OBJETIVO: Caracterizar los reportes asociados a exposiciones a productos de aseo y productos cosméticos en pacientes menores de 12 años reportados al Centro de Información Toxicológica de la Universidad Católica de Chile (CITUC). PACIENTES Y MÉTODO: Estudio descriptivo transversal de llamados telefónicos reportados a CITUC durante el año 2016. Se analizaron las variables: edad, sexo, agente, interlocutor, localización del interlocutor e inciden te, circunstancia de exposición, vía(s) de exposición, sintomatología, y severidad, mediante fichas de registro manual y desde el software de registro electrónico denominado "INTOX Data Manage ment System" de la OMS. RESULTADOS: Cumplieron criterios de inclusión 3.415 casos. Los menores de 5 años representaron el 91% de las exposiciones y el 58,5% correspondió al sexo masculino. Un 99,4% correspondió a exposiciones accidentales y el 98,6% ocurrieron en el hogar. El 68,3% no presentó síntomas, tras la exposición. Las llamadas fueron realizadas por familiares (57%) y personal de salud (42%). Los 4 agentes con mayor incidencia fueron cloro doméstico (27,6%), limpiadores y lustres de pisos (13,1%), lavalozas (7,9%) y perfumes/colonias (5,8%). La principal vía de exposición fue digestiva (89,4%). CONCLUSIONES: Los productos de aseo y cosméticos son causas comunes de exposiciones especialmente en menores de 5 años. Si bien son productos de baja mortalidad y morbilidad, es importante educar a la población para prevenir posibles intoxicaciones en la población infantil.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Assessment of relationship between the use of household products and atopic dermatitis in Seoul: focused on products with associated risks

The purpose of this study was to evaluate the relationship between the use of certain household products (HPs) at home and atopic dermatitis (AD) in adults. The study was conducted on 1,500 households in Seoul, South Korea. We obtained information on general characteristics, the use of HPs, and AD through an online panel survey in July 2018. HPs were selected as 23 kinds of products with associated risks that are management targets of the Ministry of Environment. The international study of asthma and allergies in childhood was used for the AD questionnaires. Logistic regression analysis was used to identify AD affected by the use of HPs. Average number of used HPs was 13.44 out of 23, and average usage frequency of HPs was 3.52 times a month at home in Seoul for the last 1 year. Compared with subjects with a low number of HPs used (reference), subjects with a high number of used HPs (4th quartile) were more likely to have lifetime diagnosis of AD (odds ratio (OR) = 1.77, 95% confidence interval (CI); 1.23-2.54), symptoms of AD in the last 12 months (OR = 2.66, 95% CI; 1.92-3.70), and treatment of AD in the last 12 months (OR = 2.37, 95% CI; 1.48-3.80). Compared with subjects with a low HPs usage frequency (reference), subjects with a high HPs usage frequency (4th quartile) were more likely to have lifetime diagnosis of AD (OR = 1.88, 95% CI; 1.31-2.70), symptoms of AD in the last 12 months (OR = 2.14, 95% CI; 1.54-2.96), and treatment of AD in the last 12 months (OR = 2.23, 95% CI; 1.39-3.60). Therefore, the use of HPs was significantly associated with AD. The findings of this study might be useful as basic data for managing allergic diseases and establishing preventive measures.

Assessment of relationship between the use of household products and atopic dermatitis in Seoul: focused on products with associated risks

The purpose of this study was to evaluate the relationship between the use of certain household products (HPs) at home and atopic dermatitis (AD) in adults. The study was conducted on 1,500 households in Seoul, South Korea. We obtained information on general characteristics, the use of HPs, and AD through an online panel survey in July 2018. HPs were selected as 23 kinds of products with associated risks that are management targets of the Ministry of Environment. The international study of asthma and allergies in childhood was used for the AD questionnaires. Logistic regression analysis was used to identify AD affected by the use of HPs. Average number of used HPs was 13.44 out of 23, and average usage frequency of HPs was 3.52 times a month at home in Seoul for the last 1 year. Compared with subjects with a low number of HPs used (reference), subjects with a high number of used HPs (4th quartile) were more likely to have lifetime diagnosis of AD (odds ratio (OR) = 1.77, 95% confidence interval (CI); 1.23-2.54), symptoms of AD in the last 12 months (OR = 2.66, 95% CI; 1.92-3.70), and treatment of AD in the last 12 months (OR = 2.37, 95% CI; 1.48-3.80). Compared with subjects with a low HPs usage frequency (reference), subjects with a high HPs usage frequency (4th quartile) were more likely to have lifetime diagnosis of AD (OR = 1.88, 95% CI; 1.31-2.70), symptoms of AD in the last 12 months (OR = 2.14, 95% CI; 1.54-2.96), and treatment of AD in the last 12 months (OR = 2.23, 95% CI; 1.39-3.60). Therefore, the use of HPs was significantly associated with AD. The findings of this study might be useful as basic data for managing allergic diseases and establishing preventive measures.

A saúde via consumo: a representação idealizada das donas de casa, mães e esposas nos manuais de economia doméstica e nos anúncios das revistas O Cruzeiro e Manchete, 1940-1960* / Health via consumption: the idealized representation of housewives, mothers, and wives in household economics manuals and magazine advertisements in O Cruzeiro and Manchete, 1940-1960*

Resumo Analisa a relação entre a representação da mulher idealizada nos manuais de economia doméstica e das figuras femininas dos anúncios publicados nas revistas O Cruzeiro e Manchete entre as décadas de 1940 e 1960. Com propostas editoriais diferentes, os manuais e as revistas se voltavam - predominantemente - para mulheres que exerciam as funções de esposa, dona de casa, mãe e empregada doméstica. Apesar dessa nítida delimitação de papéis, havia uma tensão em torno da figura feminina que já não se mostrava tão resignada ao lar e já ocupava postos de trabalho na esfera pública. O consumo se transformaria no denominador comum entre essas diferentes mulheres. Os novos produtos garantiriam saúde, conforto e praticidade a todas.

Abstract The relationship between the representation of the idealized woman in the household economics manuals and the female figures of the advertisements published in O Cruzeiro and Manchete magazines between the 1940s and 1960s is analyzed. With different editorial proposals, manuals and magazines were predominantly directed at women who performed the duties of wife, housewife, mother and maid. Despite this clear definition of roles, there existed some tension around the female figure who was no longer tied to the home and already occupied jobs in the public sphere. Consumption became the common denominator among these different women. The new products guaranteed health, comfort and practicality to all concerned.

Age group characteristics of children who visited the emergency department with acute poisoning by ingestion

PURPOSE: To investigate the age group characteristics of children who visited the emergency department with acute poisoning by ingestion. METHODS: We reviewed children under 19 years who visited the emergency department for acute poisoning by ingestion from 2012 to 2017. The children were divided into 3 age groups; infants (0-1 years), preschoolers (2-5 years), and schoolers (6-18 years). Clinical characteristics, intentional ingestion, involved substances (drugs, household products, artificial substances, and pesticides), decontamination and antidote therapy, and outcomes of the 3 age groups were compared. We also performed multivariable logistic regression analysis to identify factors associated with hospitalization. RESULTS: A total of 622 children with acute poisoning by ingestion were analyzed. Their annual proportions to overall pediatric emergency patients ranged from 0.3% to 0.4%. Age distribution showed bimodal peaks at 0-2 years and 15-17 years. The infants showed lower frequency of girls, intentional ingestion, ingestion of drugs, performance of decontamination and antidote therapy, and hospitalization than 2 older groups (P < 0.001). Most decontamination, antidote therapy, and hospitalization occurred in the schoolers (P < 0.001). The most frequently reported substances were household cleaning substances in the infants (18.2%), antihistamines in the preschoolers (15.8%), and analgesics in the schoolers (37.5%). The factors associated with hospitalization were intentional ingestion (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 2.85-17.61; P = 0.001) and schoolers (aOR, 2.33; 95% CI, 1.10-7.53; P = 0.031; compared with infants). Only 1 in-hospital mortality was found in a boy aged 2 years who ingested methomyl. CONCLUSION: Infants may experience non-intentional ingestion, ingestion of non-pharmacologic substances (especially household cleaning substances), discharge without decontamination and antidote therapy more frequently than older children. Thus, we need age group-specific, preventive and therapeutic plans for children with acute poisoning.

EXPOSIÇÕES TÓXICAS EM CRIANÇAS A SANEANTES DE USO DOMICILIAR DE VENDA LEGAL E CLANDESTINA / TOXIC EXPOSURES IN CHILDREN INVOLVING LEGALLY AND ILLEGALLY COMMERCIALIZED HOUSEHOLD SANITIZERS

RESUMO Objetivos: Analisar e comparar as repercussões clínicas dos acidentes com saneantes de uso domiciliar de origem legal e ilegal (clandestina) em crianças menores de 7 anos. Métodos: Estudo descritivo de corte transversal, com dados obtidos dos prontuários eletrônicos do Centro de Informações e Assistência Toxicológica de referência regional, no período de um ano completo. Foram realizadas análises estatísticas descritivas não paramétricas e de testes de associação. Resultados: A amostra foi constituída de 737 casos. A maioria das exposições ocorreu em crianças menores de 3 anos (mediana: 1 ano, intervalo interquartil: 1-3 anos) na residência habitual (92,9%) e por ingestão (97,2%). Os produtos envolvidos foram saneantes de baixa toxicidade sem efeito cáustico (38,9%), com efeito cáustico (24,1%), hidrocarbonetos (19,3%), inseticidas/raticidas (16,6%), e outros produtos (1,1%). Setenta casos decorreram de exposições a produtos clandestinos, principalmente cáusticos (n=47) e raticidas (n=15). Entre as 337 crianças que apresentaram manifestações clínicas pós-exposição, as ocorrências mais frequentes foram vômitos (n=125), queimaduras orais (n=74), tosse (n=35), salivação (n=26) e dor abdominal (n=25), significativamente mais comum com produtos clandestinos (55/70 versus 282/667; p<0,01). Dezenove crianças foram hospitalizadas (cáusticos, n=17; produtos clandestinos, n=12; mediana do tempo de internação: 2 dias), e 22 foram submetidas à endoscopia digestiva alta (hidróxido de sódio, n=14; produtos clandestinos, n=14), com alterações em 12 casos (grave=2). Não houve óbitos. Conclusões: Exposições tóxicas a saneantes de uso domiciliar de origem clandestina estão associadas com maior morbidade quando comparadas aos de venda autorizada.

ABSTRACT Objectives: To analyze and to compare clinical repercussions of accidents involving legally and illegally commercialized household sanitizers in children under 7 years of age. Methods: A descriptive cross-sectional design was used to collect data from electronic database of a regional Poison Control Center during one year. Data were analyzed by means of descriptive non-parametric statistics and association tests. Results: The sample had 737 reported cases. Most of the accidents occurred with children under 3 years of age (median: 1 year of age; interquartile interval: 1-3 years of age), at home (92.9%), by ingestion (97.2%). Products involved were cleaning products with low toxicity and no caustic effects (38.9%); caustics (24.1%); hydrocarbons (19.3%); pesticides/rodenticides (16.6%), and other products (1.1%). Seventy accidents were due to exposures to illegal products, mainly caustics (n=47) and rodenticides (n=15). Among the 337 children presenting post-exposure clinical manifestations, the most frequent were vomiting (n=125), oral burns (n=74), cough (n=35), drooling (n=26), and abdominal pain (n=25). Clinical manifestations were significantly more frequent after illegal products exposure (55/70 versus 282/667, p<0.01). Nineteen children had to be hospitalized (caustics, n=17; illegal products, n=12; median time of hospitalization: 2 days), 22 were submitted to esophagogastroduodenoscopy (sodium hydroxide, n=14; illegal products, n=14); and 12 cases had endoscopic alterations (severe in 2). No deaths occurred. Conclusion: Toxic exposures owing to illegal household sanitizer products are associated with greater morbidity when compared with legal ones.

What must be done to prevent another humidifier disinfectant disaster?

The humidifier disinfectant disaster (HDD) was not a simple poisoning accident by biocides, but a singular disaster in history created by chemicals in household products. This disaster was a result of the failure of a system for the management of chemical and product safety. Since the management authority for chemical usage safety is different from those for chemical safety in products, many blind areas for chemical safety management in products still remain. The ‘Act on the Registration and Evaluation, etc. of Chemical Substances (ARECS)’ or the new ‘Biocidal Product Act’ must not only address the blind areas in the management system for chemical and product safety, but also prevent a second HDD. To prevent another HDD, an integrated registration, evaluation, and management system for chemicals and consumer products must be incorporated into the ‘ARECS’ as an essential part for chemical safety in consumer products.

Effects of Triclosan on Neural Stem Cell Viability and Survival

Triclosan is an antimicrobial or sanitizing agent used in personal care and household products such as toothpaste, soaps, mouthwashes and kitchen utensils. There are increasing evidence of the potentially harmful effects of triclosan in many systemic and cellular processes of the body. In this study, we investigated the effects of triclosan in the survivability of cultured rat neural stem cells (NSCs). Cortical cells from embryonic day 14 rat embryos were isolated and cultured in vitro. After stabilizing the culture, triclosan was introduced to the cells with concentrations ranging from 1 muM to 50 muM and in varied time periods. Thereafter, cell viability parameters were measured using MTT assay and PI staining. TCS decreased the cell viability of treated NSC in a concentration-dependent manner along with increased expressions of apoptotic markers, cleaved caspase-3 and Bax, while reduced expression of Bcl2. To explore the mechanisms underlying the effects of TCS in NSC, we measured the activation of MAPKs and intracellular ROS. TCS at 50 muM induced the activations of both p38 and JNK, which may adversely affect cell survival. In contrast, the activities of ERK, Akt and PI3K, which are positively correlated with cell survival, were inhibited. Moreover, TCS at this concentration augmented the ROS generation in treated NSC and depleted the glutathione activity. Taken together, these results suggest that TCS can induce neurodegenerative effects in developing rat brains through mechanisms involving ROS activation and apoptosis initiation.

Accidental intoxication of the infant-juvenile population in households: profiles of emergency care / Intoxicación Accidental En La Población infanto-juvenil En Ambiente Domiciliario: Perfil De Las Atenciones De Emergencia / Intoxicação acidental na população infanto-juvenil em ambiente domiciliar: perfil dos atendimentos de emergência

OBJECTIVE Analyzing profiles of intoxication and accidental poisoning of infant-juvenile population (0-24 years) in the household, treated at a reference facility for Emergency and Primary Care, during the year 2013. METHOD A descriptive, cross-sectional study. Data were analyzed using Epi-Info, by way of simple and bivariate analyzes. The project was approved by the Research Ethics Committee (protocol 405.578). RESULTS There were 45 intoxications, with a prevalence of males (60.0%), aged 1-4 years (71.1%). Among children under one, there was a higher frequency of pesticide poisoning (66.6%), between the ages of 1-4 by cleaning products (34.4%), and between 5-9 years of age by pharmacological substances (66.6%). The primary assistance was provided only at health institutions, with hospital admissions in 24.4% of the cases. CONCLUSION The importance of prevention through legislation is evident, in order to ensure greater safety in packaging of various products, and community awareness to eliminate risks in the household environment. .

OBJETIVO Analizar el perfil de intoxicación y envenenamiento accidental en ambiente domiciliario en la población infanto-juvenil (0-24 años) atendida en un servicio de referencia en urgencia y emergencia, durante el año 2013. MÉTODO Estudio descriptivo, transversal. Los datos fueron valorados por Epi-Info, mediante análisis sencillos y bivariados. Aprobó el proyecto el Comité de Ética en Investigación (protocolo 405.578). RESULTADOS Hubo 45 intoxicaciones, de las que prevaleció el sexo masculino (60,0%) y edades entre 1-4 años (71,1%). Entre los menores de un año hubo mayor frecuencia de intoxicación por pesticidas (66,6%), entre 1-4 años por productos de limpieza (34,4%) y 5-9 años por farmacológicos (66,6%). La primera atención fue prestada solo en instituciones de salud, habiendo ingreso hospitalario en el 24,4% de los casos. CONCLUSIÓN Se evidencia la importancia de la prevención mediante legislación que asegure una mayor seguridad en los embalajes de diversos productos, además de la concientización de la comunidad, a fin de eliminar riesgos en el ambiente domiciliario. .

OBJETIVO Analisar o perfil de intoxicação e envenenamento acidental em ambiente domiciliar na população infanto-juvenil (0-24 anos) atendida em um serviço de referência em urgência e emergência, durante o ano de 2013. MÉTODO Estudo descritivo, transversal. Os dados foram analisados pelo Epi-Info, por meio de análises simples e bivariadas. O Projeto foi aprovado pelo Comitê de Ética em Pesquisa (protocolo 405.578). RESULTADOS Houve 45 intoxicações, das quais prevaleceu o sexo masculino (60,0%) e idades entre 1-4 anos (71,1%). Entre os menores de um ano houve maior frequência de intoxicação por pesticidas (66,6%), entre 1-4 anos por produtos de limpeza (34,4%) e 5-9 anos por farmacológicos (66,6%). O primeiro atendimento foi prestado apenas em instituições de saúde, havendo internação em 24,4% dos casos. CONCLUSÃO Evidencia-se a importância da prevenção através de legislação que garanta maior segurança em embalagens de diversos produtos, além da conscientização da comunidade para eliminar riscos no ambiente domiciliar. .

Household Food Insufficiency and Child Nutritional Status in Urban Slum, Dhaka, Bangladesh.

Introduction: Malnourished children are about 20% in the developing world. Food insecurity is a key risk factor for child malnutrition. Food insuffi ciency, an extreme form of household food insecurity, can aff ect physiological mechanisms that are linked to an individual’s nutritional status. Food-insuffi cient children are also more likely to have poorer health status and to experience a range of negative academic and psychosocial outcomes. Methods: We administered a cross-sectional socioeconomic survey to 354 households in research site, including a validated food insuffi ciency measurement questionnaire, and obtained anthropometric measurements from children aged 12 to 24 months. We used chi-square tests to assess the relationship between household food insuffi ciency and nutritional status of children. Results: Average age of study children was 18 months and standard deviation was (± 3.2 months). Th e status of household food insuffi ciency was 56%. Th e prevalence of underweight, stunting and wasting was 24%, 36% and 8% respectively. Th e household food insuffi ciency was signifi cantly (p<0.05) associated with underweight and stunting but not with wasting (p>0.05). Discussion: Th e study results indicate that food insuffi ciency is associated with stunting and underweight but not with wasting in urban slum of Bangladesh. We also found that child malnutrition is associated with mother’s education, father’s education, monthly family income and people per room.

High Prevalence of Psychotropics Overdose among Suicide Attempters in Korea

OBJECTIVE: The availability of suicide methods affects the risk of suicide attempts. This study examined the patterns of substances ingested by suicide attempters (SAs) and the characteristics of SAs using psychotropic overdoses. METHODS: Data for 384 of the 462 eligible SAs who used self-poisoning were analyzed. Demographic variables, clinical characteristics, and factors related to the suicide attempts were examined. RESULTS: There were 256 (66.7%) females and 128 (33.3%) males. Roughly half the SAs ingested psychotropics (n=179, 46.6%). Agricultural chemicals (n=84, 21.9%) were the second most frequently ingested substances, followed by analgesics (n=62, 16.1%), household products (n=27, 7.0%), and other prescribed medications (n=23, 6.0%). Among psychotropics, the most frequently overdosed drugs were sedative-hypnotics, including hypnotics (n=104) and benzodiazepines (n=78). SAs favored Z-drugs and alprazolam. When compared with SAs with non-psychotropic overdoses, significantly more SAs with psychotropic overdoses were female (76% vs. 58.5%, p<0.001) and had a psychiatric history (59.8% vs. 29.8%, p<0.001). They had significantly more previous suicide attempts (0.52+/-1.02 vs. 0.32+/-0.80, p<0.05) and lower risk (7.96+/-1.49 vs. 8.44+/-1.99, p<0.01) and medical severity (3.06+/-0.81 vs. 3.37+/-0.93, p<0.005) scores. CONCLUSION: Psychotropic overdose, especially with sedative-hypnotics, was a major method in suicide attempts. It is important that psychiatric patients are carefully evaluated and monitored for suicidality when prescribing psychotropics.

Use of sanitizing products: safety practices and risk situations / Uso de produtos saneantes: práticas de segurança e situações de risco

OBJECTIVES: to evaluate the handling and risk factors for poisoning and/or digestive tract injuries associated with the use of sanitizing products at home. METHODS: interviews were conducted in 419 households from different regions, collecting epidemiological data from residents and risk habits related to the use and storage of cleaning products. RESULTS: sanitizing products considered to be a health risk were found in 98% of the households where the research was conducted, and in 54% of cases, they were stored in places easily accessible to children. Lye was found in 19%, followed by illicit products in 39% of homes. In 13% of households, people produced soap, and in 12% they stored products in non-original containers. The use of illicit products and the manufacture of handmade soap were associated with lower educational level of the household owners and with the regions and socioeconomic classes with lower purchasing power. CONCLUSIONS: risk practices such as inadequate storage, manufacturing, and use of sanitizing products by the population evidence the need for public health policies, including educational measures, as a means of preventing accidents. .

OBJETIVOS: avaliar a forma de utilização e os fatores de risco para intoxicações e/ou lesões do trato digestório associados ao uso dos produtos saneantes no domicílio. MÉTODOS: foram realizadas entrevistas em 419 domicílios de diferentes regiões, estabelecendo-se dados epidemiológicos dos moradores e hábitos de risco relacionados à utilização e armazenamento dos produtos de limpeza. RESULTADOS: dos domicílios onde foi realizada a pesquisa, havia produtos saneantes considerados de risco em 98%, sendo que em 54% dos casos, eles estavam armazenados em locais de fácil acesso para crianças. A soda cáustica estava disponível em 19% e os produtos "clandestinos" em 39% das moradias. Em 13% dos domicílios havia o hábito de fazer sabão e em 12% de armazenar os produtos fora da embalagem original. O uso de produtos clandestinos e a fabricação artesanal de sabão estavam associados à baixa escolaridade das donas das casas e às regiões e às classes econômicas de poder aquisitivo mais baixo. CONCLUSÕES: práticas de risco como armazenamento, fabricação e utilização inadequados de produtos saneantes pela população estudada apontam para a necessidade de políticas de saúde pública, incluindo medidas educacionais, como forma de prevenção de acidentes. .

Association between exposure to antimicrobial household products and allergic symptoms

OBJECTIVES: Antimicrobial chemicals are used in a variety of household and personal care products. Exposure to antimicrobial household products has been hypothesized to lead to allergic diseases in children. METHODS: We investigated antimicrobial household product exposure and allergic symptoms in Korean children. An antimicrobial exposure (AE) score was derived. To examine the symptoms of allergic diseases (current wheeze, current rhinitis, and current eczema) in the past 12 months, we used a questionnaire based on the core module of the International Study of Asthma and Allergies in Children. Complete data for the analysis were available for 25,805 of the 35,590 (72.5%) children. RESULTS: The prevalence of current allergic diseases was as follows: wheeze, 5.6%; allergic rhinitis, 32.6%; and eczema, 17.7%. The mean (standard deviation) AE score was 14.3 (9.3) (range: 0-40). Compared with subjects with a low AE score (reference), subjects with a high AE score (fourth quartile) were more likely to have symptoms of wheezing and allergic rhinitis (adjusted odds ratio [aOR] for wheezing 1.24, 95% confidence interval [CI], 1.05-1.45, p for trend=0.24; aOR for allergic rhinitis 1.30, 95% CI, 1.20-1.40, p<0.01). CONCLUSIONS: These findings suggest that frequent use of antimicrobial household products was associated with current wheeze and current allergic rhinitis.

Different Characteristics of Toxic Substance/poison Exposure Data that Collected from Pre-hospital Telephone Response and Emergency Department

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.

Different Characteristics of Toxic Substance/poison Exposure Data that Collected from Pre-hospital Telephone Response and Emergency Department

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.

Avaliação das intoxicações por domissanitários em uma cidade do Nordeste do Brasil / Poisoning with household cleaning products in a city in Northeast Brazil / Evaluación de las intoxicaciones por productos domésticos en una ciudad del Nordeste de Brasil

This study analyzes toxic exposures to household cleaning products based on data from the Center for Notification and Treatment of Poisoning (CEATOX) in Campina Grande, Paraíba State, Brazil, from 2007 to 2010. The data were collected from the reporting forms from the Information System on Notifiable Diseases (SINAN), analyzed with SPSS (Version 17). Chemical identification was performed in urine samples using high-resolution chromatography techniques (GC-MS and HPLC-UV). Six hundred and sixty cases of poisoning were reported, with pesticides as the principal causal agents (42.2%). Poisoning with household cleaning products occurred mainly in children (30.1%) and/or females (55.21%) who were exposed to the product accidentally (55.4%) by the oral route (82%). These data indicate that poisoning with household cleaning products in Campina Grande should be treated with specific prevention and control measures, including evaluation of ease of access to pesticides, in order to reach the goals set by the Brazilian National Health Plan for 2012-2015.

Este trabalho analisa as exposições tóxicas a domissanitários registradas pelo Centro de Informação e Assistência Toxicológica de Campina Grande, Paraíba, Brasil, no período de 2007 a 2010. Os dados foram coletados das fichas de notificação do Sistema de Informação de Agravos de Notificação (SINAN), analisados pelo software SPSS (Versão 17), e a identificação química em amostras de urina foi feita por técnicas cromatográficas de alta resolução (CG-MS e HPLC-UV). Foram registradas 660 intoxicações e, considerando as variáveis de estudo, observados como principais agentes causais os agrotóxicos (42,2%).Os intoxicados por saneantes domésticos na região são predominantemente crianças (30,1%), e/ou do gênero feminino (55,21%), que se expõem ao produto acidentalmente (55,4%) pela via oral (82%). Diante desses dados, conclui-se que a intoxicação por domissanitários em Campina Grande e região deve ser tratada com ações específicas de prevenção e controle junto à população, como a avaliação da facilidade de acesso aos venenos agrícolas, para que se consiga atingir as metas estabelecidas pelo Plano Nacional de Saúde, para o quadriênio 2012-2015.

Este trabajo analiza las exposiciones tóxicas a productos domésticos registradas por el Centro de Información y Asistencia Toxicológica de Campina Grande, Paraíba, Brasil, durante el periodo de 2007 hasta 2010. Los datos fueron recogidos mediante la información proporcionada por el Sistema de Notificación de Enfermedades (SINAN) y analizados por el software SPSS (versión 17). La identificación química en muestras de orina fue realizada mediante alta resolución con técnicas de cromatografía (GC-MS y HPLC-UV). Se registraron 660 intoxicaciones y, teniendo en consideración las variables del estudio, se observó que los principales agentes causales eran los pesticidas (42,2%) y que los envenenados por productos domésticos de limpieza en la región eran en su mayoría niños (30,1%) y mujeres (55,21%), expuestos a un producto accidentalmente (55,4%) y por vía oral (82%). Con estos datos, se concluye que la intoxicación por productos de uso doméstico en la región debe ser tratada con acciones específicas para la prevención y el control, como la evaluación de la facilidad del acceso a venenos agrícolas para alcanzar los objetivos establecidos por el Plan Nacional de Salud.

Necessity and the strategy to establish a national poison center in Korea: through needs survey analysis and database status for Chemical Accident Emergency Respond Information System

This study is to prepare promotional strategies of establishment of the Korea Poison Center based on the chemicals and chemical products and the database (DB) construction status of Chemical Accident Emergency Respond Information System (CEIS) and the DB needs survey of the lay person. The methods of CEIS DB construction and hazard classification are; first, the researchers required material safety data sheet from the manufacturer/distributor and verified its composition/information on ingredients. Second, the researchers conducted the hazard classification of the chemical products by the mixtures classification according to the United Nations Globally Harmonized System of Classification and Labelling of Chemicals (GHS, 3rd edition) guidelines based on the verified composition/information on ingredients. The emergency measures information was established by the Emergency Department healthcare professionals. Health hazards are classified by using 13 reference databases, which include European Chemical Substances Information System (IUCLID) and IARC, and 4 reference books like Emergency Management Guides(ERG). As the result of analyzing the DB construction status of chemical products, it showed in the order of, 180 for vehicle products (15.0%), 162 for printing products (14.0%), 129 for paint (11.0%) and 120 for adhesives (10.0%). Currently in 2013, emergency respond information was established for a total of 2,400 chemicals (includes 1200 chemical products). As the result for conducting a needs survey for the establishment of emergency respond information targeting on the general public and professionals, it showed the highest level of demand for the establishment of emergency respond information on 'household products (2.87 points)' for both lay person and experts. As the result of analyzing the Q&A of the lay person until March 2013, through CEIS, it showed the highest inquiry on disinfectant and germicide products with 11 issues (27.5%). World Health Organization recommends to provide emergency consultation and information on poisoning accidents and operate a 24 hour national poison center able to perform the research functions for every nation. However, there is no such national poison center in Korea, and it can be said fundamental reform of the national poison management system and establishment of national poison center is urgent, considering the fact social demand and citizens from recent consecutive chemical poisoning accidents are increasing.

Comparison between Emergency Patient Poisoning Cases and the Tox-Info System Database

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.