Laboratory features in acute paediatric poisoning with liquid laundry detergent capsules: a seven-year retrospective study in Romania.

INTRODUCTION: The epidemiological and clinical characteristics of acute poisoning with liquid laundry detergent capsules have been comprehensively reported. However, studies of laboratory test results in these exposures are uncommon. This study analyzed the impact of the ingestion of liquid laundry detergent capsules on admission laboratory tests in paediatric patients. METHODS: This retrospective study was conducted in the clinical toxicology unit of a paediatric poison centre between 2015 and 2021. Paediatric patients (less than 18 years of age) who ingested liquid laundry detergent capsules were included. The relationship between the European Association of Poisons Centers and Clinical Toxicologists/European Commission/International Programme on Chemical Safety Poisoning Severity Score and admission laboratory test results was assessed using Fisher's exact test or analysis of variance. RESULTS: A total of 156 patients were included in the study. A considerable proportion of patients presented with leucocytosis, acidosis, hyperlactataemia or base deficit. The median values of white blood cell count (P = 0.042), pH (P = 0.022), and base excess (P = 0.013) were significantly different among the Poisoning Severity Score groups. Hyperlactataemia was strongly associated with the Poisoning Severity Score (P = 0.003). DISCUSSION: Leucocytosis is a non-specific marker of severity following ingestion of liquid laundry detergent capsules. The incidence of metabolic acidosis and hyperlactataemia was higher in this study than in previous reports, but these metabolic features were not related to the severity of exposure. The exact mechanisms of toxicity are not yet known, but the high concentration of non-ionic and anionic surfactants, as well as propylene glycol and ethanol, in the capsule are likely contributing factors. CONCLUSIONS: Pediatric patients who ingest liquid laundry detergent capsules may develop leucocytosis, metabolic acidosis, hyperlactataemia, and a base deficit.

Development of a Naturalness Preference Scale.

OBJECTIVE: Naturalness preference can influence important health decisions. However, the literature lacks a reliable way to measure individual differences in naturalness preferences. We fill this gap by designing and validating a scale to measure individual differences in naturalness preference. METHODS: We conducted 3 studies among Amazon Mechanical Turk participants. In study 1 (N = 451), we created scale items through an iterative process that measured naturalness preference in hypothesized domains. We conducted exploratory factor analysis (EFA) to identify items that assess the naturalness preference construct. In study 2 (N = 448), we conducted confirmatory factor analysis (CFA) and tests of criterion, discriminant, convergent, and incremental validity. In study 3 (N = 607), we confirmed test-retest reliability of the scale and performed additional validity tests. RESULTS: EFA revealed 3 correlated factors consistent with naturalness preference in medicine, food, and household products. The CFA confirmed the 3-factor structure and led to the decision to drop reverse-coded items. The finalized Naturalness Preference Scale (NPS) consists of 20 items and 3 subscales: NPS-medicine, NPS-food, and NPS-household products. The NPS demonstrated good test-retest reliability, and subscales had good validity in their respective domains. The NPS-medicine subscale was predictive of the uptake of a hypothetical COVID-19 vaccine (r = -0.45) and belief in unproven natural COVID remedies and treatments (r = 0.29). CONCLUSIONS: The NPS will allow researchers to better assess individual differences in naturalness preference and how they influence decision making and health behaviors. HIGHLIGHTS: This research created and validated a scale to measure individual differences in naturalness preference in 3 domains: medicine, food, and household products.This study confirms that the strength of the naturalness preference differs in different domains.An important and timely finding is that higher scores in the naturalness preference medical subscale are associated with belief in COVID-19 misinformation and reluctance toward COVID-19 vaccination.

Do Synthetic Fragrances in Personal Care and Household Products Impact Indoor Air Quality and Pose Health Risks?

Fragrance compounds (synthetic fragrances or natural essential oils) comprise formulations of specific combinations of individual materials or mixtures. Natural or synthetic scents are core constituents of personal care and household products (PCHPs) that impart attractiveness to the olfactory perception and disguise the unpleasant odor of the formula components of PCHPs. Fragrance chemicals have beneficial properties that allow their use in aromatherapy. However, because fragrances and formula constituents of PCHPs are volatile organic compounds (VOCs), vulnerable populations are exposed daily to variable indoor concentrations of these chemicals. Fragrance molecules may trigger various acute and chronic pathological conditions because of repetitive human exposure to indoor environments at home and workplaces. The negative impact of fragrance chemicals on human health includes cutaneous, respiratory, and systemic effects (e.g., headaches, asthma attacks, breathing difficulties, cardiovascular and neurological problems) and distress in workplaces. Pathologies related to synthetic perfumes are associated with allergic reactions (e.g., cutaneous and pulmonary hypersensitivity) and potentially with the perturbation of the endocrine-immune-neural axis. The present review aims to critically call attention to odorant VOCs, particularly synthetic fragrances and associated formula components of PCHPs, potentially impacting indoor air quality and negatively affecting human health.

Migration of BPA from Food Packaging and Household Products on the Croatian Market.

BPA is a plasticizer for the production of polycarbonate plastics and epoxy resins and is widely used in the production of household goods, including food packaging. Free BPA is known to migrate from packaging to food, and its uptake has been associated with adverse health effect, particularly the disruption of endocrine activity. The presence and migration of BPA from plastic consumer products are subject to strict regulation in the EU. The aim of this study is to analyse the migration of BPA from different packaging items and household products sold on the Croatian market. To simulate real life exposure, we treated samples with a food simulant. The analytical performance was confirmed with the EU requirements. BPA levels were assessed in 61 samples by HPLC-FLD and the LOQ of the method was 0.005 mg kg-1 for the food simulant. These results showed that the levels of BPA that migrated to the food simulant were below LOQ and in accordance with the specific migration limit into food, which was defined as 0.05 mg kg-1 for all samples. None of the analysed products presented a health hazard. However, these regulations do not refer to products intended for children's use, in which BPA is banned. Furthermore, regulations require testing before putting products on the market, and previous research shows that possible BPA migration occurs due to various uses, along with a cumulative effect of exposure from even very small concentrations. Therefore, for accurate BPA consumer exposure evaluation and possible health risks, a comprehensive approach is needed.

Trends in formaldehyde and formaldehyde-releaser contact allergies as compared with market exposure in Thailand.

BACKGROUND: Formaldehyde and formaldehyde releasers (FRs) are common preservatives in cosmetics and household products. Their contact allergy trends are decreasing in Europe and America, but trend data for Asia are limited. OBJECTIVES: The first objective was to determine the prevalences of and trends in contact allergies to formaldehyde and FRs. The second objective was to establish how often formaldehyde and FRs were mentioned on the labels of products sold in the Thai market. METHODS: Twenty years of data on patch test results for formaldehyde and FRs were reviewed. Their frequency of mention on the labels of 5855 products was analysed. RESULTS: The trends in contact allergy to formaldehyde and FRs were decreasing. The overall prevalence of formaldehyde contact allergy was 2.5%. The most common FR to cause contact allergy was quaternium-15. Formaldehyde and FRs were identified as ingredients in 10.2% of the products surveyed. Dimethylol dimethyl hydantoin was the most common FR (5.2%). The highest use of formaldehyde and FRs (15.5%) was in hair care products. CONCLUSION: Although contact allergy trends in Thailand were decreasing, the proportion of products with FRs remained high. Comprehensive and universal legislation is needed to control the presence of formaldehyde and FRs.

Toxico-clinical study of patients poisoned with household products; a two-year cross-sectional study.

BACKGROUND: Several studies worldwide have investigated household product poisoning. We conducted a toxico-clinical study on the two-year prevalence of poisoning with household products. METHODS: This cross-sectional study was performed in Khorshid Hospital, the main referral center for poisoning cases in Isfahan, affiliated to Isfahan University of Medical Sciences, Isfahan, central Iran. All patients with intentional or unintentional household substance poisoning, referring to the poisoning emergency center of the hospital, were evaluated with respect to epidemiological and toxico-clinical features and outcomes. RESULTS: During the study period, 5946 patients were hospitalized, of which 83 (1.39%) had been poisoned with household products including 48 (57.8%) men and 35 (42.2%) women with a mean ± SD age of 34.40 ± 17.71 years. Most patients (54.2%) were in the 20-40-year-old age group. Accidental poisoning (63.9%) was the most common type of exposure (P = 0.02) predominantly in men (57.8%, P = 0.51). The most common household products were sodium hypochlorite (32.53%) followed by petroleum hydrocarbon (21.68%). Most of the accidental poisonings (77.8%) were due to petroleum hydrocarbon. 59% of cases were poisoned at home (P < 0.0001). No patient died. CONCLUSION: Household products were not common means of poisoning in our referral center. Sodium hypochlorite and petroleum hydrocarbon were the most common substances. Most of the patients were men with accidental exposure at home. Because of the availability of the household product, the frequency and outcomes may be varied in different societies.

Consumer knowledge and awareness of the toxicity and handling of household products at a tertiary care center in Beirut, Lebanon.

Household products intoxication is a common and preventable problem. Household product hazard awareness is lacking among consumers in Lebanon, posing a public health hazard. A cross-sectional observational study was conducted at the American University of Beirut Medical Center by administering surveys to 176 adult participants. The surveys focused on demographics, awareness of product toxicity, practices used to avoid intoxication, and sources of information. Each participant was given a score for behavior and awareness. Informative brochures were handed to increase awareness among consumers. We surveyed 176 patients, of whom (84.7%) were females with a mean age of 42.2 ± 13.5 years. Most were married (77.3%), had a college education (76.7%), were employed (62.5%), and were in charge of household cleaning (76.7%). Toilet cleaners were the substances most perceived to be toxic (94.0%). Most people (86.4%) had low to medium scores on behavior, while most (77.3%) had high scores on awareness. Male gender and using product labels as sources of information were associated with higher behavior scores, while referring to a friend or a relative as a source of information on product intoxication was associated with a lower behavior score. Greater awareness scores were strongly associated with being married, having a higher monthly income, and referring to warning signs presented on the labels as a source of knowledge. Unsafe handling and storage of household products are common among consumers in our population. Therefore, it may be necessary to launch education campaigns to improve consumer handling of household products.

The influence of packaging on consumers' risk perception of chemical household products.

Chemical household products are found in most households. If consumers are to safely handle such products, they need to be aware of the risks posed by the particular product they are using. Although most countries require that chemical household products feature warning labels (e.g. the Globally Harmonized System of Classification and Labelling of Chemicals), consumers appear to also use other cues to determine the risks associated with a specific product. Thus, we studied the influence of packaging on consumers' risk perception of chemical household products. More specifically, we examined the effect of the colour of the packaging (black or pink packaging versus the original packaging) as well as the presence of images of flowers or food-imitating elements on the packaging. Significant differences with regard to consumer's risk perception were found in terms of all four studied manipulations. Therefore, we conclude that consumers' risk perception can be influenced by the packaging design. In particular, if elements that lower consumer's risk perception (e.g. featuring flowers on the label and food-imitating elements on the packaging) are omitted from the packaging, consumers might be able to more accurately judge the risks associated with a product and so take appropriate safety precautions.

How COVID-19 Lockdown in Italy Has Affected Type of Calls and Management of Toxic Exposures: a Retrospective Analysis of a Poison Control Center Database From March 2020 to May 2020.

INTRODUCTION: Between early March 2020 and the end of May 2020, Italy issued strict measures to limit further spread of coronavirus disease 2019 (COVID-19) and became the first European country that imposed a lockdown on the population. The aim of this study was to assess the impact of these restricted conditions on the activity of the Poison Control Center (PCC) of Policlinico Umberto I Hospital-Sapienza University of Rome. METHODS: This was a retrospective analysis of calls received by the PCC during the lockdown period March 9, 2020 through May 31, 2020 compared to the same time period in year 2019 (reference). RESULTS: We observed a reduction in calls from hospitals and emergency departments and an increase in calls from private citizens about exposures to products or intoxications during the lockdown. There were increases in unintentional exposures and exposures to hand and surface sanitizers among household and cleaning products. There was a decrease in calls concerning medications, which were mostly from hospitals and emergency departments. We observed increases in exposures requiring clinical observations among adults and referral to the emergency department among pre-school children. CONCLUSIONS: Public health protection measures against COVID-19 to improve hygiene and maintain clean environments can increase exposures to hazardous products in the domestic environment. We observed an increase in unintentional exposures to household and cleaning products during the lockdown and an increase in ED referrals for pre-school children compared to the previous year. Our data suggest the need for improvements in public campaigns that promote safer handling of household products and prevent unnecessary exposures during a lockdown. The public health promotion activity can benefit the community after the pandemic and prepare the community for lockdowns in the future.

Skin exposure to scented products used in daily life and fragrance contact allergy in the European general population - The EDEN Fragrance Study.

BACKGROUND: Fragrances are widely used in scented products used in daily life with the potential to induce skin sensitization. OBJECTIVE: To evaluate exposure to scented products and to explore associations between exposure and fragrance contact allergy. METHODS: A cross-sectional study on individuals from 18 to 74 years of age, who were randomly selected from the general population in five European countries. A random sample (N = 3119) was patch tested and interviewed on exposure to scented products. RESULTS: Female participants were strongly associated with exposure to scented products relative to male participants. Participants age 40 years and older showed an inverse association with exposure to scented products. Compared to Sweden, The Netherlands followed by Germany showed the highest overall exposure to scented products. Sensitive skin was associated with exposure to scented products and with fragrance allergy. In univariable regression analysis, exposure to leave-on products and to specific scented product subgroups was significantly associated with fragrance allergy. CONCLUSION: Exposure to scented products depends primarily on sex and age. Female sex and sensitive skin are relevant indicators for developing fragrance allergy. Because aggregate exposure, especially to scented leave-on products, may enhance the prevalence of contact allergy to fragrances, further investigations into exposure amounts and frequencies is warranted.

High Throughput Risk and Impact Screening of Chemicals in Consumer Products.

The ubiquitous presence of more than 80,000 chemicals in thousands of consumer products used on a daily basis stresses the need for screening a broader set of chemicals than the traditional well-studied suspect chemicals. This high-throughput screening combines stochastic chemical-product usage with mass balance-based exposure models and toxicity data to prioritize risks associated with household products. We first characterize product usage using the stochastic SHEDS-HT model and chemical content in common household products from the CPDat database, the chemical amounts applied daily varying over more than six orders of magnitude, from mg to kg. We then estimate multi-pathways near- and far-field exposures for 5,500 chemical-product combinations, applying an extended USEtox model to calculate product intake fractions ranging from 0.001 to ∼1, and exposure doses varying over more than nine orders of magnitude. Combining exposure doses with chemical-specific dose-responses and reference doses shows that risks can be substantial for multiple home maintenance products, such as paints or paint strippers, for some home-applied pesticides, leave-on personal care products, and cleaning products. Sixty percent of the chemical-product combinations have hazard quotients exceeding 1, and 9% of the combinations have lifetime cancer risks exceeding 10-4 . Population-level impacts of household products ingredients can be substantial, representing 5 to 100 minutes of healthy life lost per day, with users' exposures up to 103 minutes per day. To address this issue, present mass balance-based models are already able to provide exposure estimates for both users and populations. This screening study shows large variations of up to 10 orders of magnitude in impact across both chemicals and product combinations, demonstrating that prioritization based on hazard only is not acceptable, since it would neglect orders of magnitude variations in both product usage and exposure that need to be quantified. To address this, the USEtox suite of mass balance-based models is already able to provide exposure estimates for thousands of product-chemical combinations for both users and populations. The present study calls for more scrutiny of most impacting chemical-product combinations, fully ensuring from a regulatory perspective consumer product safety for high-end users and using protective measures for users.

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.

The Role of Environmental Exposures in Atopic Dermatitis.

PURPOSE OF REVIEW: Although genetic factors clearly play a role in the development of atopic dermatitis (AD), the recent dramatic increase in the prevalence of AD in low- and middle-income countries is not consistent with only a role of genetic factors. These findings strongly suggest that environmental factors may play an important role in the pathogenesis of AD. RECENT FINDINGS: We reviewed the role of gene-environment studies; in utero exposures including tobacco smoke, alcohol, maternal stress, various digestive supplements, and gestational diabetes; early-life exposures including diet, gut microbiota, antibiotics, and breastfeeding; climate including temperature, ultraviolet radiation exposure, and air pollution; and household products, indoor allergens, water hardness, pH, and skin microbiota and their effects on AD. Environmental factors definitely play a role in the pathogenesis of AD. However, identifying definitive factors continues to be difficult in the setting of conflicting evidence and the complex interactions between genotypes and the environment resulting in a multitude of AD phenotypes. All of the different environmental interactions discussed highlight the importance of intervening on multiple levels in a patient's environment to improve or even prevent AD symptoms. Further, the importance of modifying environmental factors early on in a person's life is demonstrated. When possible, all of these environmental factors should be considered in treating a patient with AD and the appropriate modifications should be made at population and individual levels.

Suspected environmental poisoning by drugs, household products and pesticides in domestic animals.

Animal poisoning by chemicals (pesticides and household products) and drugs is a frequent occurrence and special attention should be paid to this phenomenon to improve prevention and treatment strategies and because of the fundamental role that animals may play as bioindicators. From January 2017 to March 2019 the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan, collected and analyzed epidemiological data on animal poisoning. During this period, the CAV received a total of 442 enquiries on domestic animal poisoning episodes and, among these, 80.3 % were related to chemicals and drugs. Pesticides and drugs were the two major causes of poisoning (34.1 % and 33.5 %, respectively), followed by household products (29.3 %) and other causative agents (3.1 %, n = 11). In conclusion, these findings can provide useful information for the identification and monitoring of known and emerging toxicants, with positive repercussions on human, animal and environmental health.

Skin transferability of phthalic acid ester plasticizers and other plasticizers using model polyvinyl chloride sheets.

The transferability of phthalic acid esters (PAEs) and other plasticizers, from model polyvinyl chloride (PVC) sheets to the skin of 11 subjects was assessed by measuring the amount of substance transferred using PVC sheets containing PAEs and alternative plasticizers of different types and contents. For all subjects, the transferred amount, from sheets containing 28 wt% PAE or from mixed sheets containing 14 wt% each of di (2-ethylhexyl) phthalate (DEHP) and other PAE, was greater than that from sheets containing 15 wt% each of PAE or alternative plasticizer only. A comparison of the transferability of five types of PAE showed that transfer tended to occur more readily as the n-octanol-water partition coefficient increased, suggesting that PAE hydrophobicity affected its transferability. The transferability of the alternative plasticizers di(2-ethylhexyl) terephthalate and 1,2-cyclohexane dicarboxylic acid diisononyl ester showed a similar trend; however, the transferred amount tended to be higher from model PVC sheets containing 28 wt% PAE or mixed with DEHP. The transferability of PAEs and alternative plasticizers was higher for certain subjects, suggesting individual differences in the transferability of chemicals to the subject's skin surface and is the presence of a group of people comparatively more susceptible to such transfer.

Consumers' perceptions of chemical household products and the associated risks.

Accidents with chemical household products are prevalent worldwide and often involve young children. Previous research has shown that consumers use both analytical factors (e.g., warning symbols) and potentially misleading heuristics to evaluate the riskiness. However, it remains unclear whether consumers intuitively think of the specific risks of these products when handling them. We conducted an online survey with Swiss consumers (N = 1109) aiming to investigate consumer's spontaneous and prompted risk perception of chemical household products. First, we asked them about their free associations to laundry detergent, descaler, mold remover and essential oils. While participants were aware of the risks when prompted about them, they did not name them intuitively, but mainly thought of the possible uses and attributes of the product. Next, we examined prerequisites to safe handling of chemical household products. This included applied knowledge about the products, but also factors like perceived barriers to safe use. Finally, we assessed the predictors of perceived severity of accidents in order to estimate the potential behavioral changes that these predictors might elicit. For interventions, particular attention should be accorded to personal risk awareness and the perception of potential barriers, which were significantly related to the perceived severity of accidents.

Agents Involved and Severity of Acute Ocular Exposure Reported at a Poison Control Center.

PURPOSE: The aim was to identify severity factors useful in the initial management of patients with acute ocular exposure while considering both categories of products involved and circumstances of exposure. METHODS: A retrospective study over a one-year period that included patients who benefited from the poison center services for eye exposure to a chemical substance. RESULTS: Within a year, 1582 patients were identified. The sex ratio (M/F) was 0.8. The mean age was 28.5 ± 20.3 years. Among children, those under 4 years represented the most significant age category (n = 277; 50.1%). Exposure to chemicals were mild (n = 1342, 84.8%). Adults over 65 years appeared to be more likely to have severe ocular damage (OR: 4.75; [2.26; 9.98]). Unintentional exposures were the most frequent (n = 1548; 97.8%). Ocular exposure primarily occurred at home (n = 937; 59.2%), and at the workplace (n = 396; 25%) which was associated with a higher risk of severe injury (OR: 2.93 [2.16; 3.97]). Cleaning products accounted for 31.2% of exposure cases (n = 457). Exposure to disinfectants is a risk factor of more severe injuries (OR: 1.48 [1.002; 2.19] p = .0472) whereas pH and severity of injuries were not statistically significant. CONCLUSIONS: Our study showed the very wide variety of products involved in ocular exposures. Clinicians should pay attention to factors associated with severe injury, including young and old age, work-related injury, substances such as disinfectants, in addition to previously known factors such as acids and bases.

Safety Behaviors to Reduce Risk of Using Chemical Household Products: An Application of the Risk Perception Attitude Framework.

Various chemical household products (CHPs) can make life more convenient; however, CHP users have higher rates of chemical exposure and are faced with the risk of accidents associated with using these products. Safe use of CHPs requires that individuals perform safety-related behaviors such as reading and following CHP risk information. As such, it may be worthwhile to apply the Risk Recognition Attitude (RPA) framework to classify groups of CHP users and investigate whether there is a difference in the safety behaviors between them. Therefore, the objectives of this study are to (a) examine social determinants of each group in the RPA framework, (b) identify different policies that would be effective for each group, and (c) provide evidence to inform the development of effective policies and risk communication strategies that encourage safety behaviors. The study included 1537 subjects and used an ANOVA with a post-hoc Tukey test to examine practices of the four groups in terms of two safety behaviors. A multinomial logistic regression was performed to identify factors that influence the classification of the group types. The results confirmed that safety behaviors associated with using CHPs differed according to weak levels of efficacy beliefs. Two groups of particular concern for low rates of safety behaviors were those with lower education and income levels. Recommendations include (a) customized safety policies and risk communications based on RPA characteristics, (b) distinctive messaging for different groups, (c) policy support for vulnerable populations, and (d) implementing 'user-centered' rather than 'substance-centered' policies and communications for the public.

[Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)]. / Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETv).

OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (±22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (±151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (±19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed.

OBJETIVO: Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal. METODOS: El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. RESULTADOS: Los 10.548 casos estudiados presentaban una edad media de 38,41 (±22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (±151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (±19,58; p=0,0001). CONCLUSIONES: En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos.

[Poisoning by chemical substances and products]. / Vergiftungen durch chemische Stoffe und Produkte.

Exposure to chemical substances results in a multitude of poisonings or suspected poisonings every year. Poison centres (PCs) advise the public and medical staff on these issues and register cases in their databases. Additionally, the Federal Institute for Risk Assessment (BfR) maintains a case database with notifications reported by attending physicians within the framework of the Chemicals Act.This article describes important poisons from the field of chemicals and products and gives an example of poisoning risk management for a new product group. For this purpose, exemplary case information published in the annual reports of different PCs and the cases notified to the BfR were examined.An overview is provided on the product groups leading most frequently to poisonings and requests to the PCs. The spectrum of poisonings registered by the BfR and PCs differs clearly between reporting persons, route of exposure and severity. Substance groups with a relatively high risk compared to other chemical substances and products are highly concentrated detergents, acids and alkalis as well as carbon monoxide.PCs and the BfR databases contain valuable information to estimate the frequency and severity of various poisonings. By merging these data in a national poisoning register, new risks would be discovered more quickly in the future and a national overview of poisoning events would be gained.