Association Between Means Restriction of Poison and Method-Specific Suicide Rates

Question

Findings

Meaning

Importance

Objective

Evidence Review

Findings

Conclusions and Relevance

Suicide Overall and Suicide by Pesticide Rates among South Korean Workers: A 15-Year Population-Based Study

Suicide is a major public health concern in South Korea, and self-poisoning by pesticides is one of the common methods of suicide. Pesticide ban policies have been successful for suicide prevention; however, no studies have shown their effect according to occupational groups. The present study analyzed suicide and suicide by pesticide rates among South Korean workers aged 15–64 in 2003–2017, their associations with occupational groups, and the impact of three major economic indices on these factors. Workers in the agriculture, forestry, and fishery industries had relative risks of 5.62 (95% CI: 5.54–5.69) for suicide overall and 25.49 (95% CI: 24.46–26.57) for suicide by pesticide. The real gross domestic product had a positive association with suicide overall only in the last five-year period investigated in this study, and the unemployment rate consistently had a positive association. The economic status and policy for suicide prevention affected suicide and suicide by pesticide rates differently among occupational groups and different time periods. Policy addressing suicidal risk for different occupational groups should be of concern in South Korea.

Violent deaths among elderly in Attica, Greece: A 5-year survey (2011-2015)

According to World Health Organization (WHO) estimations, approximately 6 million people lose their lives yearly due to some kind of injury, while one-third of these incidents are due to violent acts. Violent deaths include accidents (road traffic accidents, drownings, falls, heat effects etc), suicides as well as homicides. Elderly people seem to be at greater risk due to their special characteristics as a vulnerable social group. The aim of this study was to investigate violent deaths (accidents, suicides and homicides) among elderly people in Attica, Greece, during the period 2011-2015 by examining manner of death with respect to demographic data (gender and age) and toxicological examination results. A total of 546 violent deaths among people over 65 years old were included in this study. Autopsy findings along with toxicological examination results were collected from the archives of the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens. The findings of the study showed that most of the victims were male (63.74%). The overwhelming majority of violent deaths (425 cases) were accidents, 92 cases suicides, and the remaining 29 cases homicides. Drowning was the leading cause of all accidental deaths, followed by road traffic accidents. Hangings prevailed among violent suicide methods and asphyxiation presented as a predominant homicide method.

The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review

BACKGROUND

Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide.

METHODS

WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata.

RESULTS

We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region.

LIMITATIONS

High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions.

CONCLUSION

There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally.

Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence

BACKGROUND

Pesticide self-poisoning accounts for 14-20% of suicides worldwide. Regulation aimed at restricting access to pesticides or banning highly hazardous pesticides is one approach to reducing these deaths. We systematically reviewed the evidence of the effectiveness of pesticide regulation in reducing the incidence of pesticide suicides and overall suicides.

METHODS

We did a systematic review of the international evidence. We searched MEDLINE, PsycINFO, and Embase for studies published between Jan 1, 1960, and Dec 31, 2016, which investigated the effect of national or regional bans, and sales or import restrictions, on the availability of one or more pesticides and the incidence of suicide in different countries. We excluded other interventions aimed at limiting community access to pesticides. We extracted data from studies presenting pesticide suicide data and overall suicide data from before and after national sales restrictions. Two reviewers independently assessed papers for inclusion, extracted data, and assessed risk of bias. We undertook a narrative synthesis of the data in each report, and where data were available for the years before and after a ban, we pooled data for the 3 years before and the 3 years after to obtain a crude estimate of the effect of the ban. This study is registered through PROSPERO, number CRD42017053329.

FINDINGS

We identified 27 studies undertaken in 16 countries-five low-income or middle-income countries (Bangladesh, Colombia, India, Jordan and Sri Lanka), and 11 high-income countries (Denmark, Finland, Germany, Greece, Hungary, Ireland, Japan, South Korea, Taiwan, UK, and USA). Assessments largely focused on national bans of specific pesticides (12 studies of bans in six countries-Jordan, Sri Lanka, Bangladesh, Greece [Crete], South Korea, and Taiwan) or sales restrictions (eight studies of restrictions in five countries- India, Denmark, Ireland, the UK and the USA). Only five studies used optimum analytical methods. National bans on commonly ingested pesticides in five of the six countries studied, including four studies using optimum analytical methods, were followed by reductions in pesticide suicides and, in three of these countries, falls in overall suicide mortality. Greece was the only country studied that did not show a decrease in pesticide suicide following a ban. There were no high-quality studies of restricting sales to people for occupational uses; four of the seven studies (in three of the five countries studied-India, Denmark, and the USA) showed sales restrictions were followed by decreases in pesticide suicides; one of the two studies investigating trends in overall suicide mortality reported a fall in deaths in Denmark, but there were also decreases in suicide deaths from other methods.

INTERPRETATION

National bans on highly hazardous pesticides, which are commonly ingested in acts of self-poisoning, seem to be effective in reducing pesticide-specific and overall suicide rates. Evidence is less consistent for sales restrictions. A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year.

FUNDING

None.

Suicidal self-stabbing: A report of 12 cases from Crete, Greece

Sharp-force trauma is a popular cause of homicide and suicide in many countries. Characterisation of the injuries between the two is crucial for a differential diagnosis. The current paper reviews 12 self-inflicted sharp-force trauma deaths from the island of Crete in Greece. Forensic reports between 1999 and 2015 were collated, and we studied the number and location of injuries, the demographic characteristics of the deceased, the sharp object and the medical history of the deceased. One third of the cases where the forensic reports were available (3/10) involved multiple injuries, and one case involved a combination of stabbing and hanging. Most injuries involved a kitchen knife. Ninety-two per cent (11/12) of the victims involved male Greek nationals aged >50 years. The type and location of injuries were not found to be specific to suicide alone. Thus, death-scene investigation remains crucial to the differential diagnosis between suicide and homicide. This is the first report on self-inflicted sharp-force fatalities in Greece.

Mumps caused by paraquat-induced poisoning: A case report

Paraquat (PQ) is a highly toxic herbicide that harms the liver, kidney, lungs and heart, and results in a variety of complications. The majority of patients with severe PQ poisoning may succumb to multiple organ failure, and the mortality rate is high. Although a large number of studies have been performed investigating PQ poisoning, cases of mumps caused by PQ-induced poisoning are rare. In the present case report, a 45-year-old female who ingested PQ was admitted to the Emergency Department of Liaocheng People's Hospital (Liaocheng, China). During the development of the disease, mumps was caused by a cavity ulcer following PQ poisoning. To the best of our knowledge, cases of mumps following PQ poisoning are rare.

New perspectives on dietary-derived treatments and food safety-antinomy in a new era

Despite the advances in science and technology and wide use of chemical drugs, dietary intervention (or food therapy) remains useful in preventing or treating many human diseases. A huge body of evidence shows that the dietary pattern or habit is also an important contributing factor to the development of chronic diseases such as hypertension, type 2 diabetes, hyperlipidemia, and cancers. In recent years, over-the-counter health foods, nutraceuticals, and plant-derived medicinal products have been gaining popularity all over the world, particularly in developed countries. Unfortunately, owing to the contamination with various harmful substances in foods and the presence of toxic food components, food-borne diseases have also become increasingly problematic. Incidents of food poisonings or tainted food have been increasing worldwide, particularly in China and other developing countries. Therefore, the government should put in a greater effort in enforcing food safety by improving the surveillance mechanism and exerting highest standards of quality control for foods.