Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka(Blackwell Publishing, 2023) Weerasinghe, M.; Jobe, L.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Hawton, K.; Gunnell, D.; Agampodi, S.OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.Item Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka(Blackwell Publishing Ltd, 2020) Weerasinghe, M.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Knipe, D.; Hawton, K.; Gunnell, D.; Agampodi, S.ABSTRACT: Objective: In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS: We used a case–control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS: Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7–783.4) and being a non-farmer AOR 13.3, 95% CI 1.8–99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0–99.8%) and 88.2% (95% CI 72.5–96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION: While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective. © 2020 John Wiley & Sons Ltd AUTHOR KEYWORDS: pesticide shops; pesticides; self-poisoning; Sri Lanka; suicide. INDEX KEYWORDS: pesticide, environmental factor; pesticide; poisoning; regression analysis; risk factor, adult; alcohol consumption; alcohol intoxication; Article; automutilation; case control study; controlled study; female; human; major clinical study; male; predictive value; purchasing; self poisoning; sex difference; social status; Sri Lanka, Sri LankaItem Potential interventions for preventing pesticide self-poisoning by restricting access through vendors in Sri Lanka(Hogrefe Publishing, 2018) Weerasinghe, M.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Gunnell, D.; Hawton, K.; Agampodi, S.BACKGROUND: In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immediately prior to the event. AIMS: From reviewing the literature we proposed four interventions: (a) farmer identification cards (ID); (b) prescriptions; (c) cooling-off periods; and (d) training pesticide vendors. We aimed to identify the most promising intervention. Method: The study was conducted in Sri Lanka. We mapped stakeholders' interest and power in relation to each intervention, and followed this by a ranking exercise. Seven focus group discussions (FGDs) were conducted to assess facilitators and barriers to implementation. RESULTS:Vendor training was the most supported intervention, being ranked first by the stakeholders. The participants in the FGDs strongly supported training of vendors as it was seen to be easy to implement and was considered more convenient. Farmer IDs, prescriptions, and cooling-off periods were thought to have more barriers than facilitators and they were strongly opposed by end users (farmers and vendors), who would potentially block their implementation. LIMITATIONS: Cost considerations for implementing the proposed intervention were not considered. CONCLUSION: Training vendors might be the most appropriate intervention to restrict sales of pesticides to people at risk of suicidal behavior. This requires field testingItem Hemoglobin A1c values in CKDu endemic and non endemic regions of Sri Lanka(Elsevier Science Publishers, 2017) Wijerathne, B.; Meier, R.; Salgado, S.; Agampodi, S.