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Monitoring UK pesticide exposure using National Poisons Information Service Systems - PS2612

Description
Background
The National Poisons Information Service (NPIS) provides information on poisoning to health professionals across the UK. It does this by two principal mechanisms: firstly by use of its Internet database TOXBASE, and secondly by direct telephone contact. The latter calls arise in two main ways: firstly from enquirers who do not have TOXBASE readily accessible, a significant proportion being general practitioners, and secondly enquiries about more complex cases in which the simple advice provided on TOXBASE is insufficient, and input from a more expert poisons information specialist, or, where appropriate, consultant clinical toxicologist working in the NPIS, is required.

Pilot project
Following discussion with PSD in 2003/4 a proportion of pesticide entries on TOXBASE were identified as of special interest, and the web site changed in order that enquirers could have the possibility of identifying whether their enquiry was educational, or for specific patient management. In the latter case they were offered the opportunity of filling in on-line an enquiry form regarding their patient. The website also automatically generates an e-mail to NPIS Edinburgh at the time of the enquiry, and this is then followed up, in those cases where an electronic enquiry is not submitted, by a paper enquiry.

In the report on the first year a total of 588 completed questionnaires related to patient pesticide exposures were available. Results for 2005/6 will be produced as a full report and summary later this year. Activity on the system has, however, continued at levels at least as high as in 2004/5. This contrasts with the 137 reports received by PSD in 2002.

Proposed project
The project has identified potentials for NPIS to collect and analyse data of this nature. The information collected serves a number of purposes, including:
1. identifying those pesticide products associated with human exposure and ill health enquiries to NPIS
2. providing information on symptoms reported by patients to clinicians subsequent to exposure, clinical feature detected by clinicians, and more detailed follow up of more complex cases
3. providing information on the age and gender of exposed individuals, together with the nature of the exposure
4. establishing the proportion of health service presentations arising from individual products
5. provide information of mode of use in exposures presenting to NPIS systems to licensing bodies
6. providing exposure pattern data that inform Health Education
7. identifying pregnancy related exposures and facilitate follow up via the NPIS –related National Teratology Information Service (NTIS)
8. assisting NPIS to improve care advice in cases of exposure to pesticides based on clinical information collected

Outputs from the new project include:
1. quarterly reports from all pesticide related exposures reported to the NPIS and PSD and other interested parties.
2. alerts on unusual patterns of exposure or symptoms relating to pesticides
3. academic publications indicating the extent of surveillance work carried out and supported by PSD through the NPIS
4. comprehensive coverage providing public health information on the nature and age gender breakdown of exposures in adults and children
5. where incidents occur in pregnancy follow up through the NTIS system of pregnancy outcome

The new project would include enhancement of TOXBASE to include all pesticide enquries to NPIS or a list of pesticides as agreed with PSD and all pesticide telephone enquiries to Scotland and UK referrals to NPIS, Edinburgh consultants.
Objective
1. To follow up all pesticide telephone enquiries to NPIS, Edinburgh, UK national enquiries on pesticide poisoning referred to NPIS Edinburgh consultants (3 of 9 in National rota) by postal questionnaire, and all pesticides enquiries to TOXBASE by electronic questionnaire or by post during the period of funding (3 years).
2. Identify those pesticide products associated with human exposure and ill health enquiries to NPIS at quarterly reports and annual review.
3. Provide information on symptoms reported by patients to clinicians subsequent to exposure, clinical feature detected by clinicians, and more detailed follow up of more complex cases at annual review.
4. Provide information on the age and gender of exposed individuals, together with the nature of the exposure at annual review
5. Establish the proportion of health service presentations referred to NPIS arising from individual products
6. Provide information of mode of use in exposures presenting to NPIS systems to licensing bodies ,and thus inform product packaging and labelling policies

7. Provide exposure pattern data that inform Health Education from annual and full project reports.
8. Identify pregnancy related exposures and facilitate follow up via the NPIS –related National Teratology Information Service (NTIS) in annual reports
9. Assist NPIS to improve care advice in cases of exposure to pesticides based on clinical information collected on a regular ongoing manner during the project

As this project extends a pilot all will be potentially available from project funding date, except the extension of the present pesticide target list.
Project Documents
• Final Report - SID5A : Monitoring UK pesticide exposures using National Poisons Information Service systems   (246k)
Time-Scale and Cost
From: 2006

To: 2009

Cost: £144,974
Contractor / Funded Organisations
National Poisons Information Service
Keywords
Database              
Hazardous substances              
Health              
Monitoring              
Organophosphates              
Pesticide use              
Pesticides              
Poisons              
Public Health              
Fields of Study
Pesticide Safety