Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide. Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems. Previous research has demonstrated wide variability in incidence rates for APP. This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems. This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world. It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases. Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention. By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.

Indexes of retinopathy and nephropathy were studied in a large population of diabetics using standardized methods. In each of 973 subjects, more than 100 other variables were also measured: this made It possible to take into account many confounding factors when we examined the relationships of these variables to microangiopathy. The most powerful risk factor for microangiopathy was duration of diabetes, but frequency of both retinopathy and nephropathy was impressively related to the level of plasma glucose at the time of examination. This latter relationship was independent of the effects of other variables. Risk of retinopathy was also related to factors that were probably associated with higher previous plasma glucose levels—need for insulin therapy, history of ketonuria, present level of plasma triglyceride, leanness, and younger age of onset of diabetes. In subjects with a systolic blood pressure of less than 170 mm Hg and who did not have proteinuria, no significant relationship was found between blood pressure and frequency of retinopathy, but, when the systolic pressure was greater than 169 mm Hg, rates of retinopathy were excessive, even In those subjects without proteinuria. Several other factors had no significant relationship to retinopathy or nephropathy: these included age, level of education, smoking, and plasma cholesterol. Rates of severe nephropathy were somewhat greater In men than in women, but this difference was not statistically significant. Rates of retinopathy and of mild proteinuria were similar in men and women. After adjustment for duration of diabetes, the risk of retinopathy was no higher in the 102 subjects with two diabetic parents than in the 254 who had no family history of diabetes.

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A random selection of 186 water utilities was used for this study in which raw and finished water samples were collected from each facility five times throughout a year and analyzed for iron and aluminum by atomic absorption techniques. The water samples were categorized by the supply source (ground, surface, or a combination of both), the type of water (raw, finished, or untreated distribution samples), and the type of coagulation used in the treatment process (aluminum sulfate, ferric chloride, other coagulants such as cationic polymers, or no coagulant). The samples were also categorized according to the 10 US Environmental Protection Agency regions and 4 population categories. The results indicate that aluminum is more likely to exist in surface waters than in groundwaters and that there is a 40-50 percent chance that alum coagulation increases the aluminum concentration of finished water above its original concentration in the raw water.