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At least 37 records · Page 2Linked to original sources
PubMed2006

Choice of poison for intentional self-poisoning in rural Sri Lanka.

BACKGROUND: Although intentional self-poisoning is a major public health problem in rural parts of the Asia-Pacific region, relatively little is known of its epidemiology. We aimed to determine why Sri Lankan self-poisoning patients choose particular poisons, and whether acts of self-harm with highly dangerous poisons were associated with more premeditation and effort. METHODS: We interviewed 268 self-poisoning patients presenting to two district general hospitals in rural Sri Lanka. RESULTS: Eighty-five percent of patients cited easy availability as the basis for their choice of poison. There was little premeditation: more than 50% ingested the poison less than 30 minutes after deciding to self-harm. Patients had little knowledge about treatment options or lethality of the poison chosen. We found no difference in reasons for choice of poison between people ingesting different poisons, despite marked differences in toxicity, and between people who died and those who survived. CONCLUSIONS: Poisons were chosen on the basis of availability, often at short notice. There was no evidence that people using highly toxic poisons made a more serious or premeditated attempt. Restrictions on availability of highly toxic poisons in rural communities must be considered in strategies to reduce the number of intentional self-poisoning deaths in the Asia Pacific region.

Adolescent↗
PubMed2000

Characterization of US poison centers: a 1998 survey conducted by the American Association of Poison Control Centers.

A 1998 survey of all 73 US poison centers, including 52 certified centers and 21 noncertified centers, is presented. Despite a continued decline of the number of poison centers operating in the US, the volume of calls has steadily increased. In 1997 these centers handled 3.65 million telephone consultations, including 2,475,010 human poison exposure cases, 134,646 animal poison exposures, and 1,036,148 information calls. Nearly the entire US population had access to a poison center (99.9%), although only 78.5% of the US population was served by a certified center. Certified poison centers handled 83.6% of human poison exposure cases reported to US poison centers. Calls to certified centers were twice as likely to be handled by staff who were certified as specialists in poison information. On average, poison center utilization was 9.2 human exposure consultations/1,000 population. Total national poison center expenses approached $81 million. The average cost/human exposure case was $33.30 in certified centers, a substantial savings when compared with the alternative of emergency department management. State governments provided the single largest source of funding. Poison center funding remains unstable, with 41% of centers reporting a possible or definite budget reduction anticipated in the next budget year. In the past 5 y, 47.9% of centers faced threat of closure. Center certification and increased public education activity, especially the distribution of poison prevention materials and number of media contacts, were associated with greater utilization of the poison center in the region served.

Computers↗
PubMed1998

Poisoning severity score. Grading of acute poisoning.

BACKGROUND: A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidity and facilitates comparability of data. Working from a simple grading scale proposed by the European Association of Poisons Centres and Clinical Toxicologists, a Poisoning Severity Score has been developed jointly with the International Programme on Chemical Safety and the European Commission. METHODS: The Poisoning Severity Score has been elaborated, tested, and gradually revised during a project running 1991-1994. Fourteen poisons centers from various countries have participated. Each center independently graded 371 cases of acute poisoning by ten different toxic agents. The data were then analyzed and compared. RESULTS: The concordance in grading the severity increased during the study period, and in the last phase there was an acceptable concordance among centers in 80% or more of the cases. Given the condition and quality of the original case records, this result was considered satisfactory and agreement was reached on the scoring scheme presented here. The Poisoning Severity Score grades severity as (0) none, (1) minor, (2) moderate, (3) severe, and (4) fatal poisoning. It is intended to be an overall evaluation of the case, taking into account the most severe clinical features. Use of the Poisoning Severity Score normally requires a follow-up of all cases, but may be used on admission or other times during the course of poisoning if this is clearly stated when data are presented. CONCLUSIONS: A Poisoning Severity Score has been developed and found applicable for grading the severity of poisoning. It is foreseen that the Poisoning Severity Score will meet the expectations and be used in practice, but its future use and evaluation may result in some further revision and refinement.

Acute Disease↗
PubMed2003

Carbon monoxide poisoning monitoring network: a five-year experience of household poisonings in two French regions.

BACKGROUND: In France, the epidemiological situation of acute carbon monoxide (CO) poisoning is only partially known. The purpose of this study was to assess the epidemiological situation of household poisonings in two French regions where a regional toxicovigilance network was active. METHODS: During five years, we studied, by means of a standardized data collection form, cases of acute CO poisoning admitted to regional hospitals and notified by hospital physicians. RESULTS: From 1997 to 2001, 1,458 people were involved in 489 places. Household poisonings represented the first circumstance of CO poisoning with 811 people involved in 293 places. So, analysis was performed only for household poisonings. The mean age was 33.3 years. Twenty patients died (2.6%), 16 patients were in coma (2.1%), and 11 patients had an initial isolated loss of consciousness (14.4%). Responsible appliances in household poisonings were identified in 84% of places. The appliances most often involved were vented heating systems (46.4%), mobile heaters (13.2%), and thermal motors (8.7%). In 63% of the 293 places, investigation showed that poisoning occurred because of a faulty installation. Vented gas heaters and mobile heaters were responsible for half of the severe household CO poisonings. CONCLUSION: In the countries of Rhône-Alpes and Auvergne, most of household CO poisonings are no longer caused by waterheaters but by gas heating systems. Poisonings caused by mobile heaters more frequently led to coma and death and thermal motors played a large part in moderate poisonings. These recently emerging trends justify the efforts focused on ongoing monitoring and the introduction of preventive measures.

Adolescent↗
PubMed2006

Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world.

OBJECTIVES: Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting. METHODS: Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period. FINDINGS: A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100,000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0). CONCLUSION: Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions.

Adult↗
PubMed1995

Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite.

BACKGROUND: Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America. OBJECTIVE: We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis. METHODS: A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed. RESULTS: Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion. CONCLUSION: Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.

Administration, Cutaneous↗
PubMed2001

Poison control centers and state-specific poisoning mortality rates.

OBJECTIVE: The purpose of this study was to compare poisoning mortality rates of states served by a poison control center certified by the American Association of Poison Control Centers (AAPCC) to those that are not served by a certified center because health policy has been based on certification status. METHODS: Poisoning mortality rates from 1993 to 1997 were obtained from a public use database of death certificates and were stratified by state and circumstance. Each state was classified as being fully served, partially served, or not served by an AAPCC-certified center. States in one category of service for the entire 5 years were selected for analysis. RESULTS: During this 5-year period, 39 states exhibited a consistent category of poison control center services. The mortality rates per 100,000 population during these 5 years were 5.93, 6.12, 6.01, 6.23, and 6.68 respectively (P <0.05) for all 39 states. The mean 5-year mortality rate for states with certified poison control center services (7.08 +/- 2.59; n = 17) was higher (P <0.05) than those with noncertified service (5.17 +/- 1.46; n = 15) but not significantly different from those with partial certified service (6.25 +/- 1.75; n = 7). CONCLUSION: Increased poisoning mortality rates were associated with AAPCC certification status and year. Poisoning mortality rates may not be an appropriate outcome measure of the impact of poison control centers, AAPCC-certification notwithstanding, at this time. Basing poison control center-related policy on state-specific poisoning mortality rates can not be supported by these findings.

Certification↗
PubMed2004

Poisoning prevention education during emergency department visits for childhood poisoning.

OBJECTIVE: Childhood poisoning represents a major public health problem that can be prevented through educational efforts. Commonly, young children experiencing a first poisoning episode will have a second occurrence. The aim of this study is to assess whether caretakers of children evaluated in an emergency department for acute poisoning exposure recall receiving poisoning prevention education as part of the medical encounter. METHODS: Consecutive poisoning exposures reported to a regional Poison Control Center concerning children under the age of 6 years were identified. Inclusion criteria were an emergency department referral and subsequent discharge. Within 10 days of emergency department visit, a single trained interviewer administered by telephone a scripted questionnaire concerning the provision of poisoning prevention education. Poison control center logs were reviewed for demographic and treatment data. RESULTS: Of 102 eligible subjects, 77 families were contacted and 75 participated. The median age of poison exposure was 2 years; 45% were male. Seventy-three percent (95% CI: 61% to 83%) of caregivers reported receiving no poisoning prevention education. Among the minority receiving some information, only 25% received verbal instruction. Caregivers of children treated in urban academic centers were more likely to recall prevention education than those treated at suburban and rural hospitals (RR = 5.4; 1.8 to 16.2). Caregivers of children treated at specialized children's hospitals were more likely recall prevention education than general hospitals (RR = 5.3; 1.6 to 17.7). CONCLUSION: Emergency department personnel are missing a potentially important opportunity to provide poisoning prevention education to families of children at high risk for repeat occurrence.

Academic Medical Centers↗
PubMed2003

Acute methanol poisonings reported to the Drug and Poison Information Center in Izmir, Turkey.

The demographics, sources and outcomes of methanol poisoning have not been described in Turkey. Our study identified the profile of acute methanol exposures reported to Drug and Poison Information Center (DPIC) in Izmir, Turkey, from 1993 to 2002. Data analysis included patient demographics, sources of methanol, reason for the exposure, clinical effects and outcomes of methanol poisoning. The DPIC recorded 30,485 calls concerning poisoning; 996 (3.3%) alcohol poisonings were recorded and 113 (11.3%) of them were methanol poisonings. There were 91 (80.5%) males and 22 (19.5%) females with a mean age of 34.7+/-1.3 y (range 19-65) and 4.8+/-0.9 y (range 1-18) in adults and children, respectively. The sources of methanol were eu de cologne (72.6%), spirits (10.6%) and antifreeze (2.7%). Accidental poisoning occurred in all children between 0 and 12 y old, abuse (55.7%) and intentional poisoning (27.3%) were predominant in adults. Clinical signs in all cases were central nervous system symptoms (45.1%), metabolic acidosis (23.0%), visual symptoms (21.2%) and gastrointestinal symptoms (10.6%). Sixteen patients (14.1%) died, 63 (55.8%) had complete recovery and 1 (0.9%) had irreversible visual problems. Most patients with methanol poisoning may die or present serious morbidity without appropriate treatment in a health care facility. Methanol for producing cheap "eu de colognes" in Turkey is the principal reason for severe poisoning and deaths. Public education about colognes and legislative control of cologne production are important in preventing methanol poisoning.

Adolescent↗
PubMed1996

Tetrodotoxin poisoning in Taiwan: an analysis of poison center data.

Tetrodotoxin (TTX) poisonings are not infrequently seen in Taiwan, and several outbreaks have been recorded by the Poison Control Center (PCC)-Taiwan during 1988-1995. However, their demographic data, clinical features, and medical outcome have not been reported. A retrospective study analyzed the PCC data of TTX poisonings. All patients reported to the PCC-Taiwan as TTX poisoning from July 1988 through December 1995 were included. Excluding 2 incidents, the diagnosis of TTX poisoning was documented by identification of puffer fish and/or by the analysis of TTX in it. Patient age, sex, season of poisoning, substances ingested, incubation period, presenting symptoms, recovery time, and clinical outcome were analyzed. A total of 20 incidents involved 52 patients. Males outnumbered females (52% vs 41%) with sex undetermined in 4 patients. Most incidents occurred in the spawning seasons of puffer fish, eg March to May. Puffer fish ingestion accounted for 18 incidents; ingestion of gastropod mollusks and Gobius criniger were responsible for the other 2 incidents. Following ingestion of puffer fish and other poisonous marine animals, most symptoms developed within 6 h with complete recovery usually in 24 h. Symptoms of TTX poisoning were similar as those previously reported; however, unusual features, such as hypertension (24%), pinpoint pupils (4%), bronchorrhea and facial flush (2%), were also seen. The mortality rate was 13.5%. The violent neurotoxin is present in puffer fish and occurs in other marine animals. Without adequate therapy, patients may have serious morbidity or even succumb. Careful identification of puffer fish and other poisonous marine animals, as well as proper treatment of TTX poisoning patients, are mandatory to successfully handle cases of TTX poisoning.

Aging↗
PubMed1997

Acute poisonings with drugs. A review of the data collected at the National Poison Information Centre during the period 1991-1995.

An analysis of the files collected in the National Poison Information Centre reveals that drugs are the most frequent causes of acute poisonings (followed by pesticides and other chemical substances) not only in big cities but also in rural areas. Within the drug poisoning category, about 59% of the toxicological advice related to poisonings in children up to 14 years of age. The most frequent poisonings with drugs related to poisonings with sedative and psychotropic drugs, particularly those containing benzodiazepines, phenothiazine derivatives and tricyclic antidepressants. There were frequent inquiries relating to poisonings with drug mixtures. Self-poisonings were the most frequent cause of poisonings among the adults (87.3%), in children below 14 years of age dominated accidental poisonings (96% of all drug poisonings in children).

Adolescent↗
PubMedDate not supplied

Diversion of 911 poisoning calls to a poison center.

OBJECTIVE: To determine the impact and safety of diverting poisoning calls from 911 to a regional poison center. METHODS: A prospective six-month review was performed of all calls transferred from 911 dispatchers to a regional poison center for management. Recommendations for management and transport were made by the poison center using existing protocols. Patients were followed with telephone contact by poison center staff until symptoms resolved or until hospital discharge. Medical outcomes were categorized using the American Association of Poison Control Center guidelines for medical outcome. RESULTS: A total of 262 cases were reviewed; four were excluded. The poison center was contacted prior to ambulance dispatch in 210 cases (81%). An ambulance was sent before the poison center was contacted 48 times (19%). The majority of patients originally calling 911 were managed at home (175/258; 68%). Patients experienced either no effect or minor effects in 254 cases (98%). Two patients developed moderate effects (0.8%), one developed a major effect (0.4%), and one died (0.04)%. No adverse effects or treatment delays resulted from diversion of calls to the poison center. CONCLUSIONS: Appropriate poisoning and toxic exposure cases may be diverted safely from emergency medical services dispatch to a regional poison center for management, reducing unnecessary responses, with substantial cost savings.

Adolescent↗
PubMed1990

Reliability of routine hospital data on poisoning as measures of deliberate self poisoning in adolescents.

STUDY OBJECTIVE: The aim was to assess the extent to which routinely collected data on poisoning in adolescents reflected deliberate self poisoning and, in doing, so to assess the accuracy of the diagnostic information on poisoning in the routine hospital abstracts which form the joint data base of Hospital Activity Analysis and the Oxford Record Linkage Study (ORLS). DESIGN: A comparison was made (a) of all eligible ORLS records during the study period with an independent source of records; and (b) of a random sample of records from an independent source with ORLS. SETTING: Records of patients admitted to the John Radcliffe Hospital in Oxford were used. SUBJECTS: These were (a) patients aged 10-20 years between 1980 and 1985 with a diagnosis of poisoning by drugs and medicaments in ORLS; (b) a random sample of 500 patients selected from the self harm monitoring files at the hospital (12 patients were not eligible for inclusion in ORLS and were therefore excluded from the rest of the study). MEASUREMENTS AND MAIN RESULTS: The recorded diagnosis was compared on the records selected from the two files. Of the 1123 events of poisoning identified in ORLS, 1081 (96.3%) were correctly coded as poisoning and 1065 (95%) of these were deliberate self poisoning. Of the 488 cases from the monitoring files, 467 (95.7%) of all cases had a correct diagnosis of injury or poisoning on the ORLS file. Of the 453 poisoning cases 436 (96.2%) were correctly recorded in ORLS. CONCLUSIONS: Deliberate self poisoning in adolescents can be identified through routinely collected hospital statistics. A very high percentage of the diagnostic information on poisoning in ORLS files is correctly recorded.

Adolescent↗
PubMed2005

[Changes in serum contents of inflammatory mediators after tetramethylene-disulfo-tetramine poisoning and clinical study of a new treatment regime for the poisoning].

OBJECTIVE: To study the changes in serum contents of beta-endorphin (beta-EP), endothelins (ET), nitric oxide (NO) and tumor necrosis factor (TNF) after acute tetramethylene-disulfo-tetramine (TDT) poisoning and therapeutic effect of a new treatment regime. METHODS: (1) Forty-eight patients with tetramethylene-disulfo-tetramine poisoning (experiment group) were enrolled in this study. The serum levels of beta-EP, ET, NO and TNF were measured upon hospitalization and 1, 3, 5, 7, 9, 11, 13, 15, 17 and 19 days after poisoning, respectively, and compared with those of 30 healthy individuals (control group B). (2) They were treated with the improved regime and compared with patients treated with the conventional regime designated as control group A. RESULTS: (1) In 48 patients treated with improved regime, 45 were cured and 3 died. (2) The serum levels of beta-EP, ET, NO and TNF from 45 patients who were cured were significantly higher at hospitalization compared with those of healthy individuals, with the peak values appeared on day 1 after poisoning in the mild, moderate and severe groups. Beta-EP levels returned to normal range on days 9, 13 and 17 after poisoning respectively in the mild, moderate and severe groups. ET levels returned to normal range on days 7, 13 and 15 after poisoning respectively in the mild, moderate and severe groups. NO levels returned to normal range on days 7, 11 and 11 after poisoning respectively in the mild, moderate and severe groups. TNF levels returned to normal range on days 9, 11 and 17 after poisoning respectively in the mild, moderate and severe groups. (3) The serum levels of beta-EP, ET, NO and TNF in 3 non-survivors were very high at hospitalization and continued to increase in the course of treatment. (4) The cumulative doses of diazepam and Phenobarbital, and the eclampsia time were significantly less in the experiment group than those of control group A. CONCLUSION: (1) The serum levels of beta-EP, ET, NO and TNF are correlated with the severity of tetramethylene-disulfo-tetramine poisoning and general conditions of the patients. (2) When the serum levels of beta-EP, ET, NO and TNF decrease gradually in the course of treatment, prognosis is better. On the contrary, the prognosis is poor when their levels increase gradually. (3) Measures to decrease levels of beta-EP, ET, NO and TNF result in a better prognosis of patients with tetramethylene-disulfo-tetramine poisoning. (4) The improved regime can be considered a better therapeutic strategy in tetramethylene-disulfo-tetramine poisoning.

Acute Disease↗
PubMed1997

Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis.

Data on incidence, medical spending, and payment sources for poisoning were taken from the 1987 National Medical Expenditure Survey, 1991 US Vital Statistics, the 1992 National Hospital Discharge Survey, and 1992 poison control center surveillance data. Benefits, measured as percentage reductions in medical spending attributable to use of poison control centers, were calculated from analyses of published and unpublished studies of jurisdictions in which services became unavailable. Medical spending (payments) for poisoning treatment totaled $3 billion in 1992. Spending averaged $925 per case. Poison control center services were available for 86% of poisonings As used, they reduced the number of patients who were medically treated but not hospitalized for poisoning by an estimated 350,000 (24%) and the number of hospitalizations by 40,000 (12%) in 1992. The average public call to a poison control center for aid prevented $175 in other medical spending. Poison control centers offer a large return on investment. Despite their proven benefits, many poison control centers are unstably funded and financially strapped, in part because the federal government pays far less than its fair share of center costs.

Cost-Benefit Analysis↗