Health care cost effects of public use of a regional poison control center.

Poison control centers in the United States are threatened with closure, and attempts at a cost-benefit analysis of these services have been indeterminate. The purpose of this study was to compare the operating costs of a regional poison control center resulting from public use of its telephone hotline services with those of hypothetical alternative sources of advice and care. We conducted a follow-up telephone survey among 589 public callers to the San Francisco Bay Area Regional Poison Control Center who had been managed at home without medical referral after an unintentional poisoning. All survey respondents were asked what alternative action they would have taken had the poison control center not been available to assist them by telephone consultation. We then surveyed emergency departments and physicians'' offices cited as alternatives by the callers to determine their response and charges for evaluating a suspected poisoning case. A total of 464 (79%) of the callers surveyed would have sought assistance from their local emergency health care system had the poison control center not been available. We conservatively estimated that the total charges for such evaluations would be +71,900. Comparatively, the total actual operating cost of services provided by the poison control center for all 589 poisoning cases was +13,547. Most of the study subjects (429 [73%]) had private insurance coverage. Direct public access to these services probably reduces the use of emergency health care resources, thus lowering health care costs.     

Survival of brown kiwi (

Brown kiwi (Apteryx mantelli) in central Northland have been monitored for up to 32 months of sustained exposure to brodifacoum poison. The cereal baits were placed in bait stations to target brushtail possums (Trichosurus vulpecula). Annual survival of 55 radio-tagged adult kiwi in two poisoned forest patches has been high (95.9%), and similar to that in two nearby unpoisoned forest patches and in the patches before poison was used (95.3%). The two adult birds tested of the four that died in the poisoned areas had no traces of brodifacoum at the detection limit of 0.05 mg kg(-1). With an improved detection limit of 0.02 mg kg(-1), no traces of brodifacoum were found in nine eggs collected over 18 months after adults were first exposed to the poison. Of four chicks tested (detection limit: 0.005 to 0.02 mg kg(-1)), that had apparently died of natural causes or were killed by predators, three contained traces of brodifacoum (0.01—0.18 mg kg(-1)). The median survival of 39 radio-tagged chicks in the poisoned areas (36 days) was significantly better than that of 18 chicks in untreated areas nearby (15 days). Kiwi chicks may be more vulnerable than adult kiwi to accidental poisoning because of physiological or behavioural differences; however, the effects of sustained exposure to low levels of brodifacoum poison may not be visible in the adult population for several years. At this stage of the ongoing study, the benefits to kiwi of this method of pest control outweigh the costs, because chick survival is greatly improved.     

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

Accidental poisoning deaths in British children 1958-77.

In the 20 years 1958-77 598 deaths were registered as due to accidental poisoning in British children under the age of 10-343 boys and 255 girls. Drugs caused 484 deaths, non-medicinal products 111, and plants three. The annual number of deaths reached a peak in 1964 but fell steadily thereafter; 16 deaths occurred in 1977. After 1970 tricyclic antidepressants replaced salicylates as the most commonly fatal poison. The next ten drugs most often recorded in 1970-7 were, in order, opiates (including diphenoxylate/atropine (Lomotil)), barbiturates, digoxin, orphenadrine (Disipal), quinine, potassium, iron, fenfluramine (Ponderax), antihistamines, and phenothiazines. In 20 years paracetamol caused one death, and before 1976 deaths caused by aspirin had fallen to fewer than two a year. Thus the introduction in 1976 and 1977 of safety packaging of these drugs can be expected to have little impact on the mortality from them in childhood.     

Effects of a major earthquake on calls to regional poison control centers.

We retrospectively evaluated the effect of the Loma Prieta earthquake on calls to 2 designated regional poison control centers (San Francisco and Santa Clara) in the area. In the immediate 12 hours after the earthquake, there was an initial drop (31%) in call volume, related to telephone system overload and other technical problems. Calls from Bay Area counties outside of San Francisco and Santa Clara decreased more dramatically than those from within the host counties where the poison control centers are located. In the next 2 days, each poison control center then handled a 27% increase in call volume. Requests for information regarding safety of water supplies and other environmental concerns were significantly increased. The number of cases of actual poisoning exposure decreased, particularly poison and drug ingestions in children. Most calls directly related to the earthquake included spills and leaks of hazardous materials and questions about water and food safety. Regional poison control centers play an essential role in the emergency medical response to major disasters and are critically dependent on an operational telephone system.     

Poison-related mortality effects in the endangered Egyptian vulture (<Emphasis Type="Italic">Neophron percnopterus</Emphasis>) population in Spain

A total of 211 poisoning incidents registered over the period 1990–2007 and affecting 294 Egyptian vultures (Neophron percnopterus) were studied to address the impact of poison-related mortality in the Spanish population. Poison-related mortality mainly affected the birds on an individual level, with low numbers of individuals being found in each incident (mean 1.39) with 94.9% being adults. Deaths were largely recorded (81.8%) during the breeding season, with mortality peaking during May and June (52.1%). In contrast with other raptor species, a high proportion of adult individuals (74.2%) were found in the nest or its surroundings. Age-related differences in the poisoning rate are probably related with different feeding and behavioral strategies between age classes. The illegal use of poison to control predators was the main cause of mortality (93.8%), and particularly in small hunting reserves (74.9%), since the kind of food resources that adults exploit are coincident with the type of baits employed to illegally control predators and the preferred habitat coincides with areas of small game hunting. Our results suggest that poisoning is probably one of the main causes of Egyptian vulture mortality in Spain. The eradication of the illegal use of poisoning and supplementary feeding in specific territories to provide safe food seems priority for its conservation.     

Integrating mental health into primary health care in Iraq

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.     

A survey of Canadian rheumatology training programs, 1968 to 1978.

The committee on manpower of the Canadian Rheumatism Association retrospectively surveyed Canadian rheumatology training programs for the period 1968 to 1978. There were 133 trainees during that period, who accounted for a total of 201 trainee-years. Most trainee-years were taken up by first-year trainees, especially in the first half of the decade under study. Although three training centres accounted for two thirds of all the trainee-years, there was a progressive increase in the proportion of trainees attending other centres. The majority of trainees were Canadian medical graduates. More than one third of the alumni of these programs held full-time academic positions, and more than three quarters had some academic affiliation. One third were spending at least half of their professional time in teaching and research, but only 71 were spending half or more of their practice time in rheumatology in Canada. The remainder had established residence abroad or were spending at least half of their practice time in areas other than rheumatology. The rapid expansion of Canadian training programs has not been paralleled by a proportionate increase in rheumatologic manpower in Canada.     

Role of general practitioners in the care of disabled young adults.

Services for handicapped children end when these patients become young adults. In the Exeter Health Authority district 383 disabled young adults were interviewed about their unmet needs. Many wished for advice and counselling. A quarter had not visited their general practitioner in the previous year, and two thirds of these had not had a general assessment or seen a specialist.     

Acute drug poisoning in the adult

In a prospective study of 349 patients with acute poisoning treated at The Montreal General Hospital in 1972 benzodiazepines and non-barbiturate hypnotics were found to be the most frequent putative drugs. Of the 108 patients admitted to hospital 37% had taken an overdose of a drug prescribed for them by their psychiatrist or other physician; 48% had formerly taken an overdose of drugs and 44% had had previous psychiatric treatment. Unconsciousness, respiratory depression, metabolic acidosis and acidemia, and hypokalemia were the most frequent clinical abnormalities observed. Treatment was supportive. There were six deaths. The average duration of coma was short; only five surviving patients remained unconscious for more than 24 hours. Respiratory complications were frequent.It is recommended that more attention be paid to recognizing patients whose behaviour pattern might include such an impulsive gesture, and that alternatives be found for barbiturate and non-barbiturate hypnotics.     

Confidential paediatric inquiry into neonatal deaths in Wessex, 1981 and 1982.

From 1 January 1981 to 31 December 1982, 66 256 births and 386 neonatal deaths were recorded in the Wessex Regional Health Authority, giving a neonatal mortality of 5.8/1000 live births. An experienced consultant paediatrician undertook a confidential inquiry into each death shortly after it had been reported. One hundred and forty four deaths (37%) were found to be due to lethal or severe malformations, an incidence of 2.2/1000 births. Of the 242 normally formed infants, 111 (46%) died within 24 hours of birth. Seventy seven (32%) weighed over 2500 g at birth. Factors operating before delivery accounted for 104 (43%) of the deaths of normally formed infants. The commonest factors were short gestation and low birth weight, and intrauterine hypoxia and birth injury. Factors after delivery accounted for 81 deaths (33%), the commonest being infections and sudden infant deaths. In the remaining 57 deaths (24%) it seemed that a combination of factors before and after birth had led to the death. Factors before birth thus played a part in two thirds of all deaths. Possible adverse factors in medical care were sought in 154 potentially viable babies and were identified in 38--that is, 10% of all neonatal deaths. Better provision and training of district staff in immediate care at birth would achieve more in lowering neonatal mortality in Wessex than the setting up of a regional unit specializing in advanced neonatal intensive care. Moreover, the greatest scope for improving the outcome of childbirth in Wessex would be offered if there were further advances in obstetric rather than neonatal care.     

我国七城市园林中有毒植物调查研究

通过对北京、上海、杭州等7城市的调查,统计出园林中有毒植物共计59科146种,约占城市园林常见植物种类的10%左右。分析有毒植物的中毒原因、栽培状况、有毒部位和毒性强度,并对其栽培管理提出建议。     

Comparative study of cases of poisoning by organophosphorous insecticides in various regions of Costa Rica

336 cases of organophosphorous poisoning from case records of hospitals in Costa Rica between 1972 and 1978 were classified in four categories according to signs and symptoms: 8% latent; 25.9% mild; 43.8% moderate and 22.3% severe. Eighteen of the total patients died during hospitalization. Suicidal ingestion was the principal cause of severe and latent poisoning, especially in urban areas, followed by occupational poisoning in agricultural workers in mild and moderate cases. Occupational poisoning was common in men; in women it was attempted suicide and in children accidental poisoning. Under 40 years of age, the main cause was suicidal ingestion among both men and women, and occupational poisoning after 40 years of age. After discharge from the hospital, 19.6% of the total poisoned patients were referred to psychiatric treatment; 22.7% and 18.2% had had mental and alcoholic problems, respectively, prior to poisoning. Attempted suicide was the principal cause of poisoning in 86.4% of these patients, indicating emotional instability. In this study, the incidence in psychiatric consultation after discharge from the hospital is not indicative of a relationship between mental disorders and acute insecticide poisoning. In 42.6% and in 22% of the deceased patients pralidoxime (PAM) and atropine respectively, were not administered as antidotes in the emergency room. Aminophylline and skeletal muscle relaxants among other contraindicated drugs were administered as part of the treatment in these deceased patients. The consequences of this misguided treatment are questioned.     

Retrospective study of 1000 deaths from injury in England and Wales

One thousand consecutive deaths from injury in 11 coroner''s districts in England and Wales were reviewed by four independent assessors, who studied necropsy reports to identify deaths in hospital that might have been preventable. Of 514 patients admitted to hospital alive, 102 deaths (20%) were judged by all four assessors to have been potentially preventable. When those cases in which three out of four assessors considered that the death was preventable were added the total rose to 170 (33%). Nearly two thirds of all non-central nervous system deaths were judged to have been preventable. The median age of the 170 patients whose deaths were preventable was 41, and the mean Injury Severity Score was 29. Further analysis suggested that the preventable deaths were principally the result of failure to stop bleeding and prevent hypoxia and the absence of, or delay in, surgical treatment.The results closely parallel those from similar studies from the United States and suggest that there are serious deficiencies in the services for managing severe injury in England and Wales. Debate is needed now on how to correct these deficiencies. In particular, the place of trauma centres must be considered.     

Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomised trials.

OBJECTIVE--To investigate the effect of intravenous magnesium on mortality in suspected acute myocardial infarction. DESIGN--Systematic overview of all available randomised trials in which patients were allocated to receive either intravenous magnesium or otherwise similar treatment without magnesium. SETTING--Coronary care units of several hospitals. PATIENTS--1301 patients in seven randomised trials. MAIN OUTCOME MEASURE--Short term mortality. RESULTS--Considering the seven trials collectively there were 25 (3.8%) deaths among 657 patients allocated to receive magnesium and 53 (8.2%) deaths among 644 patients allocated control, generally during hospital follow up. This represents a 55% reduction in the odds of death (p less than 0.001) with 95% confidence intervals ranging from about one third to about two thirds. 70 of 648 patients allocated magnesium compared with 109 of 641 controls had serious ventricular arrhythmias, suggesting that magnesium reduces the incidence, though the definition varied among trials. Other adverse effects were rare in the limited number of patients for whom this data were available. CONCLUSION--Despite the limited number of patients randomised this overview suggests that intravenous magnesium therapy may reduce mortality in patients with acute myocardial infarction. Further large scale trials to confirm (or refute) these findings are desirable.     

Insular bird populations can be saved from rats: a long-term experimental study of white-chinned petrels<Emphasis Type="Italic"> Procellaria aequinoctialis</Emphasis> on Ile de la Possession (Crozet archipelago)

The white-chinned petrel is a subantarctic seabird that requires urgent implementation of conservation measures for the species. At sea, adults suffer heavy mortality due to fisheries' practices. On land, introduced rats prey on chicks at several localities, and we test here if and how rats can be efficiently controlled. Since 1994, we have conducted an intensive rat-control program during each breeding season in a white-chinned petrel colony on Ile de la Possession (150 km²; Crozet archipelago, southern Indian Ocean), which had been monitored since 1986. On the same island, a control white-chinned petrel colony, where no poisoning occurred, was also monitored, and we assessed the seasonal variations of rat abundance. We compared three situations: high rat-poisoning, low rat-poisoning and control conditions without poisoning. Low-poisoning trials performed in our experimental colony between 1988 and 1991 did not lead to higher chick production than for the previous two control years. However, petrel-breeding success was significantly higher when intensive poisoning occurred (50%) than for the previous years (16%). The duration of our study (8 years before intensive poisoning, plus 8 years afterwards), combined with a comparison of petrel annual breeding success between our experimental and control colonies, allowed us to assess more effectively the impact of rats. Forty-one per cent of breeding failures occurring in non-poisoned areas were attributed to rats. We conclude that threatened insular bird populations can be conserved and restored in localities even where total rat eradication is not possible. However, only intensive and repeated (long-term) poisoning will control rats sufficiently.     

Extra-pair copulation and paternity defense in the hihi (or stitchbird)

We monitored 16 radio-tagged moreporks (Ninox novaeseelandiae) on Mokoia Island after a brodifacoum poison drop to eradicate mice (Mus musculus), normally included in the owls' diet. All 16 moreporks were alive after 13 days. One bird was found dead on day 22, and corpses of two radio-tagged birds were located on day 51. The bird found on day 22 contained 0.97 mg kg(-1) of brodifacoum in its liver. The other two carcasses were not analysed, but they probably died as a result of brodifacoum poisoning. Thus, three out of 14 birds died (21% mortality). A further eight banded and six non-banded birds were also monitored. Of these, 50% were not seen following the drop. Secondary poisoning is implicated in the disappearance of these birds. Sublethal effects such as lowered breeding success and stress may have affected morepork over a prolonged period following the poisoning operation. Further studies are needed to investigate the exact pathway of this poison, especially the potential for invertebrates to carry poison.