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YURTSEVEN A, TURAN C, ORT DM, ISLAM M, KÖSE S, SAZ EU, HENNES H. Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments. Turk J Med Sci 2023; 53:1870-1876. [PMID: 38813494 PMCID: PMC10760584 DOI: 10.55730/1300-0144.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/12/2023] [Accepted: 11/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Suicide is one of the leading causes of death among adolescents. This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the differences in management and resource utilization between two pediatric emergency departments; one in Türkiye and one in the United States of America. Materials and methods Adolescents who presented to the emergency departments with a chief complaint of suicide attempt between October 2017 and September 2018 were eligible for including in the study. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records. Outcome was defined as re-admission to the emergency department for another suicide attempt within 3 months of the index visit. Results Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p < 0.001). Social worker assessment and hospitalization rates were significantly lower, with shorter mean duration of follow-up in the emergency department among Turkish compared to American adolescents (respectively, p < 0.001, p < 0.001 and p = 0.002). Repeated suicide attempts within three months were significantly higher in the Turkish group compared to the American one (29% vs. 8%, p < 0.001). Receiving a social worker assessment, hospitalization and longer observation in emergency department reduced the incidence of repeated suicide attempts (respectively, p < 0.001, p = 0.003 and p = 0.012). Conclusion Turkish adolescents had shorter observation time in the emergency department, received fewer assessment by social workers and were less likely to be hospitalized. These may have contributed to the higher rate of repeat suicide attempts following discharge from the emergency department. Adequate resources are needed to help decrease the burden of suicide among Turkish adolescents.
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Affiliation(s)
- Ali YURTSEVEN
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Caner TURAN
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Deborah Mary ORT
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
| | - Mehrin ISLAM
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
| | - Sezen KÖSE
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Eylem Ulaş SAZ
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Halim HENNES
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
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Kinciniene O, Sambaras R, Lesinskaite A, Zilinskaite V, Lesinskiene S. Psychosocial Aspects of Deliberate Physical Suicide Attempts by Children and Adolescents. Clin Pediatr (Phila) 2023; 62:885-893. [PMID: 36717972 PMCID: PMC10411028 DOI: 10.1177/00099228221145106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Suicide is the second most common cause of death among young people in Lithuania. This study aimed to evaluate circumstance, and conditions possibly related to suicide attempt in adolescents. Study was performed at the tertiary Children's Hospital. Medical documentation of the suicide attempts from January 2011 to April 2018 was analyzed. There were 102 cases included in the study: 83.8% female and 16.2% male patients (average age of 15.02 ± 1.9); 40.6% of patients lived in divorced families, 17.7% in orphanages, 4.2% in foster care; 36.4% suffered from parental alcoholism, and 17.2% experienced suicide in close surroundings; 54.1% experienced bullying or violence (26.0%), and 85.4% showed signs of other types of self-harm, girls more often (P < .001). In 52.8% of cases, the attempt was spontaneous, and 34% relapsed. In summary female gender, living in orphanages, and signs of other self-harm were significantly related to suicide attempt.
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Affiliation(s)
- Odeta Kinciniene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rokas Sambaras
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Virginija Zilinskaite
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug Saf 2023; 46:283-295. [PMID: 36689131 PMCID: PMC9869307 DOI: 10.1007/s40264-022-01269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. METHODS We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. RESULTS We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). CONCLUSION Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Chiara Pugliese
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Bartolucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Elena Narmine Necibi
- School of Emergency Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Gonzalez-Urdiales P, Kuppermann N, Dalziel SR, Prego J, Benito J, Mintegi S. Pediatric Intentional Self-poisoning Evaluated in the Emergency Department: An International Study. Pediatr Emerg Care 2021; 37:e1631-e1636. [PMID: 32541402 DOI: 10.1097/pec.0000000000002141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is a growing public health problem during late childhood and adolescence. The leading method of suicide attempts in this age group is intentional self-poisoning. A first self-poisoning episode is a strong predictor of subsequent suicide and premature death. The objective of this study was to analyze the presentation and management of children younger than 18 years with intentional self-poisonings admitted to an emergency department (ED) in a global research network of pediatric EDs. METHODS We performed a secondary analysis of a large, international, multicenter, cross-sectional prospective registry of childhood poisoning presentations to 105 EDs in the Pediatric Emergency Research Networks (PERN) network. Data collection started at each ED between January and September 2013 and continued for 1 year. RESULTS During the study period, we included 1688 poisoning exposures. Of these, 233 (13.8%) were intentional self-poisonings, with significant variation between regions. Female/male ratio was 4.7/1 and most occurred at home. The most common toxicants were therapeutic drugs, mainly psychotropics and analgesics. Ninety patients (38.6%) gave a history of a previous episode of intentional self-poisoning. Sixty-three children (27.0%) were not assessed by a psychiatric service nor transferred to a psychiatric inpatient facility. No patient died. There was significant variation in the involved toxicants and interventions among EDs in different global regions. CONCLUSIONS Most intentional self-poisoning presentations to pediatric EDs globally are related to intentional ingestions of therapeutic drugs at home by females. Best practices have to be translated into care to guarantee the best outcomes of these patients.
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Odeta K, Auge L, Rokas S, Vankeviciene R, Dervinyte-Bongarzoni A, Sigita L. Clinical and Social Characteristics of Deliberately Intoxicated Minors Treated in Pediatric Intensive Care. Clin Med Insights Pediatr 2021; 15:11795565211029258. [PMID: 34349583 PMCID: PMC8287355 DOI: 10.1177/11795565211029258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the study was to determine and compare the clinical and social characteristics of minors using alcohol and drugs for inebriation, and the same for those using them for suicide. METHODS This study includes an analysis of case histories of adolescents hospitalized in the Pediatric Intensive Care Unit because of acute alcohol or/and drug intoxication in 2015 to 2017. Two groups (group I: inebriation, and group II: suicide) were compared on age, sex, severity of intoxication, used substances, presence of other self-harm evidence, and social status. RESULTS A total of 390 cases were registered: 78.21% in Group I and 21.79% in Group II. The Glasgow-Coma-Scale scores showed that patients from Group I were more severely intoxicated, with an average score of 11.47, whereas patients from Group II averaged 13.45 (P < .001). Self-harm was more prominent among minors from Group II, with an incidence of up to 65.09%. The most common substance used to become inebriated was alcohol (72.79%), and for committing suicide was medication (88.24%). Patients who were living in children's care homes composed 13.33% of all cases included into the study, despite the low frequency of these minors in Lithuania (0.8%). CONCLUSIONS The substance used for deliberate intoxication was mostly alcohol. Minors experiencing inebriation were hospitalized in worse clinical condition in comparison to those who had attempted suicide. Other signs of self-harm were significantly more common among suicidal minors. Living in children's care homes is a possible risk factor for deliberate intoxication among young people in Lithuania.
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Affiliation(s)
- Kinciniene Odeta
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Children’s Diseases, Vilnius,
Lithuania
| | | | - Sambaras Rokas
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
| | - Ramune Vankeviciene
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Children’s Diseases, Vilnius,
Lithuania
| | - Asta Dervinyte-Bongarzoni
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Psychiatry, Vilnius,
Lithuania
| | - Lesinskiene Sigita
- Vilnius University Faculty of Medicine,
Vilnius, Lithuania
- Institute of Clinical Medicine,
Vilnius, Lithuania
- Clinic of Psychiatry, Vilnius,
Lithuania
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Pawer S, Rajabali F, Zheng A, Smith J, Purssell R, Pike I. Analyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137003. [PMID: 34208955 PMCID: PMC8297021 DOI: 10.3390/ijerph18137003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.
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Affiliation(s)
- Samantha Pawer
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Correspondence: ; Tel.: +1-604-875-3572
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- British Columbia Drug and Poison Information Centre, BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC V5Z 4R4, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Valipour R, Shekari A, Setareh M, Soltaninejad K. Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran. Am J Forensic Med Pathol 2021; 42:23-29. [PMID: 32868498 DOI: 10.1097/paf.0000000000000607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.
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Affiliation(s)
| | | | | | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Kwan Y, Choi S, Min S, Ahn JS, Kim H, Kim MH, Lee J. Does personality problems increase youth suicide risk?: A characteristic analysis study of youth who visit the emergency department following suicide attempt. J Affect Disord 2021; 282:539-544. [PMID: 33433383 DOI: 10.1016/j.jad.2020.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Youth suicide attempts are a major risk factor for future complete suicides. However, the characteristics of suicide attempters based on the emergency department (ED) have rarely been explored, making it challenging to comprehend the characteristics of youth suicide attempters comprehensively. This study aims to investigate the characteristics of youth suicide attempters who visited the ED. METHODS We examined the youth (age: 12-25 years) and adult (age: 26-65 years) groups of suicide attempters who visited the ED in Wonju-si, Gangwon-do, Korea. Interviews were conducted with attempters and guardians to identify sociodemographic, clinical, and suicide-related variables. Besides, we performed bivariate logistic regression analysis with statistically adjusted gender, educational age, Socioeconomic Status(SES) level, and medical illness. RESULTS Youth were diagnosed more frequently with Personality disorder compared to adults. Besides, youth tended to report interpersonal or abuse as motivations for suicide, whereas adults tended to report medical illness or economic problems. Furthermore, youth attempted suicide more impulsively and repeatedly; however, medical lethality of each attempt tended to be lower than adults. LIMITATION We experienced difficulty in collecting complete information because of poor consciousness or cooperation of patients who visited the ED immediately after suicide attempt. Also, the study cohort was only recruited from one hospital in a region. CONCLUSION Youth suicide attempters are suggested to have relatively serious and persistent problems involving personality or traits than adults. Thus, this study highlights the significance of preventive strategies based on early psychopathological evaluation and treatment.
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Affiliation(s)
- Yunna Kwan
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea; Department of Psychology, Duksung Women's University, 33, Samyang-ro 144-gil, Dobong-gu, 01369 Seoul, Korea
| | - SungWon Choi
- Department of Psychology, Duksung Women's University, 33, Samyang-ro 144-gil, Dobong-gu, 01369 Seoul, Korea
| | - Seongho Min
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Joung-Sook Ahn
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Huiju Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea.
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea.
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Tirolla RM, Girotto E, Guidoni CM. CLINICAL AND EPIDEMIOLOGICAL ANALYSIS OF SUICIDE ATTEMPTS IN CHILDREN ASSISTED BY A POISON CONTROL CENTER. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2019345. [PMID: 33146292 PMCID: PMC7594506 DOI: 10.1590/1984-0462/2021/39/2019345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
Objective: To assess suicide attempts in children seeking care at a Poison Control
Center. Methods: Cross-sectional study with children (<12 years old) that attempted
suicide and were cared at the Poison Control Center in Londrina, Paraná,
Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one
product (77.9%). Among the products involved, medications were the most
important ones (88.1%). Neurological/psychiatric/muscular manifestations
(61.0%) were the main symptoms presented. The main reason identified for the
suicide attempt was conflicts with family and/or friends (27.1%). Suicide
attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent
(mainly medications), and the main reason was family conflicts..
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Kotikova K, Klepis P, Ridzon P, Hlusicka J, Navratil T, Rulisek J, Zak I, Zakharov S. Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study. Neurotoxicology 2020; 79:67-74. [DOI: 10.1016/j.neuro.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
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Charfi F, Harbaoui A, Skhiri A, Abbès Z, Belhadj A, Halayem S, Bouden A. [Epidemiological and clinical profile of suicide attempts in Tunisian children and adolescents after the revolution]. Pan Afr Med J 2019; 32:204. [PMID: 31312316 PMCID: PMC6620052 DOI: 10.11604/pamj.2019.32.204.15477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/28/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Les conduites suicidaires sont en augmentation en Tunisie et touchent une population de plus en plus jeune. Le but de notre étude était de décrire le profil sociodémographique et clinique des tentatives de suicide chez l'enfant et l'adolescent. Méthodes Cette étude était transversale et descriptive, incluant 50 suicidants, recrutés au service de pédopsychiatrie de l'Hôpital Razi de la Manouba et dans deux services de réanimation et de pédiatrie de Tunis, entre juillet 2012 et juin 2013. Ont été relevés les facteurs sociodémographiques et cliniques, les antécédents de maltraitance, la scolarité, les caractéristiques de la TS, l'intentionnalité suicidaire évaluée par le Suicide Intent Scale, et les troubles psychopathologiques à l'aide du Mini-International Neuropsychiatric Interview. Résultats Le sex-ratio était de 0,56, la moyenne d'âge était de 12,4 ans avec des extrêmes de 7 à 16 ans. Un échec ou un fléchissement scolaire a concerné 86% des suicidants. Dans 38% des cas il s'agissait de récidive; des antécédents d'automutilations ont été retrouvés dans les mêmes proportions. Un contexte de maltraitance a été signalé dans 46% des cas. L'ingestion médicamenteuse était le moyen le plus fréquent, les psychotropes étant les plus représentés. Une différence significative entre le genre a été retrouvée dans le recours aux moyens suicidaires, ainsi les garçons ont eu davantage recours aux moyens physiques (p=0,04) et les filles aux intoxications (p=0,001). L'intentionnalité suicidaire était élevée dans 44%. Un épisode dépressif majeur et le trouble de l'adaptation étaient les troubles les plus fréquemment retrouvés dans respectivement 58% et 24% des cas. Conclusion Les troubles dépressifs et la maltraitance se dégagent comme des facteurs de risque des TS chez les enfants et les adolescents, ces facteurs doivent être pris en considération dans les stratégies de prévention du suicide dans cette population.
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Affiliation(s)
- Fatma Charfi
- Service de Pédopsychiatrie, Hôpital Mongi Slim de La Marsa, Sidi Daoud 2046, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Azza Harbaoui
- Service de Pédopsychiatrie, Hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie
| | - Afef Skhiri
- Institut National de la Santé, 5-7 rue Khartoum, 1002 Tunis, Tunisie
| | - Zeineb Abbès
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie.,Service de Pédopsychiatrie, Hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie
| | - Ahlem Belhadj
- Service de Pédopsychiatrie, Hôpital Mongi Slim de La Marsa, Sidi Daoud 2046, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Soumaya Halayem
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie.,Service de Pédopsychiatrie, Hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie
| | - Asma Bouden
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie.,Service de Pédopsychiatrie, Hôpital Razi, rue des Orangers, 2010 La Manouba, Tunisie
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Carnovale C, Mahzar F, Scibelli S, Gentili M, Arzenton E, Moretti U, Leoni O, Pozzi M, Peeters GGAM, Clementi E, Medaglia M, Radice S. Central nervous system-active drug abused and overdose in children: a worldwide exploratory study using the WHO pharmacovigilance database. Eur J Pediatr 2019; 178:161-172. [PMID: 30374752 DOI: 10.1007/s00431-018-3281-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
Abstract
Recent epidemiological studies have reported an increase in central nervous system (CNS)-active drug abuse rates in paediatric settings, raising several public health concerns. No study to date has explored this issue worldwide. We performed an extensive analysis of drugs abuse/overdose reported for children in the last decade by using the largest pharmacovigilance database, i.e. the VigiBase, collecting adverse drug reaction reports that involved at least one suspect drug belonging to the Anatomical Therapeutic Chemical code "Nervous System" through the Standardised Medical Dictionary for Drug Regulatory Affairs Queries for Drug abuse. 8.682 reports matched our criteria. An increase in reporting activity was observed, starting from 2014; an intentional overdose was reported more frequently than an accidental one, with a difference between age groups. We retrieved 997 reports with death outcome. These referred more to adolescents (n = 538) than subjects of any other paediatric age group. Paracetamol and opioid analgesics were the most common suspect drugs in deaths across all age groups due to hypoxic-ischaemic encephalopathy, brain death, and cardio-respiratory arrest.Conclusion: The number of reports associated with drug abuse and overdose is increasing (for opioid and paracetamol-containing products) and a considerable number of adverse drug reactions are serious. Data on the patterns of use of such medicines from each country may help in implementing strategies of risk-minimisation and renewing healthcare recommendations worldwide. An increased clinical awareness of drug abuse and overdose is warranted, while continuing to provide effective treatments. What is Known: • The large increase in paediatric prescriptions for CNS-active drugs in the last 20 years has recently raised public health concerns about drug abuse and overdose. • No study to date has examined this issue in paediatric patients worldwide. What is New: • The number of paediatric reports associated with CNS drug abuse and intentional overdose is increasing, including those with fatal outcome; over 4 years; more than 35% of the reports was entered from European countries. • Opioid and paracetamol were most frequently suspected for ADRs with fatal outcome across all age groups, due to hypoxic-ischaemic encephalopathy and cardio-respiratory arrest, suggesting the need to implement strategies of risk-minimisation.
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Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy.
| | - Faizan Mahzar
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sara Scibelli
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Elena Arzenton
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Ugo Moretti
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Olivia Leoni
- Regional Pharmacovigilance Center of Lombardy, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Gabriëlla G A M Peeters
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy.,Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Sonia Radice
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
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Gharbaoui M, Ben Khelil M, Harzallah H, Benzarti A, Zhioua M, Hamdoun M. Pattern of suicide by self-poisoning in Northern Tunisia: An eleven-year study (2005–2015). J Forensic Leg Med 2019; 61:1-4. [DOI: 10.1016/j.jflm.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
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Prasadi GAM, Mohamed F, Senarathna L, Cairns R, Pushpakumara PHGJ, Dawson AH. Paediatric poisoning in rural Sri Lanka: an epidemiological study. BMC Public Health 2018; 18:1349. [PMID: 30522467 PMCID: PMC6282383 DOI: 10.1186/s12889-018-6259-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute paediatric poisoning is a common public health concern for both developed and developing countries. The type of agent and underlying cause differ depending on the social, cultural, economic and educational background. The objectives of this study were to identify the incidence and pattern of paediatric poisoning in a rural district in Sri Lanka and establish whether tertiary referral hospital data are a useful surrogate for estimating district level epidemiology of paediatric poisoning. METHODS A subset of epidemiological data were obtained from March 2011 to February 2013 from a randomized controlled trial (SLCTR/2010/008) conducted in 45 hospitals in Kurunegala district. RESULTS The age adjusted annual incidence of all cause of acute poisoning in children aged 1 to 12 years in the study area was 60.4 per 100,000. The incidence of poisoning of younger age group (1 to 6 years; 76 per 100,000) was significantly higher than older age group (7 to 12 years; 41 per 100,000) (p = 0.0001) in Kurunegala district. The annual incidence rate of paediatric admissions due to deliberate self-poisoning is 18 per 100,000 population. This study also established that admission data from primary hospitals provided the most accurate epidemiological information on paediatric poisoning. CONCLUSIONS In rural districts of Sri Lanka, acute paediatric poisoning cases were less frequent and less severe compared to adult poisoning cases (426-446 per 100,000 population). The incidence of poisoning was significantly higher among young children with compared to old children. In this study, deliberate self-poisoning among older children was more frequently seen than in other comparable countries. Because most of the admissions are directed to and managed by primary hospitals, data from referral hospitals alone cannot be used to represent the true incidence of acute poisoning within a district. The data set from all the primary hospitals (n = 44) yielded more accurate poisoning incidence amongst a paediatric population.
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Affiliation(s)
| | - Fahim Mohamed
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,TACT, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rose Cairns
- Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Sydney, Australia.,New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Andrew Hamilton Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Central Clinical School, University of Sydney, Sydney, Australia
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Halayem S, Ounalli H, Boudali M, Hajri M, Abbes Z, Bouden A. Évolution des tentatives de suicide en population clinique tunisienne de 2005 à 2015 : de nouvelles modalités de passage à l’acte chez les jeunes ? Encephale 2018; 44:504-511. [DOI: 10.1016/j.encep.2017.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 01/01/2023]
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Severe suicidal self-poisoning with massive dose of potassium ferricyanide(III): hyperkalemia but not free cyanide may cause death. MONATSHEFTE FUR CHEMIE 2018. [DOI: 10.1007/s00706-018-2231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Qin P, Sun S, Bøe AS, Stanley B, Mehlum L. Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry. BMC Psychiatry 2018; 18:200. [PMID: 29914430 PMCID: PMC6006963 DOI: 10.1186/s12888-018-1778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. METHODS Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10-19 years who were treated for self-poisoning with medication during 2008-2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. RESULTS 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. CONCLUSION Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Shihua Sun
- 0000 0004 1761 1174grid.27255.37Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Anne Seljenes Bøe
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
| | - Barbara Stanley
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway ,0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Lars Mehlum
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
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Wright B, Mestan S, Ahrens M, Bottei E. Trends in Teenagers' Nonopiod Substance Exposures Reported to Poison Control Centers, 2010-2015. J Pediatr 2018. [PMID: 29525071 DOI: 10.1016/j.jpeds.2017.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe current trends in nonopioid substance exposures and associated outcomes among teenagers nationwide. STUDY DESIGN In this cross-sectional study, we used 2010-2015 data from the American Association of Poison Control Centers' National Poison Data System and Poisson tests to document trends in the rate of calls to poison control centers involving adolescents stratified by sex, exposures by substance category, proportion of intentional exposures, and severity of exposures. RESULTS The number of calls per 1000 persons increased from 5.7 to 6.8 for teenage girls and decreased from 4.7 to 4.3 for boys. Reported exposures to prescription and over-the-counter medications and illicit street drugs increased between 24% and 73%, and reported opioid exposures decreased by 16%. Among teenage girls, intentional exposures increased from 57% to 68%, with cases increasingly managed in health care facilities and more likely to result in worse health outcomes. CONCLUSIONS The increase in intentional nonopioid substance exposures among teenage girls, with serious and potentially life-threatening consequences, is a matter of serious concern. Similar trends were not observed among teenage boys.
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Affiliation(s)
- Brad Wright
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA.
| | | | - Monica Ahrens
- Department of Biostatistics, University of Iowa College of Public Health, Sioux City, IA
| | - Edward Bottei
- Carver College of Medicine, University of Iowa, Iowa City, IA; Iowa Poison Control Center, Sioux City, IA
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González-Ponce HA, Rincón-Sánchez AR, Jaramillo-Juárez F, Moshage H. Natural Dietary Pigments: Potential Mediators against Hepatic Damage Induced by Over-The-Counter Non-Steroidal Anti-Inflammatory and Analgesic Drugs. Nutrients 2018; 10:E117. [PMID: 29364842 PMCID: PMC5852693 DOI: 10.3390/nu10020117] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 12/19/2022] Open
Abstract
Over-the-counter (OTC) analgesics are among the most widely prescribed and purchased drugs around the world. Most analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, are metabolized in the liver. The hepatocytes are responsible for drug metabolism and detoxification. Cytochrome P450 enzymes are phase I enzymes expressed mainly in hepatocytes and they account for ≈75% of the metabolism of clinically used drugs and other xenobiotics. These metabolic reactions eliminate potentially toxic compounds but, paradoxically, also result in the generation of toxic or carcinogenic metabolites. Cumulative or overdoses of OTC analgesic drugs can induce acute liver failure (ALF) either directly or indirectly after their biotransformation. ALF is the result of massive death of hepatocytes induced by oxidative stress. There is an increased interest in the use of natural dietary products as nutritional supplements and/or medications to prevent or cure many diseases. The therapeutic activity of natural products may be associated with their antioxidant capacity, although additional mechanisms may also play a role (e.g., anti-inflammatory actions). Dietary antioxidants such as flavonoids, betalains and carotenoids play a preventive role against OTC analgesics-induced ALF. In this review, we will summarize the pathobiology of OTC analgesic-induced ALF and the use of natural pigments in its prevention and therapy.
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Affiliation(s)
- Herson Antonio González-Ponce
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Ana Rosa Rincón-Sánchez
- Department of Molecular Biology and Genomics, University Center of Health Sciences, Universidad de Guadalajara, Guadalajara 44340, Mexico.
| | - Fernando Jaramillo-Juárez
- Department of Physiology and Pharmacology, Basic Science Center, Universidad Autónoma de Aguascalientes, Aguascalientes 20131, Mexico.
| | - Han Moshage
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
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Caustic effects of chemicals: risk factors for complications and mortality in acute poisoning. MONATSHEFTE FUR CHEMIE 2017. [DOI: 10.1007/s00706-016-1900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Nistor N, Jitareanu C, Frasinariu OE, Ciomaga IM, Rugina AL, Streanga V. Epidemiologic profile and triggering factors of voluntary poisoning in teenagers. Medicine (Baltimore) 2017; 96:e5831. [PMID: 28151858 PMCID: PMC5293421 DOI: 10.1097/md.0000000000005831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Self-poisoning is an important medical and social problem in adolescents.We performed an observational cross-sectional retrospective study on a group of 219 adolescents admitted for voluntary intoxications at "St. Mary" Children's Emergency Hospital, Iasi during 1 year period. Epidemiological aspects and triggering factors have been analyzed. Data collected from the patients' files were centralized in an SPSS 18.0 database and processed with confidence interval of 95%.We found that pharmaceutical drugs have been usually involved (34.7%), mostly in girls (56.3% vs. 15.5%; P = 0.0001). The most frequently cited reason for poisoning was family conflict, with a relative risk (RR) 1.43 times higher in girls, as well as scholar conflict (RR = 1.39). A great percentage of the monitored girls presented severe depression (23.3% vs. 6.9%; P = 0.001), with an RR more than 3 times higher than in the case of boys. All cases evolved favorably, no death having been recorded, even if 18 teenagers initially presented an extremely serious condition, being admitted in various stages of coma (Glasgow coma scale score < 8).We found that self-inflicted poisonings with pharmaceutical drugs was more common in girls and the use of drug and alcohol intoxication was found especially in boys. The most common pharmaceutical drug involved in self-poisoning was acetaminophen. Psychological disorders and family or school conflicts are the most important triggering factors of voluntary poisoning. Risk factors should be identified after stabilizing the patient, and actions should be taken in order to prevent a fatal recurrence.
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Affiliation(s)
- Nicolai Nistor
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | | | | | | | | | - Violeta Streanga
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
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Pelclova D, Vlckova S, Bezdicek O, Vaneckova M, Urban P, Ridzon P, Diblik P, Navratil T, Klusackova P, Vlcek K, Benesova O, Trestik P, Homolka J, Zakharov S. Is Chelation Therapy Efficient for the Treatment of Intravenous Metallic Mercury Intoxication? Basic Clin Pharmacol Toxicol 2017; 120:628-633. [DOI: 10.1111/bcpt.12725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Daniela Pelclova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Stepanka Vlckova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Manuela Vaneckova
- MR Unit; Department of Radiodiagnostics; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
- National Institute of Public Health; Centre for Industrial Hygiene and Occupational Medicine; Prague Czech Republic
| | - Petr Ridzon
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Tomas Navratil
- J. Heyrovský Institute of Physical Chemistry of the CAS, CR v.v.i.; Prague Czech Republic
| | - Pavlina Klusackova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Kamil Vlcek
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Olga Benesova
- Department of Internal Medicine; Hospital Kromeriz; Kromeriz Czech Republic
| | - Pavel Trestik
- Department of Internal Medicine; Hospital Kromeriz; Kromeriz Czech Republic
| | - Jiri Homolka
- 1st Department of Tuberculosis and Respiratory Diseases; First Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
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Zakharov S, Nurieva O, Kotikova K, Belacek J, Navratil T, Pelclova D. Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning. MONATSHEFTE FUR CHEMIE 2016; 148:409-419. [PMID: 28344362 PMCID: PMC5346122 DOI: 10.1007/s00706-016-1846-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022]
Abstract
ABSTRACT Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012-2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6-32.2) mmol dm-3]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57-21.34; p < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving (p < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85-23.02; p < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission. GRAPHICAL ABSTRACT
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Olga Nurieva
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Katerina Kotikova
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Jaromir Belacek
- First Faculty of Medicine, Institute of Biophysics and Informatics, Charles University in Prague, Salmovska 1, 120 00 Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i., Dolejškova 3, 182 23 Prague 8, Czech Republic
- First Faculty of Medicine, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
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Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-37. [PMID: 26921865 DOI: 10.1016/j.jad.2016.02.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/25/2016] [Accepted: 02/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data. METHOD Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares. RESULTS Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile. LIMITATIONS Grouping diverse populations and potential analytical bias due to lack of information are the main limitations. CONCLUSIONS The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Egidio Nardi
- Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
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Intoxications médicamenteuses volontaires chez 58 adolescents : étude prospective sur l’impact somatique et les complications biologiques. Arch Pediatr 2016; 23:461-7. [DOI: 10.1016/j.arcped.2016.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/10/2015] [Accepted: 02/16/2016] [Indexed: 11/20/2022]
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Urban M, Leššo R, Pelclová D. Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic. Basic Clin Pharmacol Toxicol 2016; 119:115-9. [DOI: 10.1111/bcpt.12578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/23/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Michal Urban
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
| | - Roman Leššo
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
| | - Daniela Pelclová
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
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Law BMF, Shek DTL. A 6-year Longitudinal Study of Self-harm and Suicidal Behaviors among Chinese Adolescents in Hong Kong. J Pediatr Adolesc Gynecol 2016; 29:S38-48. [PMID: 26461529 DOI: 10.1016/j.jpag.2015.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To examine the trajectories of self-harm and suicidal behaviors among Chinese adolescents in Hong Kong and to investigate the related predictors, including gender, family nonintactness, economic disadvantage, positive youth development, and family functioning. DESIGN We used quantitative data from a large sample of adolescent participants. Participants initially joined this study when they were in grade 7 (wave 1), and they were followed from grade 8 (wave 2) to grade 12 (wave 6). SETTING, PARTICIPANTS, AND INTERVENTIONS The participants consisted of 2023 grade 12 students from 28 secondary schools in Hong Kong. A multistage cluster random sampling method was adopted. MAIN OUTCOME MEASURES Self-harm and suicidal behaviors. RESULTS The trajectories of self-harm and suicidal behaviors in general declined from grade 7 to grade 12. Regarding the effect of gender, whereas adolescent girls showed a higher prevalence for self-harm and suicidal behaviors at baseline and other waves, adolescent boys showed a pronounced decline in self-harm rates. Adolescents from nonintact families were more likely to self-harm or engage in suicidal behaviors at wave 6. Economic disadvantage at wave 4 predicted higher suicidal behavior among adolescents but not self-harm at wave 6. Regarding positive youth development, several protective factors that include cognitive-behavioral competencies, prosocial attributes, general positive youth development qualities, and positive identity could help reduce self-harm and suicidal behaviors at different time points. Regarding the role of family functioning, more family conflicts predicted higher suicidality in adolescence (self-harm and suicidal behaviors), and family communication affected self-harming behaviors at wave 6. CONCLUSION The trajectories of self-harm and suicidal behaviors decline from early to late adolescence among Chinese adolescents. Positive youth development and constructive family functioning are critical to help reduce suicidal behaviors. Regarding increased risk, more attention should be paid to adolescent girls and adolescents from nonintact and economic disadvantaged families.
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Affiliation(s)
- Ben M F Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, P.R. China.
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- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, P.R. China; Centre for Innovative Programmes for Adolescents and Families, The Hong Kong Polytechnic University, Hong Kong, P.R. China; School of Social Development, East China Normal University, Shanghai, P.R. China; Kiang Wu Nursing College of Macau, Macau, P.R. China; Division of Adolescent Medicine, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky
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Zakharov S, Nurieva O, Kotikova K, Urban P, Navratil T, Pelclova D. Factors predicting optic nerve axonal degeneration after methanol-induced acute optic neuropathy: a 2-year prospective study in 54 patients. MONATSHEFTE FUR CHEMIE 2015. [DOI: 10.1007/s00706-015-1581-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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XXXV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 26–29 May 2015, St Julian's, Malta. Clin Toxicol (Phila) 2015. [DOI: 10.3109/15563650.2015.1024953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Analysis of serum anion gap and osmolal gap in diagnosis and prognosis of acute methanol poisoning: clinical study in 86 patients. MONATSHEFTE FUR CHEMIE 2015. [DOI: 10.1007/s00706-014-1374-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fast ibuprofen, ketoprofen and naproxen simultaneous determination in human serum for clinical toxicology by GC–FID. Clin Biochem 2014; 47:109-11. [DOI: 10.1016/j.clinbiochem.2014.06.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
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