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Morrongiello BA, Vander Hoeven E. Unintentional poisoning exposures: how does modeling the opening of child-resistant containers influence children's behaviors? J Pediatr Psychol 2024:jsae064. [PMID: 39118194 DOI: 10.1093/jpepsy/jsae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE Unintentional poisoning in the home is a risk for children. Over-the-counter medicinal products in child-resistant containers (CRC) are common causes of pediatric poisoning. The current study examined children's abilities to open three types of CRC mechanisms (twist, flip, and push) and corresponding control containers, comparing their ability to do so spontaneously and after explicit modeling. The study also examined if inhibitory control (IC) was associated with children's overall score for spontaneous openings. METHOD Children 5-8 years old were randomly assigned to one of three mechanism conditions (between-participants factor): twist, flip, and push, with each child experiencing both a risk and a control container (within-participants factor) having that mechanism. Children were first left alone with a container (measures: engagement with container, spontaneous opening) for up to 2 min and subsequently observed an adult explicitly model opening the container before the child was asked to do so (measure: opening after modeling). RESULTS Children were more engaged with and likely to spontaneously open control containers than CRCs, though some (4%-10%) also opened CRCs. After modeling, significantly more children opened each of the three types of CRCs, with nearly all children opening the push mechanism CRC. IC positively predicted children being more engaged with and spontaneously opening more containers. CONCLUSIONS Implications for improving pediatric poison prevention are discussed.
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Mottla ME, Bowler ME, Asgary R. Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review. J Glob Health 2023; 13:04173. [PMID: 38154015 PMCID: PMC10754493 DOI: 10.7189/jogh.13.04173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Background There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis. Results Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings. Registration PROSPERO: CRD42022315686.
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Affiliation(s)
- Mary Elizabeth Mottla
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Mary-Ellis Bowler
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ramin Asgary
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Perveen F, Ahmed N, Masud S, Ihsan MU, Khan UR, Khan NU. Parental knowledge attitude and practices about chemical and medicinal poisons: A hospital based study from Karachi, Pakistan. Injury 2023; 54 Suppl 4:110481. [PMID: 37573064 DOI: 10.1016/j.injury.2022.11.024] [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] [Received: 07/09/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 08/14/2023]
Abstract
BACKGROUND Unintentional poisoning is among the leading cause of death in children less than 20 years age. The incidence of unintentional poisoning in Low-income countries LMICs is four times higher compared to high-income countries (HICs). In Pakistan a 10% (25/211) incidence of unintentional poisonings among 0-15-year-old children has been reported. Most of the poisoning occur because of household chemical and medicines. This study aimed to assess the knowledge, attitude, and practices (KAP) of parents in Karachi regarding poisonous household chemicals and medicines. METHODS This KAP study was conducted at Aga Khan University Hospital, Karachi from May to August 2019. A maximum sample of 384 was calculated using a 50% knowledge about household chemicals. Data were collected about parental knowledge, attitude and practices about poisons and chemicals at home and presented as frequency and percentages. Chi-square test of independence (or Fisher's exact test) was used. Data were analyzed using SPSS version 20. RESULTS A total of 364 parents of 0-16-year-old children completed the survey out of which 229 were mothers and 127 were fathers (eight had missing data). We had 70% of parents that kept chemicals and medicines locked in cabinets and 80% chose to never leave medicines unattended, there are still 20-30% parents that need improvement in the parental knowledge and practices for storing chemicals and medicines. A general lack of knowledge regarding poisoning first aid and emergency response centers was noted. CONCLUSIONS Two-pronged approach for future interventions could be useful; (1) Improving the knowledge and practice among the remaining 20-30% through repeated awareness' sessions for the community. (2) Information regarding PCCS needs to be made readily available to the parents which is a measure useful in cases a child poisoning occurs.
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Affiliation(s)
- Feroza Perveen
- Department of Pharmacy, Aga Khan University Hospital Karachi, Pakistan
| | - Naveed Ahmed
- Department of Emergency Medicine, Aga Khan University Hospital Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Sarwat Masud
- Department of Emergency Medicine, Aga Khan University Hospital Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | | | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University Hospital Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
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Cornell E, Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Poisoning-related emergency department visits in children with autism spectrum disorder. Inj Epidemiol 2022; 9:41. [PMID: 36544233 PMCID: PMC9768872 DOI: 10.1186/s40621-022-00402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and its prevalence has increased markedly in the past two decades. Research indicates that people with ASD are at increased risk for premature mortality from injuries. Often, children with ASD are prescribed multiple medications, increasing their risk for intentional and unintentional poisonings. We examined the epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD and the association of ED-treated poisonings with ASD according to common co-occurring conditions. METHODS We analyzed data from the Nationwide Emergency Department Sample for 2016-2018 to estimate the frequencies of ED-treated poisonings among autistic children aged 1-20 years and adjusted odds ratios of ED-treated poisoning associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID). The ICD-10-CM external cause-of-injury matrix was utilized to identify poisoning cases. RESULTS During 2016-2018, there were an estimated 523,232 ED visits in children with ASD aged 1-20 years, including 12,152 (2.3%) visits for poisoning. Of ED-treated poisonings in children with ASD, 73.6% were related to pharmaceutical drugs, such as psychotropic medications and prescription opioids, 16.6% were intentional, 36.5% were unintentional, and 47.0% were undetermined. Among children with ASD, those aged 5-9 had the highest odds of poisoning-related ED visits compared to all other age-groups (adjusted OR = 3.41; 95% CI 3.15, 3.68). The odds of poisoning for children with ASD were 59.0% greater than for their peers (adjusted OR = 1.59; 95% CI 1.53, 1.66) and varied significantly with age and co-occurring ADHD or ID. CONCLUSIONS Children with ASD are at a significantly increased risk of poisoning, particularly among those aged 5-9 years. Co-occurring ADHD or ID with ASD further increases the risk of poisoning. Interventions to reduce poisoning in children with ASD should prioritize the safety of prescription medications.
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Affiliation(s)
- Emma Cornell
- grid.21729.3f0000000419368729Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 USA
| | - Ashley Blanchard
- grid.21729.3f0000000419368729Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-1-116, New York, NY 10032 USA
| | - Stanford Chihuri
- grid.21729.3f0000000419368729Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - Carolyn G. DiGuiseppi
- grid.430503.10000 0001 0703 675XDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Bldg. 500, Rm. W3138, Aurora, CO 80045 USA
| | - Guohua Li
- grid.21729.3f0000000419368729Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th St, PH5-505, New York, NY 10032 USA
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Stehr P, Reifegerste D, Rossmann C, Caspar K, Schulze A, Lindemann AK. Effective communication with caregivers to prevent unintentional injuries in children under seven years. A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:2721-2730. [PMID: 35537900 DOI: 10.1016/j.pec.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries. METHODS Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs. RESULTS Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective. CONCLUSION The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies. PRACTICE IMPLICATIONS Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.
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Affiliation(s)
- Paula Stehr
- Department of Media and Communication, LMU Munich, Munich, Germany.
| | | | | | - Katja Caspar
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Annett Schulze
- Department Risk Communication, Federal Institute for Risk Assessment, Berlin, Germany
| | - Ann-Kathrin Lindemann
- Department Risk Communication, Federal Institute for Risk Assessment, Berlin, Germany
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Wells M, Bujkiewicz S, Hubbard SJ. Using threshold analysis to assess the robustness of public health intervention recommendations from network meta-analyses: application to accident prevention in households with children under five. BMC Public Health 2022; 22:966. [PMID: 35562726 PMCID: PMC9107143 DOI: 10.1186/s12889-022-13377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the appraisal of clinical interventions, complex evidence synthesis methods, such as network meta-analysis (NMA), are commonly used to investigate the effectiveness of multiple interventions in a single analysis. The results from a NMA can inform clinical guidelines directly or be used as inputs into a decision-analytic model assessing the cost-effectiveness of the interventions. However, there is hesitancy in using complex evidence synthesis methods when evaluating public health interventions. This is due to significant heterogeneity across studies investigating such interventions and concerns about their quality. Threshold analysis has been developed to help assess and quantify the robustness of recommendations made based on results obtained from NMAs to potential limitations of the data. Developed in the context of clinical guidelines, the method may prove useful also in the context of public health interventions. In this paper, we illustrate the use of the method in public health, investigating the effectiveness of interventions aiming to increase the uptake of accident prevention behaviours in homes with children aged 0–5. Methods Two published random effects NMAs were replicated and carried out to assess the effectiveness of several interventions for increasing the uptake of accident prevention behaviours, focusing on the safe storage of other household products and stair gates outcomes. Threshold analysis was then applied to the NMAs to assess the robustness of the intervention recommendations made based on the results from the NMAs. Results The results of the NMAs indicated that complex intervention, including Education, Free/low-cost equipment, Fitting equipment and Home safety inspection, was the most effective intervention at promoting accident prevention behaviours for both outcomes. However, the threshold analyses highlighted that the intervention recommendation was robust for the stair gate outcome, but not robust for the safe storage of other household items outcome. Conclusions In our case study, threshold analysis allowed us to demonstrate that there was some discrepancy in the intervention recommendation for promoting accident prevention behaviours as the recommendation was robust for one outcome but not the other. Therefore, caution should be taken when considering such interventions in practice for the prevention of poisonings in homes with children aged 0–5. However, there can be some confidence in the use of this intervention in practice to promote the possession of stair gates to prevent falls in homes with children under 5. We have illustrated the potential benefit of threshold analysis in the context of public health and, therefore, encourage the use of the method in practice as a sensitivity analysis for NMA of public health interventions.
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Affiliation(s)
- Molly Wells
- Biostatistics Research Group, University of Leicester, Leicester, UK.
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, University of Leicester, Leicester, UK
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Hill T, Coupland C, Kendrick D, Jones M, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Orton E. Impact of the national home safety equipment scheme 'Safe At Home' on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022; 76:53-59. [PMID: 34158405 PMCID: PMC8666806 DOI: 10.1136/jech-2021-216613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a 'natural experiment' for evaluating the scheme's impact on hospital admissions for unintentional injuries. METHODS Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision. RESULTS 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11%-0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended. CONCLUSIONS A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.
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Affiliation(s)
- Trevor Hill
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sarah Rodgers
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Shalev L, Rudolf MCJ, Spitzer S. Better safe than sorry: Evaluating the implementation process of a home-visitation intervention aimed at preventing unintentional childhood injuries in the hospital setting. FRONTIERS IN HEALTH SERVICES 2022; 2:944367. [PMID: 36925878 PMCID: PMC10012825 DOI: 10.3389/frhs.2022.944367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022]
Abstract
Background Child home injuries prevention interventions have rarely been implemented in hospitals. The SHABI program ("Keeping our Children Safe"; in Hebrew: "SHomrim Al BetIchut Yeladenu") recruits at-risk families arriving with child injury to the Emergency Department. Medical/nursing students conduct two home visits four months apart, providing safety equipment and guidance. One hundred thirty-five families had a first visit and 98 completed the second. Fifty percentage of families were ultra-Orthodox Jews, 11% Arab, and 28% had ≥3 preschool children. We investigated SHABI's implementation using the Consolidated Framework for Implementation Research (CFIR). Methods Between May 2018 and March 2021 SHABI was implemented in the Emergency Department of a hospital in Israel's northern periphery, an area with high child injury rates. The Implementation process was examined through Emergency Department medical records and tracking registries, hospital management, nurses', and home visitors' meetings notes (n = 9), and a research diary. Hospital's inner setting and SHABI's characteristics were evaluated through interviews with hospital management, nurses, and home visitors 8 months after baseline (n = 18). Home visitors' characteristics were evaluated through interviews, post-visit questionnaire on challenges encountered (n = 233), families' perceptions of SHABI and home visitors' skills through telephone interviews (n = 212); and home visitors awareness of dangers at home (n = 8) baseline and 8 months later. Qualitative data were analyzed through explanatory content analysis according to CFIR constructs. Quantitative data were analyzed using X2 and Wilcoxon test for dependent subgroups. Results Despite alignment between SHABI and the hospital's mission, structural hospital-community disconnect prevented implementation as planned, requiring adaptation and collaboration with the medical school to overcome this barrier. Recruitment was included in the initial patient triage process but was only partially successful. Medical/nursing students were recruited as home visitors, and following training proved competent. Children were a distraction during the visits, but home visitors developed strategies to overcome this. Conclusions Injury prevention programs in hospitals have significant benefits. Identifying implementation barriers and facilitators allowed implementers to make adaptations and cope with the innovative implementation setting. Models of cooperation between hospital, community and other clinical settings should be further examined.
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Affiliation(s)
- Ligat Shalev
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Mary C J Rudolf
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sivan Spitzer
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Li H, Dodd-Butera T, Beaman ML, Pritty MB, Heitritter TE, Clark RF. Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009-2019 U.S. National Poison Data System Annual Reports. Pediatr Rep 2021; 13:613-623. [PMID: 34842797 PMCID: PMC8628925 DOI: 10.3390/pediatric13040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0-19 years and compare the odds of death by children's age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = -2.54%, 95% CI = -3.94% to -1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0-5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6-12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrast, the odds of children 13-19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6-12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13-19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.
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Affiliation(s)
- Hong Li
- Biobehavioral and Health Research Center, Department of Doctoral Studies, School of Nursing, Azusa Pacific University, Monrovia, CA 91016, USA
| | - Teresa Dodd-Butera
- Biobehavioral and Health Research Center, Department of Public Health and Doctoral Studies, School of Nursing, Azusa Pacific University, San Diego, CA 92108, USA
| | - Margaret L Beaman
- Department of Nursing, California State University, San Bernardino, CA 92407, USA
| | | | - Thomas E Heitritter
- Pharmacy Informatics, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA
| | - Richard F Clark
- California Poison Control System, San Diego, CA 92103, USA
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA 92093, USA
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Babić Ž, Kovačić J, Franić Z, Šakić F, Prester L, Varnai VM, Cvijetić Avdagić S, Bjelajac A, Macan J, Turk R. Prevention of poisonings by educational intervention aimed at parents of preschool children. Int J Inj Contr Saf Promot 2021; 28:486-493. [PMID: 34551681 DOI: 10.1080/17457300.2021.1955936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the study was to assess the effectiveness of the specific design of a poisoning prevention intervention. This controlled before-after study followed Solomon design for educational interventions using two groups (the educational intervention group and the control group). Participants comprised parents of children attending kindergartens under the jurisdiction of the City of Zagreb and in the vicinity of Zagreb. The intervention group (N = 336) underwent an educational intervention during parents' meetings comprising oral presentation by the Croatian Poison Control Centre (CPCC) and distribution of gift packages containing child-proof locks, flyers, and stickers with the CPCC contact number. After the intervention they more frequently started keeping the CPCC's number by their telephone or in the list of important numbers than parents in the control group, and this association remained significant when tested by generalized estimating equations for binary outcomes, after the adjustment for parents' characteristics (age, gender and educational level), and clustered by kindergartens (p < 0.001). This means parents acknowledged the CPCC as an adequate and accessible way for initial management of poisoning incidents.
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Affiliation(s)
- Željka Babić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Kovačić
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Zrinka Franić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Franka Šakić
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Ljerka Prester
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Veda Marija Varnai
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Selma Cvijetić Avdagić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Adrijana Bjelajac
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Macan
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia
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11
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Ribeiro CCFS, Tonon MM, Oliveira JYD, Guedes MRJ, Tacla MTGM, Baldissera VDA, Oliveira MLFD. Dialogic educational practices in the context of child intoxication: an approach based on Paulo Freire. Rev Bras Enferm 2021; 74:e20201196. [PMID: 34320153 DOI: 10.1590/0034-7167-2020-1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/03/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the knowledge and practices of education of Family Health Strategy professionals regarding child intoxication for the autonomy and empowering of the families. METHODS Qualitative research, carried out through semistructured interviews with 50 professionals from the Family Health Strategy of a city in the Northwest of Paraná. Data was problematized using Paulo Freire's sociocultural approach and its concepts of dialogism and autonomy. RESULTS The statements showed the many ways in which the care for child intoxication is perceived and their relations with educational action, but these were traditional educational practices, with elements focused on the dissemination of information about health-disease, probably because the dialogic approach is still abstract and has no interface with the concrete practices. FINAL CONSIDERATIONS The education knowledge and practices of the professionals for the autonomy and empowering of families suggested that there is a transition stage between the biomedical model, focused on a cure, and the dialogical one.
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Tiguman GMB, Almeida MBDD, Silva MT, Galvao TF. AVAILABILITY AND STORAGE OF HAZARDOUS PRODUCTS IN HOUSEHOLDS IN THE METROPOLITAN REGION OF MANAUS: A POPULATION-BASED SURVEY, 2015. REVISTA PAULISTA DE PEDIATRIA 2021; 39:e2020130. [PMID: 33566883 PMCID: PMC7872011 DOI: 10.1590/1984-0462/2021/39/2020130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus. METHODS Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted. RESULTS A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13). CONCLUSIONS Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.
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Petit-Frere P, Miltenberger RG. Evaluating a modified behavioral skills training procedure for teaching poison prevention skills to children with autism. J Appl Behav Anal 2020; 54:783-792. [PMID: 33225468 DOI: 10.1002/jaba.799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/05/2022]
Abstract
Accidental poisonings can occur for children with disabilities as a result of ingesting household products, such as medications and cleaning chemicals, if the products are not stored safely. Behavioral approaches such as behavioral skills training (BST) have been used in previous research to teach safety skills to children with disabilities. However, research suggests that BST is not always effective for teaching safety skills to children with and without disabilities. Thus, the purpose of this study was to evaluate the efficacy of a modified BST package that incorporated a system of least prompts. A nonconcurrent multiple baseline design across participants was used to evaluate the effects of intervention with three 6-8-year-old children with autism. Results showed that BST with the prompt sequence increased poison prevention skills for all 3 participants and the skills maintained at follow-up.
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Bhatta S, Mytton J, Deave T. Environmental change interventions to prevent unintentional home injuries among children in low- and middle-income countries: A systematic review and meta-analysis. Child Care Health Dev 2020; 46:537-551. [PMID: 32410304 DOI: 10.1111/cch.12772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/16/2020] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unintentional home injury is an important cause of death and disability among children, especially those living in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs. METHODS Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta-analysis was conducted. RESULTS Four studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta-analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) -0.77; 95% CI [-1.36, -0.19]] and burn-related unsafe practices (MD -0.37; 95% CI [-0.66, -0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD -0.5; 95% CI [-0.66, -0.33]) but not for ingestion hazards. CONCLUSION There is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.
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Affiliation(s)
- Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, University of the West of England, Bristol, UK
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Vilaça L, Volpe FM, Ladeira RM. ACCIDENTAL POISONING IN CHILDREN AND ADOLESCENTS ADMITTED TO A REFERRAL TOXICOLOGY DEPARTMENT OF A BRAZILIAN EMERGENCY HOSPITAL. ACTA ACUST UNITED AC 2019; 38:e2018096. [PMID: 31778403 PMCID: PMC6909246 DOI: 10.1590/1984-0462/2020/38/2018096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/30/2018] [Indexed: 12/05/2022]
Abstract
Objective: To describe the profile of children and adolescents admitted for exogenous unintentional poisoning in the emergency room and analyze factors associated with subsequent in-hospital admissions. Methods: This is a cross-sectional study based on hospital records of all subjects up to 19 years-old admitted in 2013 at a specialized toxicology service on a major public emergency hospital due to unintentional intoxication (as reported). Accidents with poisonous animals and insects were excluded. Percentages and frequencies were calculated for the qualitative variables, and measures of central tendency and dispersion for the continuous quantitative variables. Multivariate analysis was performed using binary logistic regression to identify variables associated with subsequent in-hospital admissions. Results: In 2013, 353 cases were reported. Poisonings were more frequent in children 0-4 years-old (72.5%) and in boys (55%). The vast majority was of dwellers of the Metropolitan Region of Belo Horizonte (83%), and 90% of the accidental poisonings occurred at home. 82.7% of the poisonings occurred by oral ingestion, especially of medicinal (36.5%) and cleaning products (29.4% of all poisonings). Only 12.2% of the cases resulted in hospitalization, and only one resulted in death. Residing outside Belo Horizonte (OR=5.20 [95%CI 2.37-11.44]) and poisoning by two or more products (OR=4.29 [95%CI 1.33-13.82]) were considered risk factors for hospitalization. Conclusions: Accidental poisonings occurred most frequently by ingestion of household medications and cleaning products, especially among children under 4 years-old. Preventive strategies should be primarily directed for this prevalent profile.
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Affiliation(s)
- Luciana Vilaça
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil
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Abstract
Unintentional poisonings are a global health problem frequently resulting in hospital admissions. Propafenone is a class 1C antiarrhythmic drug used in the second-line management of supraventricular and ventricular arrhythmias and, when unintentionally ingested, can lead to severe and life-threatening poisoning. We describe a case of a 3-year-old male patient unintentionally ingesting 300 mg (20 mg/kg) of propafenone and presenting with ventricular tachycardia with QT prolongation. Two boli of intravenous hypertonic sodium bicarbonate (total amount of 3 mEq/kg), followed by 3-hours continuous infusion of 1 mEq kg h sodium bicarbonate, were able to restore the clinical conditions of the patient. With this case report, we aim to highlight the existing challenge in the therapeutic management of propafenone intoxication that finds intravenous hypertonic bicarbonate to be a useful tool also in pediatric population.
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Barcelos RS, Del-Ponte B, Santos IS. Interventions to reduce accidents in childhood: a systematic review. J Pediatr (Rio J) 2018; 94:351-367. [PMID: 29291398 DOI: 10.1016/j.jped.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To review the literature on interventions planned to prevent the incidence of injuries in childhood. SOURCE OF DATA The PubMed, Web of Science, and Bireme databases were searched by two independent reviewers, employing the single terms accidents, accident, injuries, injury, clinical trial, intervention, educational intervention, and multiple interventions, and their combinations, present in the article title or abstract, with no limits except period of publication (2006-2016) and studies in human subjects. SYNTHESIS OF DATA Initially, 11,097 titles were located. Fifteen articles were selected for the review. Eleven were randomized trials (four carried out at the children's households, five in pediatric healthcare services, and two at schools), and four were non-randomized trials carried out at the children's households. Four of the randomized trials were analyzed by intention-to-treat and a protective effect of the intervention was observed: decrease in the number of risk factors, decrease in the number of medical consultations due to injuries, decrease in the prevalence of risk behaviors, and increase of the parents' knowledge regarding injury prevention in childhood. CONCLUSION Traumatic injuries in childhood are amenable to primary prevention through strategies that consider the child's age and level of development, as well as structural aspects of the environment.
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Affiliation(s)
- Raquel S Barcelos
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil.
| | - Bianca Del-Ponte
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
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Interventions to reduce accidents in childhood: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amorim MLP, Mello MJGD, Siqueira MTD. Poisoning in children and adolescents notified at a toxicology center in the Northeast of Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-93042017000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objective: to analyze the clinical and epidemiological profile of poisoning in children and adolescents under 12years old. Methods: a crosssectional study with analytical component based on poisoning notifications at the Centro de Toxicologia de Pernambuco (Toxicological Center in Pernambuco), carried out in 2012 and 2014. Allergic reactions and contaminated food poisoning were excluded. Sociodemographic characteristics, type of toxic agent, circumstance, place of occurrence, time until care and patients' evolution were analyzed. The distribution of frequencies and associations among the variables through prevalence ratio and the chisquared test was determined. Results: Among 2,843 patients registered, 1,601 (56.3%) were poisoned by chemical substances and 1,242 (43.7%) by poisonous animals. Most lived in urban areas (90.6%) and were attended for care after an hour of the incident (47.6%). The poisoning frequency of chemical substances was higher among children under five years old (PR=2.34; CI95%= 2.142.56) and there was no difference in the sexes (PR=1.00; CI95%= 0.941.07). The predominant medicine (45.0%) for poisoning was between chemical substance and scorpions (77.0%). Poisoning occurred as accidental in 92.2% and 99.6% of chemical substance occurred at home. There were six deaths by chemical intake and two by scorpions.. Conclusions: poisoning in Pernambuco State is considered a public health issue given by its frequency and it occurred mostly with children under 5 years old accidentally and at home.
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Achana F, Sutton AJ, Kendrick D, Hayes M, Jones DR, Hubbard SJ, Cooper NJ. A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children. BMC Public Health 2016; 15:705. [PMID: 27488449 PMCID: PMC4973049 DOI: 10.1186/s12889-016-3334-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews and a network meta-analysis show home safety education with or without the provision of safety equipment is effective in promoting poison prevention behaviours in households with children. This paper compares the cost-effectiveness of home safety interventions to promote poison prevention practices. METHODS A probabilistic decision-analytic model simulates healthcare costs and benefits for a hypothetical cohort of under 5 year olds. The model compares the cost-effectiveness of home safety education, home safety inspections, provision of free or low cost safety equipment and fitting of equipment. Analyses are conducted from a UK National Health Service and Personal Social Services perspective and expressed in 2012 prices. RESULTS Education without safety inspection, provision or fitting of equipment was the most cost-effective strategy for promoting safe storage of medicines with an incremental cost-effectiveness ratio of £2888 (95 % credible interval (CrI) £1990-£5774) per poison case avoided or £41,330 (95%CrI £20,007-£91,534) per QALY gained compared with usual care. Compared to usual care, home safety interventions were not cost-effective in promoting safe storage of other household products. CONCLUSION Education offers better value for money than more intensive but expensive strategies for preventing medicinal poisonings, but is only likely to be cost-effective at £30,000 per QALY gained for families in disadvantaged areas and for those with more than one child. There was considerable uncertainty in cost-effectiveness estimates due to paucity of evidence on model parameters. Policy makers should consider both costs and effectiveness of competing interventions to ensure efficient use of resources.
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Affiliation(s)
- Felix Achana
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, SE16 4DG, UK
| | - David R Jones
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Stephanie J Hubbard
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
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Achana FA, Sutton AJ, Kendrick D, Wynn P, Young B, Jones DR, Hubbard SJ, Cooper NJ. The effectiveness of different interventions to promote poison prevention behaviours in households with children: a network meta-analysis. PLoS One 2015; 10:e0121122. [PMID: 25894385 PMCID: PMC4404249 DOI: 10.1371/journal.pone.0121122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is evidence from 2 previous meta-analyses that interventions to promote poison prevention behaviours are effective in increasing a range of poison prevention practices in households with children. The published meta-analyses compared any intervention against a “usual care or no intervention” which potentially limits the usefulness of the analysis to decision makers. We aim to use network meta-analysis to simultaneously evaluate the effectiveness of different interventions to increase prevalence of safe storage of i) Medicines only, ii) Other household products only, iii) Poisons (both medicines and non-medicines), iv) Poisonous plants; and v) Possession of poison control centre (PCC) telephone number in households with children. Methods Data on the effectiveness of poison prevention interventions was extracted from primary studies identified in 2 newly-undertaken systematic reviews. Effect estimates were pooled across studies using a random effects network meta-analysis model. Results 28 of the 47 primary studies identified were included in the analysis. Compared to usual care intervention, the intervention with education and low cost/free equipment elements was most effective in promoting safe storage of medicines (odds ratio 2.51, 95% credible interval 1.01 to 6.00) while interventions with education, low cost/free equipment, home safety inspection and fitting components were most effective in promoting safe storage of other household products (2.52, 1.12 to 7.13), safe storage of poisons (11.10, 1.60 to 141.50) and possession of PCC number (38.82, 2.19 to 687.10). No one intervention package was more effective than the others in promoting safe storage of poisonous plants. Conclusion The most effective interventions varied by poison prevention practice, but education alone was not the most effective intervention for any poison prevention practice. Commissioners and providers of poison prevention interventions should tailor the interventions they commission or provide to the poison prevention practices they wish to promote. Highlights
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Affiliation(s)
- Felix A. Achana
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Alex J. Sutton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- * E-mail:
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - David R. Jones
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Stephanie J. Hubbard
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Nicola J. Cooper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
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