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Oulee A, Waldrop I, Mendoza R, Onyekonwu C, Plurad DS, Sheets NW. Children ages one to four are disproportionally affected by chemical burns in a cross-sectional analysis of NEISS 2012-2021. Burns 2023; 49:1729-1732. [PMID: 37003848 DOI: 10.1016/j.burns.2023.03.008] [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: 10/01/2022] [Revised: 01/25/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Household cleaning and personal care products (HC&PCPs) are irreplaceable in most daily routines. However, data are sparse on chemical burns caused by HC&PCPs. METHODS We queried the National Electronic Injury Surveillance System (NEISS) from 2012 to 2021 to characterize chemical burns caused by HC&PCPs as well as the most common causative categories of HC&PCPs responsible for chemical burns. RESULTS We found 2729 total emergency department (ED) visits due to chemical burn injuries within the years 2012-2021 due to HC&PCPs. Chemical burns disproportionally affect children ages four and under, accounting for 36.4% of all patients. Within this subpopulation, boys were more frequently affected by chemical burns and the eyes were the most affected area. The most common HC&PCPs involved in chemical burns in individuals ages one to four were laundry soaps and detergents (22.0%) and bleaches (21.3%). CONCLUSION Children ages four and under are disproportionately affected by chemical burns due to non-intentional exposure of HC&PCPs, with laundry detergents and bleaches being the most common causative agents. Adequate storage of all HC&PCPs and improved parental supervision are paramount in preventing chemical burns in this age group.
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Affiliation(s)
- Aislyn Oulee
- University of California Riverside School of Medicine, Riverside, CA 92521, USA.
| | - Ian Waldrop
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - Roy Mendoza
- University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - Chiemelie Onyekonwu
- University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - David S Plurad
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - Nicholas W Sheets
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
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2
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Patterson KN, Beyene TJ, Gil LA, Minneci PC, Deans KJ, Halaweish I. Procedural and Surgical Interventions for Esophageal Stricture Secondary to Caustic Ingestion in Children. J Pediatr Surg 2023; 58:1631-1639. [PMID: 36878759 DOI: 10.1016/j.jpedsurg.2023.01.048] [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: 09/06/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal injury after caustic ingestion can vary in severity and may result in significant long-term morbidity due to stricture development. The optimal management remains unknown. We aim to determine the incidence of esophageal stricture due to caustic ingestion and quantify current procedural and operative management strategies. METHODS The Pediatric Health Information System (PHIS) was utilized to identify patients 0-18 years old who experienced caustic ingestion from January 2007-September 2015 and developed subsequent esophageal stricture until December 2021. Post-injury procedural and operative management was identified utilizing ICD-9/10 procedure codes for esophagogastroduodenoscopy (EGD), esophageal dilation, gastrostomy tube placement, fundoplication, tracheostomy, and major esophageal surgery. RESULTS 1,588 patients from 40 hospitals experienced caustic ingestion of which 56.6% were male, 32.5% non-Hispanic White, and the median age at time of injury was 2.2 years (IQR: 1.4,4.8). Median length of initial admission was 1.0 day (IQR: 1.0, 3.0). 171/1,588 (10.8%) developed esophageal stricture. Among those who developed stricture, 144 (84.2%) underwent at least 1 additional EGD, 138 (80.7%) underwent dilation, 70 (40.9%) underwent gastrostomy tube, 6 (3.5%) underwent fundoplication, 10 (5.8%) underwent tracheostomy, and 40 (23.4%) underwent major esophageal surgery. Patients underwent a median of 9 dilations (IQR 3, 20). Major surgery was performed at a median of 208 (IQR: 74, 480) days after caustic ingestion. CONCLUSION Many patients with esophageal stricture after caustic ingestion will require multiple procedural interventions and potentially major surgery. These patients may benefit from early multi-disciplinary care coordination and the development of a best-practice treatment algorithm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Lindsay A Gil
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ihab Halaweish
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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3
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Pacini A, Tsutaoka B, Lai L, Durrani TS. Unintentional pediatric exposures to household cleaning products: a cross-sectional analysis of the National Poison Data System (2000-2015). J Occup Med Toxicol 2023; 18:16. [PMID: 37568177 PMCID: PMC10422824 DOI: 10.1186/s12995-023-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Household cleaning products are the second most common cause of unintentional poisoning in children < 6 years old in the United States. The aim of this study is to characterize exposures to household cleaning substances in this age group from data collected from the Nation's Poison Control Centers. METHODS This cross-sectional study analyzed all household cleaner calls classified as age < 6 years old made to the American Association of Poison Control Centers between January 1st 2000 and December 31th 2015. RESULTS Significant clinical effects or injury was low, making up only 2.6% of cases with a known medical outcome. Alkali-based cleaning products accounted for the third highest frequency of overall exposures and the highest number of all exposure outcomes determined to have a significant clinical effect or injury. CONCLUSIONS This study demonstrated particular danger of adverse outcomes after exposure to alkali-based cleaning products, specifically alkali-based oven and drain cleaners. Both of which are readily accessible in many households. This study may be a good starting point for further study and poison prevention efforts.
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Affiliation(s)
- Anthony Pacini
- Division of Occupational and Environmental Medicine, University of California, San Francisco, Box 1369, San Francisco, CA, 94143-1369, USA
| | - Ben Tsutaoka
- California Poison Control System, University of California, San Francisco, San Francisco, USA
| | - Leslie Lai
- California Poison Control System, University of California, San Francisco, San Francisco, USA
| | - Timur S Durrani
- Division of Occupational and Environmental Medicine, University of California, San Francisco, Box 1369, San Francisco, CA, 94143-1369, USA.
- California Poison Control System, University of California, San Francisco, San Francisco, USA.
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Alves M, Asbell P, Dogru M, Giannaccare G, Grau A, Gregory D, Kim DH, Marini MC, Ngo W, Nowinska A, Saldanha IJ, Villani E, Wakamatsu TH, Yu M, Stapleton F. TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface. Ocul Surf 2023; 29:1-52. [PMID: 37062427 DOI: 10.1016/j.jtos.2023.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.
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Affiliation(s)
- Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, University of Campinas Campinas, Brazil.
| | - Penny Asbell
- Department of Bioengineering, University of Memphis, Memphis, USA
| | - Murat Dogru
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Cantanzaro, Italy
| | - Arturo Grau
- Department of Ophthalmology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Darren Gregory
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, USA
| | - Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | | | - William Ngo
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Anna Nowinska
- Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Tais Hitomi Wakamatsu
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, Brazil
| | - Mitasha Yu
- Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
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Bosshart N, Bearth A, Wermelinger S, Daum M, Siegrist M. Seeing household chemicals through the eyes of children-Investigating influential factors of preschoolers' perception and behavior. JOURNAL OF SAFETY RESEARCH 2022; 83:400-409. [PMID: 36481033 DOI: 10.1016/j.jsr.2022.09.015] [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: 04/26/2022] [Revised: 06/24/2022] [Accepted: 09/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Children who encounter household chemicals run the risk of unintentional injury. The aim of this study was to understand which factors heighten children's attention or misguide their decision-making concerning household chemicals. We hypothesized that certain product attributes (i.e., label, packaging, closure types), storage context, and parental beliefs play a role in this setting. METHOD We conducted a laboratory study with N = 114 children (M = 45 months, SD = 6.5) and their parents (M = 38 years, SD = 4.92). Children completed a series of behavioral tasks in which they had to choose between products with different attributes, identify products in different storage contexts, and sort household chemicals. RESULTS The results confirmed that the children preferred products with cartoon-style labels compared to products without such labels. However, children's decision-making did not differ for products with different closure types (child-resistant vs sprayer-type closures). Regarding the storage context, our results showed that the children particularly struggled to identify dishwashing tabs when they were stored with other food items rather than household chemicals. In terms of parental beliefs, our study found that parents rated more household chemicals as child-safe than their children did. PRACTICAL APPLICATION Parents should buy household chemicals with neutral labels and pay attention to how their household chemicals are stored. Manufacturers should consider potential adverse effects when developing new product designs.
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Affiliation(s)
- Noah Bosshart
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland.
| | - Angela Bearth
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland
| | - Stephanie Wermelinger
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), Switzerland; Jacobs Center for Productive Youth Development, UZH, Switzerland
| | - Moritz Daum
- Developmental Psychology: Infancy and Childhood, Department of Psychology, University of Zurich (UZH), Switzerland; Jacobs Center for Productive Youth Development, UZH, Switzerland
| | - Michael Siegrist
- Consumer Behavior, Institute for Environmental Decisions (IED), ETH Zurich (ETHZ), Switzerland
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6
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Lin GD, Wu JY, Peng XB, Lu XX, Liu ZY, Pan ZG, Qiu ZW, Dong JG. Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic: Case series. World J Clin Cases 2022; 10:8872-8879. [PMID: 36157658 PMCID: PMC9477020 DOI: 10.12998/wjcc.v10.i25.8872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Misuse of disinfectants during the coronavirus disease 2019 pandemic has led to several poisoning incidents. However, there are few clinical case reports on poisoning caused by improper mixing of household disinfectants.
AIM To summarize the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents.
METHODS
We retrospectively analyzed baseline and clinical data, clinical symptoms, and treatment methods of seven patients with chlorine poisoning who were admitted to the National Army Poisoning Treatment Center.
RESULTS Among the seven patients, the average poisoning time (exposure to admission) was 57 h (4-240 h). All patients were involved in cleaning bathrooms. Chest computed tomography scans revealed bilateral lung effusions or inflammatory changes in five patients. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. Humidified oxygen therapy, non-invasive mechanical ventilation, anti-inflammatory corticosteroids, antioxidants, and antibiotics were administered for treatment. The average length of hospital stay was 7 d (4-9 d). All seven patients recovered and were discharged.
CONCLUSION Improper mixing of household disinfectants may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases, and symptomatic supportive treatment should be performed early.
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Affiliation(s)
- Guo-Dong Lin
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong Province, China
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Jie-Yi Wu
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong Province, China
| | - Xiao-Bo Peng
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Xiao-Xia Lu
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Zhong-Ying Liu
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Zhi-Guo Pan
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong Province, China
| | - Ze-Wu Qiu
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Jian-Guang Dong
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
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Suting E, Bhaskar V, Batra P. Changing epidemiology of poisoning in children: A retrospective study from a tertiary care center in New Delhi, India. Indian J Public Health 2022; 65:400-402. [PMID: 34975087 DOI: 10.4103/ijph.ijph_234_21] [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: 11/04/2022] Open
Abstract
Poisoning is the fourth leading cause of unintentional injuries in children. With continuously changing environment, the epidemiology of poisoning keeps on changing. The present study was undertaken to describe the clinical and epidemiological profile of childhood poisoning in a tertiary care center of New Delhi, India. All children <12 years of age admitted to pediatric ward with a history of ingestion of poison or envenomation between January 2019 and June 2020 were identified, and their medical records were obtained from medical records department. A total of 203 patients were enrolled in the study. Drugs and medications were the most common agents (19.2% cases), followed by prallethrin (13.7% cases). Majority of the cases were asymptomatic. Vomiting (25%) was the most common symptom. Drugs and medications were the leading cause of poisoning, followed by liquid mosquito repellant. This study highlights the change in characteristics of acute poisoning in Indian children.
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Affiliation(s)
- Enboklang Suting
- Senior Resident, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikram Bhaskar
- Assistant Professor, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Prerna Batra
- Director Professor, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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8
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Leubitz A, Spiller HA, Jolliff H, Casavant M. Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws. Pediatr Emerg Care 2021; 37:e969-e973. [PMID: 34908380 DOI: 10.1097/pec.0000000000001841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years. METHODS This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization. RESULTS From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced a wide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation. CONCLUSION There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.
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Affiliation(s)
- Andrew Leubitz
- From the Ohio University Heritage College of Osteopathic Medicine, Athens
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Ten Years of Pediatric Ocular Chemical Burn Experience in a Tertiary Eye Care Center in Turkey. Eye Contact Lens 2021; 48:175-179. [DOI: 10.1097/icl.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/09/2022]
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10
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Yen CW, Lee EP, Cheng SC, Hsia SH, Huang JL, Lee J. Household cleaning products poisoning in a pediatric emergency center: A 10- year cross-sectional study and literature review. Pediatr Neonatol 2021; 62:638-646. [PMID: 34332912 DOI: 10.1016/j.pedneo.2021.05.026] [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: 01/11/2021] [Revised: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). METHODS This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. RESULTS The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (p < 0.001), and medications(steroids [p < 0.001], antibiotics [p < 0.001], and antacids [p = 0.001]) were associated with esophageal stricture. CONCLUSION Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade ≥ 3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study.
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Affiliation(s)
- Chen-Wei Yen
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chuan Cheng
- Department of Family Medicine, China Medical University Hospital, Taipei, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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11
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Kamboj A, Spiller HA, Funk AR, Badeti J, Smith GA. Cosmetics and Personal Care Products-Related Ocular Exposures Reported to United States Poison Control Centers. Ophthalmic Epidemiol 2021; 29:573-581. [PMID: 34551657 DOI: 10.1080/09286586.2021.1980590] [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
PURPOSE To study cosmetics and personal care products-related ocular exposures in the United States. METHODS A retrospective analysis of cosmetics and personal care products-related ocular exposures from 2000 through 2018 was conducted using data from the National Poison Data System. RESULTS From January 2000 through December 2018, United States Poison Control Centers received 266,743 calls concerning eye exposures to cosmetics and personal care products, corresponding to a mean of 14,039 calls per year. Young children (<6 years old) represented 51.6% of exposures, while older children and teenagers (6-19 years old) and adults (≥ 20 years old) represented 19.5% and 28.9% of exposures, respectively. Over the study period, the annual frequency of exposures decreased by 46.0%. The product subcategories associated with the highest proportion of exposures were perfumes, colognes, and aftershaves (19.0%), suntan and/or sunscreen products (11.2%), nail polishes (9.5%), soaps (6.3%), and creams, lotions, and make-up (5.8%). The product subcategories associated with the greatest proportion of moderate or major medical outcomes were acrylic nail adhesives (14.4%), miscellaneous nail products (12.9%), other hair care products excluding peroxides (10.9%), hair coloring agents excluding peroxides (8.9%), and peroxides (7.5%). CONCLUSIONS Although the annual frequency of exposures to cosmetics and personal care products declined during the study period, public health efforts are needed to prevent further ocular exposures to these products. Containers of potentially ocular-toxic products should be redesigned to reduce confusion with eye dropper bottles and to reduce attractiveness to young children, with immediate priority placed on acrylic nail adhesives.
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Affiliation(s)
- Alisha Kamboj
- Center for Injury Research and Policy, the Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Henry A Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Alexandra R Funk
- Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaahnavi Badeti
- Center for Injury Research and Policy, the Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, the Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Child Injury Prevention Alliance, Columbus, OH, USA
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12
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Deguigne M, Cellier M, Hamon Y, Legay M, Descatha A. Poisoning exposure from non-pharmaceutical products in residents of structured living facilities. Clin Toxicol (Phila) 2021; 60:371-378. [PMID: 34409905 DOI: 10.1080/15563650.2021.1965158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. METHOD This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS ≥ 2. RESULTS This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS ≥ 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). CONCLUSION Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested.
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Affiliation(s)
- Marie Deguigne
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Morgane Cellier
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Yveline Hamon
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Marion Legay
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Alexis Descatha
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, Ehesp, Irset (Institut de recherche en santé, environnement et travail - Research Institute for Environmental and Occupational Health), Angers, France
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13
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O'Donnell EP, Canares TL. Accidents Waiting to Happen: A Review of Unintentional Household Injuries in Children. Pediatr Rev 2021; 42:109-122. [PMID: 33648990 DOI: 10.1542/pir.2019-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Erin P O'Donnell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Therese L Canares
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Nemanich A, Chen B, Valento M. Toxic boost: Acute, reversible neurotoxicity after ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) mistaken for an energy drink. Am J Emerg Med 2020; 42:261.e3-261.e5. [PMID: 32919805 DOI: 10.1016/j.ajem.2020.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022] Open
Abstract
Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organometallic compound used as a gasoline additive for its antiknock properties. Human ingestion of MMT has not previously been reported. We present the case of a 54-year-old man who developed seizures and altered mental status after drinking 12 oz. of MMT-containing NOS Octane Booster Racing Formula. Due to label similarities, he mistook this for the NOS High Performance energy drink. The patient was intubated due to persistent seizures despite benzodiazepine treatment and admitted to the intensive care unit. He had two further seizures while intubated, but he was successfully extubated on the 4th day post-ingestion. He was confused and ataxic following extubation, but one day later his symptoms resolved and he was discharged without further incident. This case highlights the importance of responsible labeling of consumables. It is important for clinicians and poison centers to report any such instances to the United States Food and Drug Administration.
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Affiliation(s)
| | - Betty Chen
- University of Washington, Department of Emergency Medicine, USA; Washington Poison Center, USA.
| | - Matthew Valento
- University of Washington, Department of Emergency Medicine, USA; Washington Poison Center, USA.
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15
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Hanway SJ, Rodgers GB. Impact of the Voluntary Safety Standard for Liquid Laundry Packets on Child Injuries Treated in US Hospital Emergency Departments, 2012-2018. Am J Public Health 2020; 110:1242-1247. [PMID: 32552030 DOI: 10.2105/ajph.2020.305650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard's publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department-treated injuries during the study period.
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Affiliation(s)
- Stephen J Hanway
- Stephen J. Hanway is with the Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, MD. Gregory B. Rodgers is with the Directorate for Economic Analysis, US Consumer Product Safety Commission
| | - Gregory B Rodgers
- Stephen J. Hanway is with the Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, MD. Gregory B. Rodgers is with the Directorate for Economic Analysis, US Consumer Product Safety Commission
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16
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Household cleaning product-related ocular exposures reported to the United States poison control centres. Eye (Lond) 2019; 34:1631-1639. [PMID: 31813934 PMCID: PMC7608403 DOI: 10.1038/s41433-019-0691-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 11/08/2022] Open
Abstract
Background/objectives To investigate ocular exposures associated with household cleaning products in the United States. Subjects/methods A retrospective analysis of ocular exposures associated with household cleaning products was conducted using data from the National Poison Data System from 2000 through 2016. Results From January 2000 through December 2016, poison control centres in the United States received 319,508 calls for household cleaning product-related ocular exposures, averaging 18,795 exposures annually. The annual frequency of exposures decreased significantly by 28.8% during the study period. The rate of exposures per 100,000 US residents was 28.4 among young children (<6 years), 4.8 among older children (6–12 years), 4.2 among teenagers (13–19 years), and 4.2 among adults (≥20 years); children 2 years old had the highest rate of exposure (62.8). Bleaches (25.9%), wall/floor/tile cleaners (13.4%), disinfectants (10.8%), laundry detergents (6.1%), and glass cleaners (5.3%) were the non-miscellaneous product subcategories most commonly associated with ocular exposures. The product subcategories associated with the greatest proportion of major medical outcomes were drain cleaners (1.4%), oven cleaners (1.1%), and automatic dishwasher detergents (0.4%). Conclusions On average, the United States poison control centres received approximately two reports of household cleaning product-related ocular exposures every hour during the 17-year study period. Although the annual number and rate of exposures declined during this time, the number of these exposures remains high, especially among young children, underscoring the need for additional prevention efforts. Contrary to the overall trend, ocular exposures to laundry detergent packets have increased significantly and merit special preventive action.
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17
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Vajda J, McAdams RJ, Roberts KJ, Zhu M, McKenzie LB. Cosmetic-Related Injuries Treated in US Emergency Departments: 2002 to 2016. Clin Pediatr (Phila) 2019; 58:1493-1501. [PMID: 31203655 DOI: 10.1177/0009922819850492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for children <5 years who were treated in US emergency departments (EDs) from 2002-2016) for a cosmetic-related injury. An estimated 64 686 (95% confidence interval = 53 037-76 335) children were treated in EDs for cosmetic-related injuries during the 15-year study period. There was no significant change in the rate (slope = 1.1 per 10 000 children per year, P = .95) of injuries over the study period. Injuries were most commonly associated with nail care (28.3%), hair care (27.0%), skin care (25.0%), and fragrance (12.7%) products. Children aged <2 years were most frequently injured (59.3%), and poisoning was the most common diagnosis (86.2%). To our knowledge, this is the first study to use a nationally representative sample to describe the epidemiology of cosmetic-related injuries among children aged <5 years. Unintentional exposure to cosmetics is an important source of injury for young children.
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Affiliation(s)
- Jordan Vajda
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rebecca J McAdams
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kristin J Roberts
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Motao Zhu
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lara B McKenzie
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
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18
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Hermanns-Clausen M, Desel H, Färber E, Seidel C, Holzer A, Eyer F, Engel A, Prasa D, Tutdibi E, Stürer A. MAGAM II – prospective observational multicentre poisons centres study on eye exposures caused by cleaning products. Clin Toxicol (Phila) 2019; 57:765-772. [DOI: 10.1080/15563650.2018.1560462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maren Hermanns-Clausen
- Poisons Information Centre, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Herbert Desel
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Elke Färber
- GIZ-Nord Poisons Center, University Medical Center, Göttingen, Germany
| | - Carola Seidel
- Poison Center Bonn, Children's University Hospital, Bonn, Germany
| | | | - Florian Eyer
- Department of Clinical Toxicology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Antje Engel
- Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Poison Information Centre, Berlin, Germany
| | | | - Erol Tutdibi
- Poison Center of the Saarland, University Children’s Hospital, Saarland University Hospital, Homburg, Germany
| | - Andreas Stürer
- Poisons Centre – Clinical Toxicology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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19
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Gaw CE, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. Safety Interventions and Liquid Laundry Detergent Packet Exposures. Pediatrics 2019; 144:peds.2018-3117. [PMID: 31160344 DOI: 10.1542/peds.2018-3117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard. METHODS Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed. RESULTS From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old increased by 63.4% from 2012 to 2015 and declined by 55.5% from 2015 to 2017. Serious outcomes among children <6 years old increased by 78.5% from 2012 to 2015 and declined by 32.9% from 2015 to 2017. CONCLUSIONS The number, rate, and severity of liquid laundry detergent packet exposures have decreased modestly in recent years among children <6 years old, likely attributable, in part, to the voluntary product safety standard and public awareness efforts. Exposures among older children and adults are increasing. Opportunities exist to strengthen the current product safety standard to further reduce exposures.
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Affiliation(s)
- Christopher E Gaw
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Henry A Spiller
- Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Thitphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Child Injury Prevention Alliance, Columbus, Ohio
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20
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Farrell PR, Farrell MK. 50 Years Ago in TheJournal ofPediatrics: Esophageal Injury by Liquid Chlorine Bleach: Experimental Study. J Pediatr 2019; 209:159. [PMID: 31128724 DOI: 10.1016/j.jpeds.2018.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peter R Farrell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael K Farrell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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21
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Cohen L, Jefferies A. Environmental exposures and cancer: using the precautionary principle. Ecancermedicalscience 2019; 13:ed91. [PMID: 31281435 PMCID: PMC6546253 DOI: 10.3332/ecancer.2019.ed91] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 12/02/2022] Open
Abstract
Since the 1970s, more than 87,000 chemicals have been approved for commercial use. Yet of those thousands of chemicals, only just over one thousand have been formally examined and graded for their carcinogenic potential. Of those, five hundred have been found worthy of being graded on a cautiously worded scale ranging from “known” carcinogens to “possibly” carcinogenic. In addition to carcinogenic substances, a new field has emerged researching how environmental toxins cause endocrine or hormonal disruption. A class of these compounds known as endocrine-disrupting chemicals (EDCs) can be found in our food, our environment, and in the products we put on our bodies. Rather than being directly linked to causing cancer, like substances such as asbestos, EDCs influence our health by mimicking or enhancing or changing metabolic regulation. These compounds interfere with hormone production and metabolism in ways that may—especially over the long term—create biological conditions that make us more susceptible to cancer and other diseases. Most of us are exposed to a cocktail of environmental toxins on an ongoing daily basis and at a relatively low level of exposure. Given the lax regulation of chemicals and the reactionary approach of government regulators, it is up to the consumer to be diligent about reading labels and making healthy choices to limit exposure to chemicals and toxins. It is ideal to adopt the Precautionary Principle: until a chemical is found to be harmless, try to not use it. The precautionary principle means that you are maintaining awareness of what you are putting on and in your body and taking steps to avoid exposing yourself unnecessarily to toxins in your household and environment.
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Affiliation(s)
- Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, Section of Integrative Medicine, The University of Texas MD Anderson Cancer Center Houston, TX 77030, USA.,Vital Matters, LLC, Houston, TX 77025, USA
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22
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Holm SM, Leonard V, Durrani T, Miller MD. Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes. Am J Infect Control 2019; 47:82-91. [PMID: 30172610 DOI: 10.1016/j.ajic.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague. METHODS This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines. RESULTS Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity. CONCLUSIONS A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.
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23
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Kamboj A, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. Ocular Exposures Reported to United States Poison Control Centers. Ophthalmic Epidemiol 2018; 26:84-94. [DOI: 10.1080/09286586.2018.1521982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alisha Kamboj
- Center for Injury Research and Policy at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Henry A. Spiller
- The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Marcel J. Casavant
- Center for Injury Research and Policy at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Gary A. Smith
- Center for Injury Research and Policy at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
- Child Injury Prevention Alliance, Columbus, OH, USA
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24
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Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India. J Forensic Leg Med 2018; 58:205-211. [PMID: 30015223 DOI: 10.1016/j.jflm.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/13/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023]
Abstract
Extensive use of different chemicals in various fields and their easy availability has led to an increased incidence of accidental and intentional poisoning in developing countries including India. A diverse range of household products commonly used for domestic purposes comprise pesticides, household cleaners, thermometer mercury, antiseptics, kerosene, paint thinners etc. Any of these products, if misused or mishandled can cause poisoning. In India, the National Poisons Centre (NPIC) at the All India Institute of Medical Sciences, New Delhi, provides information on management of poisoning to treating physicians. Analysis of data based on telephone calls received by the NPIC (April 2006-March 2016) has highlighted a high incidence of poisoning due to household products, followed by pharmaceuticals, agricultural pesticides and industrial chemicals. The objective of the present retrospective study was to determine the incidence of poisoning due to various household products as reported to the NPIC during the ten years period. The total number of calls received by the Centre was 16,420. There were 7114 calls (45.5%) due to household products with adults (>18yrs.) and children (<1-18yrs.) constituting 38.7% and 61.2% calls respectively. Males outnumbered females (M = 62.4%, F = 37.5%). The mode of poisoning was mainly unintentional (66.8%) followed by intentional mode (33.2%). The commonest route of exposure was oral (95.6%). Household pesticides were commonly implicated (43.7%) followed by household cleaners (21.8%), thermometer mercury (5.2%) naphthalene balls (5%), antiseptics (3%), kerosene (2%) and paint thinner (2%). Miscellaneous products comprising of camphor, silica gel, hair dye, nail polish remover, cosmetics, adhesives etc were also involved in poisoning (17.1%). The trend and pattern of poisoning varies in different parts of the country, because all calls on poisoning are not reported to the Centre. So the data as such may not be a true reflection of the scenario in India. However, the results do indicate an increasing incidence of poisoning due to household products especially in children. The probable reasons for high incidence could be careless storage, ignorance, non compliance with prescribed instructions for use and negligible parental supervision in case of children. The results of the study highlight, an urgent need to identify high risk circumstances, common toxic products involved and implementation of prevention and awareness programmes, to achieve poisons control at home.
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Hashmi MU, Ali M, Ullah K, Aleem A, Khan IH. Clinico-epidemiological Characteristics of Corrosive Ingestion: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab Pakistan. Cureus 2018; 10:e2704. [PMID: 30062078 PMCID: PMC6063384 DOI: 10.7759/cureus.2704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Corrosive ingestion is a grave public health problem. It is a medical emergency and shows diverse clinical presentations. The ingestion of corrosive substances has devastating effects on upper gastrointestinal and respiratory tracts and the corrosive injury is associated with numerous life-threatening complications. The present study aims to explore the clinico-epidemiological characteristics of patients of corrosive ingestion presenting at a tertiary care hospital of Multan, Pakistan. Method The target study population consists of all the patients with primary diagnosis of corrosive ingestion who presented to the department of thoracic surgery, Nishtar Medical University Hospital Multan, Pakistan, from January 2016 to December 2017. The follow-up cases and the cases with ingestion of substances other than corrosives were not included in the study. All the included cases were evaluated by detailed history, thorough physical examination and the necessary investigations. The post-cor-rosive tissue damage was classified accord-ing to Zargar's classification system. All the demographic data and other variables were measured and recorded using a Performa. The data were analyzed by using computer program SPSS 21 version. Results The total study population was 206 patients. There were 135 females (65.5%) and 71 male patients (34.5%). Age ranged from 2 to 42 years (mean 23.44 ± 7.19). Only seven cases were found in the age group of 2-7 years. The residents of rural areas showed a slightly increased inclination towards corrosive ingestion. One hundred and ten cases were unmarried (53.4%) while 90 patients were married (43.7%). The incidence of corrosive ingestion was much high in illiterate/less educated patients belonging to the groups of lower socio-economic status. One hundred and ninety-seven patients ingested corrosive substances deliberately with the suicidal intention (95.6%). The acid used as bathroom cleaner and the laundry bleaches were the most commonly used corrosive agents. In 166 cases the corrosive materials were already present at home for domestic purposes (80.6%), but 18 subjects particularly purchased these corrosive substances to commit suicide. The quantity of ingested material ranged between 10 ml and 150 ml with a mean of 42.6 ml ± 33.2. The shortest hospital stay was one day, and the longest one was 60 days. Esophagus and oropharyngeal area were the most common site which sustained the corrosive injury, whereas corrosive injury to duodenum was least frequent (34.5 %). Conclusion Corrosive ingestion is a serious medical problem and it requires a multidisciplinary approach and a good coordination between different medical specialists. Underprivileged teenager females of rural areas are more likely to ingest corrosive materials with suicidal intention. In most of the ingestions, household cleaning products are used. Only the patients with severe corrosive injury should be admitted to intensive care units. Enforcing regulations for the manufacturers of household cleaning products can significantly reduce the incidence of this potentially fatal condition.
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Affiliation(s)
| | - Mansoor Ali
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Kaleem Ullah
- Upper Gi and Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Abdul Aleem
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Iftikhar H Khan
- Thoracic and General Surgery, Nishtar Medical University, Multan, PAK
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26
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Abstract
Nonpharmaceutical household products are the most common substances involved in exploratory ingestions in young children. Fortunately, most of these products are not toxic if ingested in small volumes. However, there are several household products that have the potential to cause significant toxicity and, rarely, fatalities in young children. Key products reviewed in this article include alcohols, button batteries, corrosive cleaning products, laundry detergent pods, hydrocarbons, and magnets. [Pediatr Ann. 2017;46(12):e449-e453.].
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Miller JD. IH issues in natural disasters: Residents, first responders & public health. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:158-160. [PMID: 28574755 DOI: 10.1080/15459624.2017.1328107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- J David Miller
- a Department of Chemistry , Carleton University , Ottawa , Ontario
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28
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Abstract
Burns are a common cause of preventable morbidity and mortality in children. Thermal and chemical burns are the most common types of burns. Their clinical appearance can be similar and the treatment is largely similar. Thermal burns in children occur primarily after exposure to a hot surface or liquid, or contact with fire. Burns are typically classified based on the depth and total body surface area, and the severity and onset of the burn can also depend on the temperature and duration of contact. Chemical burns are caused by chemicals-most commonly acids and alkalis-that can damage the skin on contact. In children, the most common cause of chemical burns is from household products such as toilet bowl cleaners, drain cleaners, detergents, and bleaches. Mild chemical burns generally cause redness and pain and can look similar to other common rashes or skin infections, whereas severe chemical burns are more extreme and may cause redness, blistering, skin peeling, and swelling.
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Affiliation(s)
- Shan Yin
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati, Cincinnati, OH, USA
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Abstract
Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. Serial dilation is the mainstay of oesophageal stricture therapy, with oesophageal replacement reserved for severe refractory strictures. Intra-lesional steroid or mitomycin C may decrease the dilatations required for severe strictures, although long-term effects are unknown. Risk of secondary oesophageal carcinoma mandates long-term surveillance.
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Affiliation(s)
- Marion Arnold
- Division of Paediatric Surgery, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Alp Numanoglu
- Division of Paediatric Surgery, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
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Campos AMDS, Bucaretchi F, Fernandes LCR, Fernandes CB, Capitani EMD, Beck ARM. EXPOSIÇÕES TÓXICAS EM CRIANÇAS A SANEANTES DE USO DOMICILIAR DE VENDA LEGAL E CLANDESTINA. REVISTA PAULISTA DE PEDIATRIA 2017; 35:11-17. [PMID: 28977311 PMCID: PMC5417804 DOI: 10.1590/1984-0462/;2017;35;1;00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/28/2016] [Indexed: 01/09/2023]
Abstract
Objectives: To analyze and to compare clinical repercussions of accidents involving legally and illegally commercialized household sanitizers in children under 7 years of age. Methods: A descriptive cross-sectional design was used to collect data from electronic database of a regional Poison Control Center during one year. Data were analyzed by means of descriptive non-parametric statistics and association tests. Results: The sample had 737 reported cases. Most of the accidents occurred with children under 3 years of age (median: 1 year of age; interquartile interval: 1-3 years of age), at home (92.9%), by ingestion (97.2%). Products involved were cleaning products with low toxicity and no caustic effects (38.9%); caustics (24.1%); hydrocarbons (19.3%); pesticides/rodenticides (16.6%), and other products (1.1%). Seventy accidents were due to exposures to illegal products, mainly caustics (n=47) and rodenticides (n=15). Among the 337 children presenting post-exposure clinical manifestations, the most frequent were vomiting (n=125), oral burns (n=74), cough (n=35), drooling (n=26), and abdominal pain (n=25). Clinical manifestations were significantly more frequent after illegal products exposure (55/70 versus 282/667, p<0.01). Nineteen children had to be hospitalized (caustics, n=17; illegal products, n=12; median time of hospitalization: 2 days), 22 were submitted to esophagogastroduodenoscopy (sodium hydroxide, n=14; illegal products, n=14); and 12 cases had endoscopic alterations (severe in 2). No deaths occurred. Conclusion: Toxic exposures owing to illegal household sanitizer products are associated with greater morbidity when compared with legal ones.
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Lepore A, D'Antini D, Raimondo P, Mirabella L, Pennisi L, Carrillo G, Cotoia A, Dambrosio M, Cinnella G. Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid. Int Med Case Rep J 2016; 9:353-356. [PMID: 27853393 PMCID: PMC5104299 DOI: 10.2147/imcrj.s119638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy.
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Affiliation(s)
- Anna Lepore
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Davide D'Antini
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Pasquale Raimondo
- Department of Anesthesia and Intensive Care, "Santa Maria" Hospital, Via De Ferrariis, Bari, Italy
| | - Lucia Mirabella
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Leonardo Pennisi
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Giuseppe Carrillo
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Antonella Cotoia
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Michele Dambrosio
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
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English K, Jagals P, Ware RS, Wylie C, Sly PD. Unintentional insecticide poisoning by age: an analysis of Queensland Poisons Information Centre calls. Aust N Z J Public Health 2016; 40:457-461. [DOI: 10.1111/1753-6405.12551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/01/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Karin English
- Children's Health and Environment Program; Queensland Children's Medical Research Institute
- UQ Child Health Research Centre, School of Medicine; The University of Queensland
| | - Paul Jagals
- School of Public Health; The University of Queensland
| | - Robert S. Ware
- UQ Child Health Research Centre, School of Medicine; The University of Queensland
- School of Public Health; The University of Queensland
| | - Carol Wylie
- Queensland Poisons Information Centre; Children's Health Queensland Hospital and Health Service
| | - Peter D. Sly
- Children's Health and Environment Program; Queensland Children's Medical Research Institute
- UQ Child Health Research Centre, School of Medicine; The University of Queensland
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36th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 24-27 May, 2016, Madrid, Spain. Clin Toxicol (Phila) 2016; 54:344-519. [DOI: 10.3109/15563650.2016.1165952] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A Nationwide Population-Based Study of Corrosive Ingestion in Taiwan: Incidence, Gender Differences, and Mortality. Gastroenterol Res Pract 2015; 2016:7905425. [PMID: 26819610 PMCID: PMC4706953 DOI: 10.1155/2016/7905425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 12/30/2022] Open
Abstract
Corrosive injury results from the intake of corrosive-acid-based chemicals. However, this phenomenon is limited to a small number of cases and cannot be extrapolated to the epidemiology of corrosive injuries in actual situations. This study focuses on the annual incidence of corrosive injury and its connection to gender, risk factors, and in-hospital mortality. All patients with corrosive injury (ICD-9 947.0–947.3) were identified using a nationwide inpatient sample from 1996 until 2010. Chi-squared tests and multivariate logistic regression were used to examine risk factors of gender differences and in-hospital mortality of corrosive injury. Young adults comprised the majority of patients (71.2%), and mean age was 44.6 ± 20.9 years. Women showed a higher incidence rate of corrosive injuries, age, suicide, psychiatric disorder, and systemic complications compared with men (p < 0.001). The present study demonstrated that age (OR = 10.93; 95% CI 5.37–22.27), systemic complications (OR = 5.43; 95% CI 4.61–6.41), malignant neoplasms (OR = 2.23; 95% CI 1.37–3.62), gastrointestinal complications (OR = 2.02; 95% CI 1.63–2.51), chronic disease (OR = 1.30; 95% CI 1.08–1.56), and suicide (OR = 1.23; 95% CI 1.05–1.44) were strongly associated with in-hospital mortality. Educational programs may be helpful for reducing the incidence of ingestion of corrosive chemicals.
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D’Cruz R, Pang TC, Harvey JG, Holland AJ. Chemical burns in children: Aetiology and prevention. Burns 2015; 41:764-9. [DOI: 10.1016/j.burns.2014.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/28/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
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A Qualitative Exploration of Less Acculturated Mexican Mothers' Safety Perceptions of Herbs, Medicines, and Cleaners in the Home. J Immigr Minor Health 2015; 18:420-7. [PMID: 25801449 DOI: 10.1007/s10903-015-0195-z] [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: 10/23/2022]
Abstract
Childhood poisoning is a leading public health concern in our society. The death rate from unintentional poisonings among children has increased by 80% from 2000 to 2009. Immigrant children are also at-risk. A qualitative study, consisting of a pile sort, was conducted among immigrant Mexican mothers to determine their safety perceptions of commonly used medicines, herbs, and cleaners. Participants (N = 35) were selected for semi-structured interviews from a pediatric primary care clinic in the Dallas/Fort Worth Metroplex. Some mothers over-estimated their children's ability to discern the dangers of substances, relied heavily on sensory skills of children, and perceived a medicine as safe after successful use in the past. Other mothers were more cognizant of allergic reactions, ingestion, and the need to store substances carefully. Brief interventions that incorporate culturally-appropriate safety messages are needed to assist Mexican mothers in creating a safe home environment.
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Crosslin K, Tsai R. Unintentional ingestion of cleaners and other substances in an immigrant Mexican population: a qualitative study. Inj Prev 2015; 22:140-3. [PMID: 25782982 DOI: 10.1136/injuryprev-2014-041446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/05/2015] [Indexed: 11/04/2022]
Abstract
Paediatric poisoning is a salient issue worldwide and also affects the USA. In past years, ingestion of household cleaners was the second leading cause of unintentional poisonings in children. All children are at risk for ingestions, although immigrant children may be at greater risk. The purpose of this study was to document child ingestion experiences from toxic household substances via semistructured interviews with immigrant Mexican mothers. Participants were recruited from a paediatric primary care practice in Dallas/Fort Worth, Texas (N=35). Eighteen of 35 respondents (51%) reported that their child, nephew/niece or a friend's child had accidentally ingested a cleaning solution, gasoline or herbal remedy. Of those ingestions, 12 were reportedly from an alternative container, such as a juice box or soda bottle. Improper storage was the primary reason for ingestion. Culturally appropriate home visits and interventions are needed to better prevent ingestion in young children.
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Affiliation(s)
- Katie Crosslin
- Department of Health Studies, Texas Woman's University, Denton, Texas, USA
| | - Ray Tsai
- Children's Health, Dallas, Texas, USA
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38
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Gielen AC, McDonald EM, Shields W. Unintentional home injuries across the life span: problems and solutions. Annu Rev Public Health 2015; 36:231-53. [PMID: 25581150 DOI: 10.1146/annurev-publhealth-031914-122722] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.
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George M, Topaz M, Rand C, Sommers MLS, Glanz K, Pantalon MV, Mao JJ, Shea JA. Inhaled corticosteroid beliefs, complementary and alternative medicine, and uncontrolled asthma in urban minority adults. J Allergy Clin Immunol 2014; 134:1252-1259. [PMID: 25218286 DOI: 10.1016/j.jaci.2014.07.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/09/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults. OBJECTIVES This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care. METHODS Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. RESULTS Psychometric testing of the instrument identified 17 items representing ICS beliefs (α = .59) and CAM endorsement (α = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. CONCLUSION Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.
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Affiliation(s)
- Maureen George
- University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa.
| | - Maxim Topaz
- University of Pennsylvania School of Nursing, Philadelphia, Pa; University of Haifa, Haifa, Israel
| | - Cynthia Rand
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Marilyn Lynn Sawyer Sommers
- University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, Pa
| | - Karen Glanz
- University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Michael V Pantalon
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Jun J Mao
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Judy A Shea
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
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Basso F, Robert-Demontrond P, Hayek M, Anton JL, Nazarian B, Roth M, Oullier O. Why people drink shampoo? Food Imitating Products are fooling brains and endangering consumers for marketing purposes. PLoS One 2014; 9:e100368. [PMID: 25207971 PMCID: PMC4160172 DOI: 10.1371/journal.pone.0100368] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/22/2014] [Indexed: 01/13/2023] Open
Abstract
A Food Imitating Product (FIP) is a household cleaner or a personal care product that exhibits food attributes in order to enrich consumption experience. As revealed by many cases worldwide, such a marketing strategy led to unintentional self-poisonings and deaths. FIPs therefore constitute a very serious health and public policy issue. To understand why FIPs are a threat, we first conducted a qualitative analysis on real-life cases of household cleaners and personal care products-related phone calls at a poison control center followed by a behavioral experiment. Unintentional self-poisoning in the home following the accidental ingestion of a hygiene product by a healthy adult is very likely to result from these products being packaged like foodstuffs. Our hypothesis is that FIPs are non-verbal food metaphors that could fool the brain of consumers. We therefore conducted a subsequent functional neuroimaging (fMRI) experiment that revealed how visual processing of FIPs leads to cortical taste inferences. Considered in the grounded cognition perspective, the results of our studies reveal that healthy adults can unintentionally categorize a personal care product as something edible when a food-like package is employed to market nonedible and/or dangerous products. Our methodology combining field (qualitative) and laboratory (behavioral and functional neuroimaging) findings could be of particular relevance for policy makers, as it can help screening products prior to their market release – e.g. the way they are packaged and how they can potentially confuse the mind of consumers – and therefore save lives.
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Affiliation(s)
- Frédéric Basso
- Psychology@LSE, London School of Economics and Political Science, St Clements Building, London, United Kingdom
- Graduate School of Management, University Rennes 1 & Center for Research in Economics and Management, UMR CNRS 6211, Rennes, France
- Aix Marseille Université, CNRS, LPC UMR 7290, Cognitive Psychology Laboratory, Fédération de Recherche 3C, FR 3512, Case D, Marseille, France
- * E-mail:
| | - Philippe Robert-Demontrond
- Graduate School of Management, University Rennes 1 & Center for Research in Economics and Management, UMR CNRS 6211, Rennes, France
| | | | - Jean-Luc Anton
- Centre d’IRM Fonctionnelle Cérébrale, Institut de Neurosciences de la Timone, UMR 7289, Aix-Marseille Université, CNRS, Marseille, France
| | - Bruno Nazarian
- Centre d’IRM Fonctionnelle Cérébrale, Institut de Neurosciences de la Timone, UMR 7289, Aix-Marseille Université, CNRS, Marseille, France
| | - Muriel Roth
- Centre d’IRM Fonctionnelle Cérébrale, Institut de Neurosciences de la Timone, UMR 7289, Aix-Marseille Université, CNRS, Marseille, France
| | - Olivier Oullier
- Aix Marseille Université, CNRS, LPC UMR 7290, Cognitive Psychology Laboratory, Fédération de Recherche 3C, FR 3512, Case D, Marseille, France
- * E-mail:
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Management of electrical and chemical burns in children. J Surg Res 2014; 190:210-3. [DOI: 10.1016/j.jss.2014.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/24/2014] [Accepted: 03/05/2014] [Indexed: 11/20/2022]
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Ferreira AL, Ferreira JM, Silva PMCD, Constancio DF. Genitalia burn: accident or violence? Concerns that transcend injury treatment. REVISTA PAULISTA DE PEDIATRIA 2014; 32:286-90. [PMID: 25119763 PMCID: PMC4183022 DOI: 10.1590/0103-0582201432213713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/13/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment
(sexual abuse and neglect by lack of supervision). CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an
extensive burn in the vulva and perineum. The mother claimed the burn had been
caused by a sodium-hydroxide-based product. However, the injury severity led to
the suspicion of sexual abuse, which was then ruled out by a multidisciplinary
team, based on the consistent report by the mother. Besides, the lesion type
matched those caused by the chemical agent involved in the accident and the family
context was evaluated and considered adequate. The patient had a favorable outcome
and was discharged after four days of hospitalization. Outpatient follow-up during
six months after the accident enabled the team to rule out neglect by lack of
supervision. COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and
the differential diagnosis between them can be a challenge for healthcare workers,
especially in rare clinical conditions involving patients who cannot speak for
themselves. The involvement of a multidisciplinary trained team helps to have an
adequate approach, ensuring child protection and developing a bond with the
family; the latter is essential for a continued patient follow-up.
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Adukwu EC, Allen SC, Phillips CA. A comparison of the sensitivity of four Staphylococcus aureus isolates to two chlorine-based disinfectants and an eco-friendly commercially available cleaning agent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2014; 25:115-125. [PMID: 24725246 DOI: 10.1080/09603123.2014.903905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine the effect of household bleach, a sodium dichloroisocyanurate (NaDCC)-based disinfectant and an eco-friendly cleaning agent (EFCA) on four Staphylococcus aureus strains, including two isolated from community infections. The products were assessed using the suspension (EN 1276) and surface (EN 13697) tests, while biofilm activity was determined using the 96-well plate method. Bleach and NaDCC caused > 5 log reduction in viable counts within 5 min in suspension, whilst on surfaces the reduction was < 3 log. Bleach at 5000 ppm free available chlorine completely eradicated MSSA NCTC 13297 and PVL CA MSSA biofilms within 10 min, but not at 500 and 50 ppm, NaDCC was less effective against biofilms. The EFCA demonstrated no antimicrobial activity. It is of concern that at the recommended "use" dilution, bleach did not eradicate biofilms. Although increasing contact time and/or concentration should improve the activity, this may not be acceptable to the user.
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Affiliation(s)
- Emmanuel C Adukwu
- a Department of Biology and Biomedical Science , University of the West of England , Bristol , UK
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44
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Hardwicke J, Bechar J, Bella H, Moiemen N. Cutaneous chemical burns in children – A comparative study. Burns 2013; 39:1626-30. [DOI: 10.1016/j.burns.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022]
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Portal Venous Gas Emboli after Accidental Ingestion of Concentrated Hydrogen Peroxide. J Emerg Med 2013; 45:345-7. [DOI: 10.1016/j.jemermed.2013.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 10/16/2012] [Accepted: 02/05/2013] [Indexed: 01/14/2023]
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46
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Jolliff HA, Fletcher E, Roberts KJ, Baker SD, McKenzie LB. Pediatric hydrocarbon-related injuries in the United States: 2000-2009. Pediatrics 2013; 131:1139-47. [PMID: 23650296 DOI: 10.1542/peds.2012-3913] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To generate national estimates of hydrocarbon-related exposures occurring in children ≤5 years of age who were treated in US emergency departments or called a regional poison control center. METHODS This retrospective review compared hydrocarbon-related injuries that occurred from January 1, 2000, through December 31, 2009, that were reported to the National Poison Data System and the National Electronic Injury Surveillance System for children ≤5 years of age. RESULTS From 2000 through 2009, the National Poison Data System reported 65 756 actual calls to regional poison centers, and the National Electronic Injury Surveillance System reported an estimated 40 158 emergency department visits for hydrocarbon-related injuries. Individuals involved were predominantly male and 1 to 2 years of age. Ingestion was the most common mechanism of injury, and most injuries did not result in hospitalization. The rate of emergency department visits and calls to poison centers decreased significantly (P < .0001) over the 10-year study period. Exposures to hydrocarbons demonstrated seasonal variation, with more occurrences in the summer months. CONCLUSIONS The comparison of the two data sets illustrates a similar trend in hydrocarbon-related injuries in children. Although cases have declined, most likely due to existing prevention efforts, hydrocarbons are still a large source of preventable exposure and injury in children.
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Affiliation(s)
- Heath A Jolliff
- Central Ohio Poison Center, Nationwide Children’s Hospital,Columbus, OH, USA.
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47
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van Beelen MEJ, Beirens TMJ, den Hertog P, van Beeck EF, Raat H. First-time parents are not well enough prepared for the safety of their infant. PLoS One 2013; 8:e58062. [PMID: 23483969 PMCID: PMC3590294 DOI: 10.1371/journal.pone.0058062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/31/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Unintentional falls and poisonings are major causes of death and disability among infants. Although guidelines are available to prevent these injuries, safety behaviours are not performed by parents, causing unnecessary risks. Little is known about safety behaviours of first-time parents and whether they behave according to these guidelines. AIMS/OBJECTIVES/PURPOSE: The objective of this study was to compare safety behaviours of first-time parents with those of non-first-time parents and to determine correlates of unsafe behaviour of parents of infants. We used self-report questionnaires to assess safety behaviours in a cross-sectional study sample. METHODS A total of 1439 parents visiting a preventive youth healthcare centre in the Netherlands were invited to complete a questionnaire with regard to the prevention of falls and poisonings. Parents were categorized into first-time parents and non-first-time parents. Correlates of parents' child safety behaviours were determined using multiple logistic regression analyses. RESULTS/OUTCOME Most respondents were mothers (93.2%); 48.2% of families were first-time parents. The mean age of the infants was 7.2 months (SD 1.1; range 4-12), 51.8% were boys, and 34.5% of infants could crawl. First-time parents were more likely not to have a stair gate installed (OR 16.46; 95% CI 12.36-21.93); were more likely to store cleaning products unsafely (OR 4.55; 95% CI 3.59-5.76); and were more likely to store medicines unsafely (OR 2.90; 95% CI 2.31-3.63) than non-first-time parents. First-time parents were more likely to not have a window guard installed (OR 1.52; 95% CI 1.08-2.15) (all P<0.05). DISCUSSION/CONCLUSION First-time parents are not well prepared for the safety of their infant, causing unnecessary risks. The various parents' safety behaviours were influenced by different variables, for example, age of the infant, crawling of the infant, mother's educational level, mother's ethnicity, self-efficacy, vulnerability, severity.
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Affiliation(s)
| | - Tinneke M. J. Beirens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dutch Association for Youth Health Care Physicians, Utrecht, The Netherlands
| | | | - Eduard F. van Beeck
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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48
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George M, Topaz M. A systematic review of complementary and alternative medicine for asthma self-management. Nurs Clin North Am 2013; 48:53-149. [PMID: 23465447 DOI: 10.1016/j.cnur.2012.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article is a systematic review of complementary and alternative medicine use for pediatric and adult asthma self-management. The aim of the review was to summarize the existing body of research regarding the types and patterns of, adverse events and risky behaviors associated with, and patient-provider communication about complementary therapies in asthma. This evidence serves as the basis for a series of recommendations in support of patient-centered care, which addresses both patient preferences for integrated treatment and patient safety.
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Affiliation(s)
- Maureen George
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
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49
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Complications of chlorine inhalation in a pediatric chemical burn patient: a case report. J Burn Care Res 2012; 33:e216-21. [PMID: 22665132 DOI: 10.1097/bcr.0b013e318254d1c8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of burn injuries in the pediatric population occur at home, and a significant proportion are the result of exposure to household cleaning products. A common injury-causing agent is bleach, which has the potential to release chlorine gas, a potent respiratory irritant that leads to the added risk of inhalation injury. The survival of pediatric patients with chemical burns is extremely high, and the 3 strongest predictors of mortality are large burn size, age <48 months, and the presence of inhalation injury. The authors present a rare case of a pediatric fatality from a chemical bleach burn that resulted in acute respiratory distress syndrome as well as hemodynamic and pulmonary instability that required extracorporeal membrane oxygenation. The authors critically appraised the management of this patient to determine the possible effect certain events had on the unexpected and poor outcome of this patient, including fluid resuscitation, the effect of the chemical inhalation injury, sedation, and the need for invasive extracorporeal membrane oxygenation life support.
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Tiedeken J, Uradomo L, Anderson KD, Brody F. Minimally invasive repair of a late stricture in a reversed gastric tube. J Pediatr Surg 2012; 47:2321-6. [PMID: 23217898 DOI: 10.1016/j.jpedsurg.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
Ingestion of caustic agents may result in severe scarring and stricture formation of the esophagus. Reversed gastric tube esophagoplasty is an option for definitive surgical management of severe esophageal stricture refractory to medical treatment. Delayed complications from this procedure have rarely been reported. We present a case involving a patient who developed a delayed gastric stricture three decades after receiving a reversed gastric tube esophagoplasty. A historical review of the reversed gastroplasty is presented as well.
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Affiliation(s)
- John Tiedeken
- Department of Surgery, The George Washington University Medical Center, Washington, DC 20037, USA
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