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Eizadi-Mood N, Sanjari H, Feizi A, Yazdi R, Dorostkar A, Mahvari R, Mirmoghtadaee P, Meamar R. Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran. Sci Rep 2024; 14:10493. [PMID: 38714819 PMCID: PMC11076496 DOI: 10.1038/s41598-024-61411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/06/2024] [Indexed: 05/10/2024] Open
Abstract
The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, Khorshid hospital, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Sanjari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Yazdi
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Dorostkar
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Mahvari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Mirmoghtadaee
- Deputy of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Khorshid hospital, Isfahan University of Medical Sciences, Ostandari Street, Hasht Behest Avenue, Isfahan, 81458-31451, Iran.
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Laflamme L, Lindholm E, Möller J. Repeated hospital admission for intentional poisonings among older adults - a Swedish national register-based study. BMC Geriatr 2024; 24:157. [PMID: 38360600 PMCID: PMC10870539 DOI: 10.1186/s12877-024-04717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event. METHODS We conducted a nationwide register-based cohort study of people aged 50-100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006-2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)). RESULTS Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45-2.01 and 1.89 (95% CI = 1.60-2.19) respectively). CONCLUSION Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect.
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Affiliation(s)
- L Laflamme
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - E Lindholm
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Jette Möller
- Department of Global Public Health , Karolinska Institutet, Widerströmska huset Tomtebodavägen 18A, 17177, Stockholm, Sweden.
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Jang JS, Seo WS, Koo BH, Kim HG, Yun SH, Jo SH, Bai DS, Kim YG, Cheon EJ. The characteristics of elderly suicidal attempters in the emergency department in Korea: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:30-38. [PMID: 38155553 PMCID: PMC10834272 DOI: 10.12701/jyms.2023.01004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group. METHODS Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18-64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group. RESULTS Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01). CONCLUSION Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.
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Affiliation(s)
- Ji-Seon Jang
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Wan-Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Hey-Geum Kim
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok-Ho Yun
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - So-Hey Jo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae-Seok Bai
- Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
| | - Young-Gyo Kim
- Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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Sánchez-Teruel D, Robles-Bello MA, Sarhani-Robles A. Suicidal vulnerability in older adults and the elderly: study based on risk variables. BJPsych Open 2022; 8:e77. [PMID: 35361297 PMCID: PMC9059621 DOI: 10.1192/bjo.2022.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Predicting suicidal vulnerability based on previous risk factors remains a challenge for mental health professionals, especially in specific subpopulations. AIMS This study aimed to use structural equation modelling to assess which sociodemographic and clinical variables are most predictive and modulating of repeated self-injury or reattempts at suicide in older adults and the elderly with previous attempts. METHOD We obtained digital data for 619 people (N = 342; 55.3% women), aged 50-96 years (mean 71.2 years, s.d. 3.65), who presented to the emergency department with a repeated self-injury or suicide attempt. Data were collected from several public and private hospitals in southern Spain. RESULTS There were different sociodemographic and clinical profiles between people who repeat self-injury and those who reattempt suicide. In addition, we show that outcome variables may directly or indirectly modulate these behaviours. CONCLUSIONS The study findings provide only a limited insight into suicidal vulnerability in older people, and there is an urgent need for specific care protocols for the prevention of repeated self-injury or reattempts at suicide that are adapted to the psychosocial characteristics of this age group. There is also a need to improve social and health alert actions for older adults and the elderly who present with suicide risk profiles, and the presence of mental health professionals in hospital emergency departments should be improved.
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Affiliation(s)
- David Sánchez-Teruel
- Department of Personality, Assessment and Psychological Treatment, University of Granada, Spain; Department of Personality, Assessment and Psychological Treatment, Spanish Society of Suicidology, Spain; and Department of Personality, Assessment and Psychological Treatment, Spanish Society of Clinical and Health Psychology, Spain
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Abstract
Civil religion refers to a country’s beliefs, symbols, and rituals that bolster national unity and strengthen its citizens’ sense of identity and belonging. However, the literature on civil religion is divided between those who attribute it to bottom-up cultural spontaneity and those who see it as an ideological top-down construction. Moreover, there has been a relative lack of scholarly attention to Korean civil religion. This paper addresses both issues by arguing that a strong civil religion indeed exists in the country and that it has been an important part of the “nation-building” process since the founding of the Republic of Korea in 1948. The paper highlights how a succession of authoritarian regimes (1948–1987) successfully mobilized a strong civil religion for political purposes. The resulting civil religion targeted economic growth as the national goal to overcome all social ills, focused on the country’s ethnic and cultural homogeneity to boost national confidence and pride, exalted its traditional religions, especially Confucianism, as repositories of Korean traditional culture, and rendered sacred meanings to national symbols such as the flag and national anthem. Even after democratization, Korean civil religion remains largely ideological, as the Korean government is heavily involved in framing, planning, sponsoring, and promoting the country’s civil religion. Nevertheless, the paper concludes by observing that this civil religion is entering a period of crisis due to political fragmentation among Korean elites and deeply rooted cultural and societal change.
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