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1.
Rev Bras Epidemiol ; 23: e200024, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401920

RESUMO

BACKGROUND: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. AIM: To assess poisonings and associated factors with lethality by pesticides. METHOD: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. RESULTS: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. CONCLUSION: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.


Assuntos
Praguicidas/envenenamento , Envenenamento/mortalidade , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Doenças dos Trabalhadores Agrícolas/mortalidade , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
2.
Rev Bras Epidemiol ; 23: e200016, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159627

RESUMO

INTRODUCTION: In Brazil, drugs are the main causative agents of poisonings, and children under age five are the group with the highest number of cases. The objective of the present study was to describe hospitalizations due to drug poisoning in this population regarding demographics, deaths and worsening indicators in hospitalizations. METHODS: The frequency of hospitalizations for drug poisoning between 2003 and 2012 was verified using data from the Hospital Information System. The study variables were year, gender, age, place of residence and hospitalization, patient follow-up, main diagnosis, secondary diagnosis, nature of the health establishment and amount related to Intensive Care Unit expenses. RESULTS: There were 17,725 hospitalizations due to drug poisoning in children under five, predominantly two-year-old male children. The hospitalizations outside the city of residence occurred in 25% of the cases, with predominance in the Northeastern region. The proportion of deaths in hospitalizations was 0.4%, with a higher number of deaths in the Southeastern region. CONCLUSION: Despite the decrease in the number of hospitalizations in the period, regional disparities remained, which could be attenuated with the provision of specialized attention to drug poisonings in municipalities, expanding the access to a more complex care.


Assuntos
Tratamento Farmacológico/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Hospitalização/estatística & dados numéricos , Preparações Farmacêuticas/administração & dosagem , Envenenamento/mortalidade , Distribuição por Idade , Brasil/epidemiologia , Pré-Escolar , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Distribuição por Sexo
3.
Medicine (Baltimore) ; 99(6): e19063, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028427

RESUMO

BACKGROUND: Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning. METHODS: We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis. RESULTS: Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95% CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis. CONCLUSION: Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.


Assuntos
Paraquat/envenenamento , Envenenamento/mortalidade , Humanos , Paraquat/sangue , Envenenamento/sangue , Valor Preditivo dos Testes , Índice de Gravidade de Doença
4.
Am J Forensic Med Pathol ; 41(1): 18-26, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000223

RESUMO

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.


Assuntos
Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/análise , Criança , Grupos de Populações Continentais/estatística & dados numéricos , District of Columbia/epidemiologia , Afogamento/mortalidade , Etanol/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/análise , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
7.
Am J Forensic Med Pathol ; 40(4): 312-317, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688052

RESUMO

BACKGROUND: Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes. METHODS: This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012. RESULT: A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death. CONCLUSIONS: The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.


Assuntos
Morte Súbita/epidemiologia , Esquizofrenia/epidemiologia , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Médicos Legistas , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Adulto Jovem
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1013-1017, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537230

RESUMO

OBJECTIVE: To evaluate the prognostic value of early white blood cell count (WBC) in patient of acute paraquat poisoning. METHODS: The literatures about the studies on early WBC and prognosis after paraquat poisoning published in journals at home and abroad were searched. The Chinese literature database contained CNKI, VIP, Wanfang Database, and China Biomedicine Database (CBM), and the journals were limited to the core journals. The foreign language database included PubMed, Embase and Cochrane library clinical controlled trial database. The retrieval date was from the initial publication to April 22nd in 2019, without the limitation of languages. Two researchers independently extracted literature information, and the Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality. The odds ratio (OR), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) were combined and analyzed through the Stata 15.0 software to evaluate the predictive value of early WBC after acute paraquat poisoning. Publication bias was analyzed by Deeks funnel graph. RESULTS: There were 7 retrospective studies and 1 prospective study in a total of 980 paraquat poisoning patients, 5 of them were English literatures, the others were Chinese literatures. There was no heterogeneity among the studies (I2 = 43.5%, P > 0.05). The OR and its 95% confidence interval (95%CI) of the literature was combined through the fixed effect model. The Meta-analysis results were statistically significant (OR = 18.63, 95%CI = 13.63-25.48, P < 0.001), suggesting that the WBC was significantly correlated with the mortality of patients. The combined sensitivity, specificity, PLR, NLR and DOR were 0.75 (95%CI = 0.66-0.82), 0.85 (95%CI = 0.80-0.90), 5.14 (95%CI = 3.86-6.86), 0.29 (95%CI = 0.22-0.39), 17.53 (95%CI = 12.23-25.13) respectively, and the area under the SROC of the WBC was 0.88 (95%CI = 0.85-0.91). Deeks funnel plot was symmetrical (P = 0.21), and there was no obvious publication bias. CONCLUSIONS: The early WBC has a certain predictive value for the prognosis of acute paraquat poisoning patients.


Assuntos
Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , China , Humanos , Contagem de Leucócitos , Estudos Prospectivos , Estudos Retrospectivos
9.
Med J Aust ; 211(5): 218-223, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31389025

RESUMO

OBJECTIVES: To assess the numbers of paracetamol overdose-related hospital admissions and deaths in Australia since 2007-08, and the overdose size of intentional paracetamol overdoses since 2004. DESIGN, SETTING: Retrospective analysis of data on paracetamol-related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007-08 to 2016-17), the New South Wales Poisons Information Centre (NSWPIC; 2004-2017), and the National Coronial Information System (NCIS; 2007-08 to 2016-17). PARTICIPANTS: People who took overdoses of paracetamol in single ingredient preparations. MAIN OUTCOME MEASURES: Annual numbers of reported paracetamol-related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses. RESULTS: The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007-08 to 2016-17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2-4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0-9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004-2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5-4.2%). The median number of tablets taken increased from 15 (IQR, 10-24) in 2004 to 20 (IQR, 10-35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30-47%). 126 in-hospital deaths were recorded in the NHMD, and 205 deaths (in-hospital and out of hospital) in the NCIS, with no temporal trends. CONCLUSIONS: The frequency of paracetamol overdose-related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased.


Assuntos
Acetaminofen/envenenamento , Analgésicos não Entorpecentes/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição , Estudos Retrospectivos , Adulto Jovem
10.
PLoS One ; 14(7): e0219711, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31323036

RESUMO

BACKGROUND: Increase in mortality involving poisoning, particularly by narcotics, is known to have been one of the factors that affected life expectancy in the US during the last two decades, especially for white Americans and Native Americans. However, the contribution of medicaments other than narcotics to mortality in different racial/age groups is less studied. METHODS: We regressed annual rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics (ICD-10 codes T36-39.xx or T41-50.8 but not T40.xx present as either underlying or contributing causes of death), as well as annual rates of mortality for certain subcategories of the above, including mortality involving poisoning by psychotropic drugs but not narcotics/psychodysleptics (ICD-10 codes T43.xx but not T40.xx present as either underlying or contributing causes of death) in different age/racial groups for both the 2000-2011 period and the 2011-2017 period against calendar year. RESULTS: Annual numbers of deaths involving poisoning by medicaments but not narcotics/psychodysleptics grew from 4,332 between 2000-2001 to 11,401 between 2016-2017, with the growth in the rates of those deaths being higher for the 2011-2017 period compared to the 2000-2011 period. The largest increases in the rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics were in non-elderly Non-Hispanic Native Americans, followed by Non-Hispanic whites. Most of those increases came from increases in the rates of mortality involving poisoning by psychotropic medications; the latter rates grew for the period of 2015-2017 vs. 2000-2002 by factors ranging from 2.75 for ages 35-44y to 5.37 for ages 55-64y. CONCLUSIONS: There were major increases in mortality involving poisoning by non-narcotic, particularly psychotropic medicaments, especially in non-elderly non-Hispanic whites and Native Americans. Our results support the need for a comprehensive evaluation of the effect of psychotropic medications on health-related outcomes, including mortality for causes other than poisoning, and the impact of medication misuse.


Assuntos
Mortalidade/tendências , Envenenamento/mortalidade , Psicotrópicos/envenenamento , Adulto , Idoso , Grupos de Populações Continentais , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Humanos , Índios Norte-Americanos , Pessoa de Meia-Idade , Entorpecentes/envenenamento , Análise de Regressão , Estados Unidos/epidemiologia
11.
Int J Occup Med Environ Health ; 32(4): 489-501, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31241049

RESUMO

OBJECTIVES: Many research studies conducted in various toxicology centers point to drugs as the most common cause of intoxication. Long-term observations make it possible to clarify the nature of these poisonings. The aim of this study was to examine the trends and reasons of intoxication in patients hospitalized over a 10-year observation period (2005-2015), as well as to compare the number of patients poisoned with nonsteroidal anti-inflammatory drugs (NSAIDs), mainly over-the-counter (OTC) drugs. MATERIAL AND METHODS: A retrospective observational study examined the medical documentation of patients hospitalized in the Department of Toxicology and Internal Diseases of the T. Marciniak Lower Silesian Specialist Hospital in Wroclaw in 2005-2015, including the analysis of the causes of intoxication as well as total poisoning-related death statistics. Quarterly and annual analyses of the numerical data, and comparisons of the frequency of poisonings were included. The patient population from the area of Lower Silesia, Poland, was examined. RESULTS: The number of hospitalized patients has increased, with attempted suicide being the leading cause of death. Male intoxication and mortality have been found to predominate. Drugs are the most common cause of poisoning, and among these the most common are sedatives and psychotropic drugs. Intoxication due to NSAIDs, especially OTC drugs, increased significantly in the observation period. In 2005 no fatal cases were reported as a result of NSAID intoxication, while in 2015 mortality significantly increased to 43%. CONCLUSIONS: The lack of a common trend in poisonings is observed but the number of hospitalized patients has increased, especially among young people, which is consistent with global trends. Drugs are the most common cause of mortality, and a significant increase in NSAID (mainly OTC) poisonings in particular indicates the growing prevalence of an uncontrolled use of these drugs. Int J Occup Med Environ Health. 2019;32(4):489-501.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Envenenamento/epidemiologia , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/envenenamento , Uso Indevido de Medicamentos/mortalidade , Feminino , Humanos , Hipnóticos e Sedativos/envenenamento , Masculino , Pessoa de Meia-Idade , Envenenamento/mortalidade , Polônia/epidemiologia , Psicotrópicos/envenenamento , Estudos Retrospectivos , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Xenobióticos/envenenamento
12.
J Forensic Leg Med ; 65: 124-132, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153007

RESUMO

Poisoning is recognized as a major factor for deaths in majority of low-income and middle-income countries. Although it is considered as a global burden, the nature of poisoning may vary in different areas across the world. The Charutar region in the state of Gujarat in western India has a unique topography and cultivation practises which sets it apart from the rest of the state. Due to the dearth of studies pertaining to the access of the population at this area to different types of poisons and pattern of poisoning, we planned this study to find magnitude, morbidity and mortality of poisoning with a specific consideration of gender, age and poison in contrast to the usual adopted cumulative approach. In a retrospective study, 1092 cases were identified as poisoning cases. The study revealed a higher vulnerability to poisoning in males, married individuals, during the third decade of life, from rural areas, due to accidental causes, during day time events and during the monsoon seasons. The gender specific approach clarified additional comparative data. More deaths were reported from suicidal poisoning than accidental ones. 49 specific poisons were found in the study, among which accidental snake bite poisoning, insecticidal substances and aluminium phosphide were prevalent. Aluminium phosphide and quinalphos were responsible for the highest fatalities (in terms of number of persons died). Gender predominance was observed for specific poisons. Age wise distribution of specific poisons was derived. Treatment duration and survival period for specific poisons were calculated.


Assuntos
Envenenamento/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Compostos de Alumínio/envenenamento , Criança , Toxicologia Forense , Humanos , Índia/epidemiologia , Inseticidas/envenenamento , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Fosfinas/envenenamento , Estudos Retrospectivos , Fatores de Risco , População Rural/estatística & dados numéricos , Estações do Ano , Distribuição por Sexo , Mordeduras de Serpentes/mortalidade , Venenos de Serpentes/envenenamento , Suicídio/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
J Forensic Leg Med ; 65: 137-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31154091

RESUMO

INTRODUCTION: Bereavement is usually difficult to come to terms with. However, sudden, violent or traumatic death can be particularly hard to accept for any family, group or nation as a whole. A retrospective study of all autopsies on unnatural and traumatic deaths of medico-legal importance was made at the Komfo Anokye Teaching Hospital from 2008 to 2016. METHODS: Information on cause of death and other relevant detail as well as demographics were extracted from the Autopsy Log Book of the department of pathology, Komfo Anokye Teaching Hospital where data on cause of death from autopsy findings and other relevant data were gathered and kept secured. The data was then analyzed using SPSS version 22. RESULTS: Findings from the study showed that Road Traffic Accidents (RTA) contributed to 58.51% of the total forensic death cases of a total of the 1470 registered unnatural deaths. Males accounted for 75.37% of deaths as compared to 24.63% for females. The mean age for the various cause of unnatural deaths was 34 years. The age ranges from a minimum of 0.02 year (1 week) to a maximum of 97 years with median age of 33. The modal age is 30 years with 75 cases. 1108 males and 362 females were involved, resulting in a gender ratio of 3:1. The age group 30-39 recorded the highest percentage of deaths due to Hanging, Gunshots, RTA and Falls with 22.45%, 34.69%, 21.75% and 25.44% respectively. Children aged ≤9 recorded the highest number of deaths due to chemical poisoning and drowning with 25.5 8% and 40.00% of cases respectively. People in the extremes of ages (≤9 and ≥ 70) recorded the least number of death cases by percentage. CONCLUSION: Road traffic accident is therefore the leading cause of unnatural traumatic deaths as it accounted for more than half of all unnatural traumatic death cases reported in the forensics department. Men, especially the youth are also more prone to violent unnatural deaths compared to women in general. It is shown that, men die more in the various categories than women. Males are likely to die on the average, 3 times more than the females by any of the manner of deaths.


Assuntos
Causas de Morte , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Criança , Pré-Escolar , Afogamento/mortalidade , Feminino , Medicina Legal , Gana/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Abuso Físico/estatística & dados numéricos , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
14.
Medicine (Baltimore) ; 98(23): e15973, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169729

RESUMO

BACKGROUND: Although the prognostic significance of base excess (BE) in patients with paraquat (PQ) poisoning has been investigated for several years, the results remain controversial. Thus, we performed for the first time a comprehensive meta-analysis to explore the value of BE in predicting the prognosis of patients with PQ poisoning. METHODS: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and the Chinese National Knowledge Infrastructure to identify all relevant papers that were published up to August 2018. The data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis. RESULTS: Pooled analysis revealed that a decreased BE is correlated with poor mortality (pooled OR = 21.358, 95% CI: 12.716-35.873, P < .001). Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 78% (95% CI: 0.66-0.86), 88% (95% CI: 0.66-0.97), 6.6 (95% CI: 2.2-19.9), 0.25 (95% CI: 0.18-0.36), and 26 (10-69), respectively. No publication bias was detected by Egger test (P = .263) and Begg test (P = .462). Sensitivity analyses indicated no important differences among the estimates of effects. CONCLUSION: Our findings show that BE is useful for predicting the prognosis of PQ poisoning.


Assuntos
Equilíbrio Ácido-Base , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Humanos , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
15.
J Forensic Leg Med ; 65: 76-80, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31112932

RESUMO

According to World Health Organization (WHO) estimations, approximately 6 million people lose their lives yearly due to some kind of injury, while one-third of these incidents are due to violent acts. Violent deaths include accidents (road traffic accidents, drownings, falls, heat effects etc), suicides as well as homicides. Elderly people seem to be at greater risk due to their special characteristics as a vulnerable social group. The aim of this study was to investigate violent deaths (accidents, suicides and homicides) among elderly people in Attica, Greece, during the period 2011-2015 by examining manner of death with respect to demographic data (gender and age) and toxicological examination results. A total of 546 violent deaths among people over 65 years old were included in this study. Autopsy findings along with toxicological examination results were collected from the archives of the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens. The findings of the study showed that most of the victims were male (63.74%). The overwhelming majority of violent deaths (425 cases) were accidents, 92 cases suicides, and the remaining 29 cases homicides. Drowning was the leading cause of all accidental deaths, followed by road traffic accidents. Hangings prevailed among violent suicide methods and asphyxiation presented as a predominant homicide method.


Assuntos
Acidentes/mortalidade , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Queimaduras/mortalidade , Afogamento/mortalidade , Feminino , Grécia/epidemiologia , Humanos , Masculino , Lesões do Pescoço/mortalidade , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade
16.
Toxicol Mech Methods ; 29(7): 511-517, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31070080

RESUMO

During an avian mass mortality event investigation at the National Fish and Wildlife Forensic Laboratory in Ashland, OR, imidacloprid became an insecticide of concern. A qualitative analytical toxicology screen of seeds, plucks (tongue, esophagus, and trachea), and ventricular contents was requested. A method for the extraction and qualitative analysis of the insecticide in animal tissues was therefore developed. The procedure relies on a combined Food Emergency Response Network (FERN) and QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) approach to sample extraction followed by qualitative analysis by gas chromatography-tandem mass spectrometry. Since imidacloprid is not amenable to the conditions of gas chromatography, a trimethylsilyl derivative was created and characterized. Proposed mechanisms for the creation of this derivative and its mass spectrum are described. The imidacloprid-trimethylsilyl (TMS) derivative was detected in all samples submitted.


Assuntos
Aves , Toxicologia Forense/métodos , Neonicotinoides/análise , Nitrocompostos/análise , Patologia Veterinária/métodos , Resíduos de Praguicidas/análise , Animais , Autopsia , Doenças das Aves/mortalidade , Toxicologia Forense/instrumentação , Cromatografia Gasosa-Espectrometria de Massas/veterinária , Neonicotinoides/envenenamento , Nitrocompostos/envenenamento , Patologia Veterinária/instrumentação , Resíduos de Praguicidas/envenenamento , Envenenamento/mortalidade , Envenenamento/veterinária , Espectrometria de Massas em Tandem/veterinária
17.
Public Health ; 170: 78-88, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30978579

RESUMO

OBJECTIVES: Comprehensive and up-to-date data on fatal injury trends are critical to identify challenges and plan priority setting. This study provides a comprehensive assessment of poisoning mortality trends across Iran. STUDY DESIGN: The data were gathered from various resources, including death registration systems, cemetery databases of Tehran and Esfahan, the Demographic and Health Survey of 2000, and three rounds of national population and housing censuses. METHODS: After addressing incompleteness for child and adult death data separately and using a spatio-temporal model and Gaussian process regression, the level and trend of child and adult mortality were estimated. For estimating cause-specific mortality, the cause fraction was calculated and applied to the level and trend of death. RESULTS: From 1990 to 2015, 40,586 deaths due to poisoning were estimated across the country. The poisoning-related age-standardized death rate per 100,000 was estimated to have changed from 3.08 (95% uncertainty interval [UI]: 2.32-4.11) in 1990 to 0.96 (95% UI: 0.73-1.25) in 2015, and the male/female ratio was 1.35 during 25 years of study with an annual percentage change of -5.4% and -4.0% for women and men, respectively. The annual mortality rate was higher among children younger than 5 years and the elderly population (≥70 years) in the study period. CONCLUSIONS: This study showed that mortality from poisoning declined in Iran over the period from 1990 to 2015 and varied by province. Understanding the reasons for the differences of poisoning mortality by province will help in developing and implementing measures to reduce this burden in Iran.


Assuntos
Envenenamento/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Adulto Jovem
18.
Am J Forensic Med Pathol ; 40(3): 220-226, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30994496

RESUMO

Childhood and adolescent suicides have been increasing worldwide in recent years, and the investigation of such deaths is often complex. Forensic pathologists frequently find themselves having to opine as to the manner of death in these difficult cases. The present study was undertaken to identify distinguishing features in childhood and adolescent suicides to assist in the investigation and prevention of these deaths. A 25-year review of pediatric suicides in a metropolitan area was performed, which showed a steady increase in pediatric suicides over time. Male pediatric suicides were more common than female, with both having an average age of 15 years. Gunshots wounds and hanging were the most common methodologies seen, with drug toxicity being more common in females and gunshot wounds more common in males. Approximately 20% of decedents had a psychiatric history, 25% had a previous history of a suicide attempt or ideation, and 24% had a history of drug use. Only a minority of decedents made their intentions known prior to the suicidal act (16%) or left a note of intent (16%). In 62% of cases, a temporal, precipitating event could be identified, of which conflict with a significant other (boyfriend or girlfriend) was the most common. No specific trends over time were identified. While these features may assist forensic pathologists in assessing a possible suicidal death in the pediatric age group, medicolegal death investigators must approach these deaths as they would any violent death in an attempt to accurately determine the manner of death regardless of the societal and familial implications of such a determination.


Assuntos
Suicídio/estatística & dados numéricos , Adolescente , Distribuição por Idade , Asfixia/mortalidade , Criança , Conflito Psicológico , Conflito Familiar , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Lesões do Pescoço/mortalidade , Envenenamento/mortalidade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade
19.
Am J Public Health ; 109(6): 854-858, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30998413

RESUMO

Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.


Assuntos
Mortalidade , Angústia Psicológica , Causas de Morte , Humanos , Renda , Hepatopatias Alcoólicas/mortalidade , Envenenamento/mortalidade , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia
20.
J Stud Alcohol Drugs ; 80(2): 201-210, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31014465

RESUMO

OBJECTIVE: Despite the rising toll of drug poisoning deaths in the United States, the extent of the problem among adolescents and young adults ages 15-24 years has received relatively little attention. We examined sociodemographic characteristics and state trends in drug poisoning deaths among adolescents and young adults from 2006 to 2015 and estimated the costs of drug poisoning mortality in this population. METHOD: We used the National Vital Statistics System's Multiple Cause of Death files from 2006 to 2015. We analyzed trends using Joinpoint regression analysis and calculated total costs of drug poisoning deaths, including medical costs, work loss costs, and quality of life loss, based on widely used cost estimates. RESULTS: Drug poisoning death rates (per 100,000 population) in adolescents and young adults increased from 8.1 in 2006 to 9.7 in 2015. The rates increased significantly for Whites (1.7% per year) and Asian/Pacific Islanders (4.3% per year) from 2006 to 2015 and for Blacks (11.8% per year) from 2009 to 2015. By U.S. region, the rates increased significantly in the Midwest (4.4% per year) from 2006 to 2015 and in the Northeast (11.0% per year) from 2009 to 2015. Trends varied by age group, intent for drug poisoning, drug category (i.e., opioids, pharmaceutical drugs excluding opioids, illicit drugs excluding opioids, and unspecified drugs), urbanization level, and state. The estimated costs of drug poisoning deaths among adolescents and young adults totaled approximately $35 billion in 2015. CONCLUSIONS: Trends in drug poisoning deaths and estimated costs inform state-specific prevention and intervention efforts.


Assuntos
Analgésicos Opioides/envenenamento , Drogas Ilícitas/envenenamento , Envenenamento/epidemiologia , Adolescente , Feminino , Humanos , Masculino , Envenenamento/mortalidade , Qualidade de Vida , Estados Unidos/epidemiologia , Adulto Jovem
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