The spectrum of accidental childhood poisoning in the Caribbean.

OBJECTIVE: To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America. DESIGN AND METHODS: We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. RESULTS: In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. CONCLUSIONS: There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.     

Accidental poisoning among children and adolescents in a county in southern Brazil

This study analyzes the characteristics of accidental poisoning among children and young adolescents (< 15 years) in Londrina, Paraná State, Brazil, in 2001. Data were obtained from patient records in general hospitals, the local Poison Control Center, and the municipal Mortality Information Center. There were 473 cases of poisoning, with an incidence rate of 339.8 per 100,000, 58.5% due to poisonous substances and 39% due to venomous animals and plants. Increased risk was observed in the 1-3-year age group, due to poisonous substances. Medications (47.5%), pesticides (14.1%), and cleaning products (11.3%) were the main substances involved (284 cases), and 17.2% of children were hospitalized. Among 189 cases of contact with venomous animals and plants, caterpillars (29.1%), bees (25.9%), and spiders (22.8%) were the main agents, with a 1.1% hospitalization rate. Incidence of poisoning is high, and there are important differences in the types of agents involved according to age group, which may help orient the prevention of such accidents.     

2010-2017年广西有毒动植物中毒事件分析

目的 分析广西2010-2017年有毒动植物食物中毒事件流行病学特征,为下一步预防和控制有毒动植物食物中毒的发生提供科学依据。方法 收集广西2010-2017年食源性疾病暴发监测系统资料数据,并按时间、地区、场所、中毒因素等进行统计分析。结果 2010-2017年广西共报告有毒动植物事件148起,其中有毒植物144起(97.3%),有毒动物4起(2.7%)。发生暴发最多的是第二季度63起(42.6%),发生起数最多的地区是南宁市29起(19.6%),发生起数最多的场所是家庭(62.2%),7~19岁青少年是主要中毒人群(37.5%),误食误用是中毒主要致病原因(81.8%),毒菌毒素(43.9%)和桐子酸及异桐子酸(27.0%)是主要致病因子。结论 广西有毒植物中毒问题仍较突出,应加强广泛宣传有毒植物中毒的预防知识,以有效地减少广西有毒植物中毒事件的发生。     

某市36起毒蕈中毒事件调查

目的：了解长沙市毒蕈中毒发生情况，以预防类似事件的发生。方法：统计了湖南省从1994－2000年的36起毒蕈中毒事件，并测定了主要毒蕈的毒素含量。结果：在中毒事件中，共有210人食用，205人中毒，中毒率为962％，83人死亡，死亡率为39．52％，引起中毒的主要毒蕈为：灰花纹鹅膏，鳞柄白毒鹅膏，亚稀褶黑菇，中毒多发生在6月至8月。结论：中毒原因主要是食用者缺乏对毒蕈的认识，中毒后死亡率高的原因是因为毒蕈含毒素量高，中毒后就诊确诊太晚和缺乏特效解毒药物。     

毒杀社鼠的引诱剂选择试验

在大米中分别加入9类不同物质作为引诱剂,对社鼠进行室内食量观察。结果表明,5%白糖、3%菜油 5%白糖和3%猪油 5%白糖的适口性最好。毒鼠磷正常毒饵与加糖毒饵对比显示,后者对社鼠的适口性更佳,两者的摄食量具有显著差异。因此,白糖在毒杀社鼠中可作为一种有效的引诱剂。     

北京市0～6岁儿童血铅水平与相关影响因素的研究

目的　了解近期北京市 0～ 6岁儿童血铅水平及其影响因素。方法　采取分层整群随机抽样的方法。 2 0 0 1年 5～ 7月调查北京市常住人口中 0～ 6岁儿童 2 2 62名。采用石墨炉原子吸收法进行微量血中铅含量的测定 ,并做相关因素问卷调查。结果　北京市 0～ 6岁儿童血铅水平均值为96.8μg L,血铅值≥ 10 0 μg L为 3 5.7% ,血铅值≥ 2 0 0 μg L为 2 .5%。农村儿童铅中毒为 43 % ,明显高于城区和郊区儿童。 2岁组铅中毒为 45.1%高于其他年龄组。男童血铅平均值 10 0 .2 μg L明显高于女童血铅平均值 93 .0 μg L(P <0 .0 1)。不喝或偶喝牛奶、居室距繁华马路≤ 50m、家庭居住 1层楼房或平房为儿童高血铅的主要危险因素。结论　目前北京市儿童血铅水平≥ 10 0 μg L的比例不容忽视 ,应对重点人群采取行之有效的干预措施     

Eucalyptus oil poisoning among young children: mechanisms of access and the potential for prevention

Abstract: We studied unintentional paediatric eucalyptus oil poisoning to identify potential intervention strategies. The epidemiology of paediatric eucalyptus oil poisoning in Victoria was determined by analysis of four databases. The sequence of events preceding ingestion was examined by a telephone survey involving 109 parents or guardians of children under five years involved in an actual or suspected ingestion of eucalyptus oil. Such children were identified prospectively from all callers during a nine–month period to the Victorian Poisons Information Centre and those presenting to the emergency departments of the participating hospitals of the Victorian Injury Surveillance System. Eucalyptus oil was a leading agent associated with hospitalisation for poisoning among Victorian children aged under five years. In the telephone survey, 90 incidents were found to involve vaporiser solutions, 15 eucalyptus oil preparations, and the remainder other eucalyptus–oil–containing products of a medicinal nature. Regardless of the type of product, 74 per cent gained access via a home vaporiser unit, most frequently placed at ground level. Although amounts ingested are usually small, the reported range of toxic doses is wide, necessitating at least a medical assessment following ingestion. Potential countermeasures identified in a consultative workshop included: discontinuing the use of eucalyptus oil as a therapeutic agent; confirmation that vaporiser–well residues are nontoxic; removal of barriers to product reregistration following safety–related modifications; improved child–resistant closures; discouraging vaporiser use for respiratory infections among young children; and development and dissemination of protocols for treatment of suspected ingestion.     

深圳市福田区0~6岁儿童血铅监测模式的探讨

目的:了解福田区0~6岁儿童血铅水平分布状况并探讨血铅监测模式。方法:随机整群抽取0~6岁儿童末梢血1817份,采用石墨炉原子吸收光谱法进行血铅水平测定,用SPSS13·0软件分析血铅水平状况。结果:福田区儿童血铅水平几何均值为8·2μg/dl,铅中毒率11·03%,均值曲线图显示6个月、30个月为峰值。结论:目前福田区0~6岁儿童血铅水平处于全国较低水平,在儿童保健工作中建立0~6岁儿童血铅监测模式对儿童铅污染进行干预,将为消除儿童铅中毒提供有效可行的办法。     

隆昌县铅中毒儿童血铅水平检测结果分析

[目的]了解隆昌县铅中毒儿童含量,探讨其综合防治措施以及血铅污染的来源。[方法]以隆昌县鱼建镇金属铅回收厂周围800m以内的1～12岁的424名儿童作为检测对象,以2009年7月～2010年2月泸州医学院附属医院儿科体检的3548名儿童作为参考对象,用原子吸收光谱仪测量其铅含量,计算机统计分析。[结果]隆昌县鱼建镇金属铅回收厂周围800m以内的4岁以下的儿童铅元素含量与对照组比较差异有统计学意义(P﹤0.01),4岁以上的儿童铅元素含量与对照组比较差异具有统计学意义(P﹤0.05),且年龄越小铅中毒阳性率越高。[结论]隆昌县鱼建镇金属铅回收厂周围800m以内的儿童铅元素含量明显高于对照组,且随年龄减少而上升,年龄越小,捡出率越高。应予以足够重视,寻找污染来源,注意环境污染的治理及个人和家庭卫生,保持饮食合理,营养平衡,防治铅重毒给儿童带来的伤害。     

Risque de survenue d’une intoxication par le plomb lors du suivi d’enfants à risque dont la plombémie de primodépistage est inférieure à 100 μg/L

BackgroundFollow-up is recommended for children initially screened with a lead blood level below the threshold for lead poisoning of 10 μg/dL when they have one or more risk factors. At first, the frequency of a follow-up lead blood test was calculated in children at risk for lead poisoning. In second time, we calculated the rate of occurrence and independent factors for lead poisoning in the follow-up group.MethodsSince 1992, the Greater Paris lead poisoning monitoring system (SSSIILF) has been systematically recording data on lead levels in blood tests conducted for screening and follow-up in Greater Paris. Children initially screened before the age of seven whose blood lead level was inferior to 10 μg/dL and who had one or more risk factors were selected. The association between qualitative variables and a follow-up lead blood test was compared using the Chi² test. For children given follow-up, the association between qualitative variables and occurrence of lead poisoning was compared using the Chi² test; independent factors for lead poisoning were estimated by logistic regression.ResultsA follow-up lead blood test was more frequent and the difference was statistically significant, for children with one or more of the following risk factors identified at the time of screening: home address in Seine Saint-Denis or central Paris, screened in mother/child healthcare centers (PMI) or through a private physician, a blood lead level 5 μg/dL on initial screening, young age (< 24 months) at the time of screening and some others known risk factors. The rate of occurrence of lead poisoning during follow-up was 25.9% for children screened between 1992 to 1994 and decrease to 5.1% for children screened in 2004 to 2005 (p < 0.001) and was lower in central Paris and Seine Saint-Denis than in other districts in Greater Paris (p < 0.01). The rate of occurrence during follow-up, independent of known risk factors for lead poisoning (p < 0.01), was higher for children screened before the age of two (p < 0.01) and for children whose mothers were from Sub-Saharan Africa (p < 0.01).ConclusionIt is essential to follow up children at risk with an initial lead blood level below 10 μg/dL, especially those initially screened before the age of 24 months. Local action on home environment could also be needed when the initial blood lead level is 5 μg/dL and more than one risk factor has been identified.     

The care and health needs of children in residential care in the Maltese Islands

OBJECTIVES: To survey the health needs of children in residential care in the Mediterranean Islands of Malta and Gozo. SETTING: Thirteen children's Residential Homes in the Maltese Islands. STUDY DESIGN: Cross-sectional interview survey. METHODS: Carers at the Residential Homes were interviewed using a semistructured questionnaire between June and November 1996. Data related to all the children resident in the homes at the time of the interview were collected including socio-demographic factors, reasons for admission to care, medical needs and medical services received. RESULTS: In all, 309 children, aged birth-16 years-equivalent to 4.2/1000 Maltese children-were in residential care at the time of the study. Fifty-three per cent were boys and 52% were < 8 years of age. The most common reasons for admission into residential care were single parenthood (25%), separated parents and parents unable to offer adequate care (19% each). Admission 'medicals' rarely included a developmental assessment or use of growth charts. Medical and developmental examinations were not carried out on a regular basis and children were medically examined only when required. Dental check-ups were performed more regularly; 30% of the children had a dental check-up every 6 months. Behavioural problems were common affecting 20.7% of all children, followed by chronic bronchial asthma which was present in 7.4%. Developmental delay (global or specific) was reported in 23.3% of children under the age of 4. CONCLUSIONS: Residential care is the predominant form of substitute care for disadvantaged children in Malta and Gozo. The demography of the child population in Residential Homes in these Islands is different from that in other countries, in that 52% of children in residential care are < 8 years of age compared to proportionately more adolescents in other countries. Medical supervision is minimal. A standardised medical and developmental assessment should be established as an essential part of this form of substitute care.     

105例急性中毒患儿临床特征分析

目的 分析儿科重症监护室(PICU)急性中毒患儿的临床特征,为有效防治儿童急性中毒提供依据。方法 回顾性分析2007年1月-2016年12月西京医院儿科PICU 105例中毒患儿的临床资料。 结果 105例急性中毒患儿中,≤ 6岁者67例(63.8%),农村患儿77例(73.3%),意外中毒89例(84.8%),药物中毒34例(32.4%),农药中毒25例(23.8%),CO中毒19例(18.1%),食物中毒11例(10.5%)。城镇患儿以药物中毒为主(42.9%),农村患儿以农药中毒为主(32.5%)。自服毒物主要发生在6~15岁儿童。药物、CO中毒患儿以神经系统症状为主,农药、食物中毒以消化系统症状为主,鼠药中毒以血液系统症状为主。治疗总有效率为92.4%,未愈4例(3.8%),死亡4例(3.8%)。结论 儿童急性中毒主要发生于婴幼儿和学龄前期,多为意外中毒,多发生在农村,药物是首位中毒物质,不同物质中毒患儿临床表现不同,中毒物质量大和延误治疗将导致不良后果。     

Immigration and risk of childhood lead poisoning: findings from a case control study of New York City children

Objectives. We investigated whether foreign birthplace and residence were associated with an increased risk of childhood lead poisoning.Methods. We conducted a matched case–control study among New York City children (mean age=3 years) tested for lead poisoning in 2002 (n=203 pairs). Children were matched on age, date of test, and residential area. Blood lead and housing data were supplemented by a telephone survey administered to parents or guardians. Conditional logistic regression analysis was used to examine the relationship of lead poisoning status to foreign birthplace and time elapsed since most recent foreign residence after adjustment for housing and behavioral risk factors.Results. Both foreign birthplace and time since most recent foreign residence had strong adjusted associations with lead poisoning status, with children who had lived in a foreign country less than 6 months before their blood test showing a particularly elevated risk of lead poisoning relative to US-born children with no foreign residential history before their blood test (odds ratio [OR]=10.9; 95% confidence interval [CI]=3.3, 36.5).Conclusions. Our findings demonstrate an increased risk of lead poisoning among immigrant children.Despite a dramatic decline in childhood lead poisoning in the United States, an estimated 1.6% of US children aged 1 to 5 years (approximately 310000 children) have elevated blood lead levels of at least 10 μg/dL. Furthermore, the growing scientific evidence on cognitive impairments associated with blood lead levels below 10 μg/dL suggest that even a greater number of children are at risk of being adversely affected by low-level exposure to lead.2^–4The most common high-dose source of lead exposure among US children is interior lead-based paint,5^–8 but children who spend time outside the United States may be exposed to additional sources. The literature on lead poisoning among immigrant children living in the United States is scant. Surveillance and case studies have revealed a higher prevalence or incidence of elevated blood lead levels among refugee and internationally adopted children living in the United States than among the general US population of children.9^–12 However, these reports have lacked a comparison group and presented results not adjusted for confounding factors.To our knowledge, a recent national study involving Mexican American children is the only investigation in which individual- and family-level characteristics (e.g., age, family income, language spoken at home) and source of drinking water were controlled for in any examination of the association between foreign birthplace and lead poisoning. The results of that study revealed higher blood lead levels among foreign-born children than among US-born children of Mexican descent.13In this study, we examined the associations of childhood lead poisoning with birth and residence in a foreign country among a multiethnic urban sample while accounting for child and family demographic characteristics, child behaviors, and current residential building characteristics. We hypothesized that lead poisoning would be positively associated with birth and residence in a foreign country after control for known risk factors.     

急性毒鼠强中毒的临床治疗评价

目的 评价4种治疗方法对急性毒鼠强中毒的疗效,以及毒鼠强中毒对儿童智力发育的影响。方法 将86例入选急性毒鼠强中毒患者随机分为基础治疗组、丙戊酸钠组、二巯丙磺钠组和血液灌流组,给予相应治疗后观察治疗效果。另选30例毒鼠强中毒儿童,与健康儿童按年龄、居住地、性别、受教育情况和家庭经济状况等因素进行1：1配对,使用韦氏儿童智力量表中国修订本进行智商测定。结果 基础组、丙戊酸钠组与二巯丙磺钠组在癫痫控制时间、地西泮用量、出现精神症状及精神症状持续时间等治疗评价指标上,差异均无统计学意义;血液灌流治疗的13例患者中10例癫痫发作停止,3例发作次数明显减少,从每日10～16次减少到1～2次。血液灌流前后血浆中毒鼠强的含量并不降低。毒鼠强中毒儿童的总智商、言语智商和操作智商比对照儿童明显降低,均值分别比对照组降低了9．1、8．8和7．7分;中毒病情重的儿童总智商下降更明显,均值比对照组降低了15分。结论 二巯丙磺钠和丙戊酸钠对急性毒鼠强中毒的治疗效果并不优于单纯使用地西泮和苯巴比妥,血液灌流对毒鼠强中毒有肯定疗毒鼠强中毒对儿童的智力发育有一定影响。     

1986-2010年宁德市有毒动植物食物中毒分析

目的掌握宁德市有毒动植物食物中毒发生规律与特点,为防控其中毒提供科学决策。方法对1986-2010年宁德市有毒动植物食物中毒事故报告资料进行综合分析。结果 25年间共发生有毒动植物食物中毒101起,中毒人数591人,死亡36例。第二、三季度为全年中毒高发季节,中毒地点和场所均以农村和家庭居首,致病因素以毒蘑菇和河豚鱼为主,病死率以断肠草、河豚鱼和有毒贝类为高。结论应针对有毒动植物食物中毒发生的重点季节、重点地区、重点人群、重点场所和重点食物,有的放矢和适时采取科学有效的防控对策。     

一起光气等有毒物质泄漏事故分析

目的 分析一起光气等化合物泄漏事故的原因、危害程度以及抢救危重病人成功经验.方法 通过现场调查,危重病人抢救的全过程病例分析,以及其他接触者的系统观察分析.结果 该次事故共有561人受毒物泄漏污染影响,经按GBZ 29-2002《职业性急性光气中毒诊断标准》诊断,急性光气重度中毒2例（死亡1例）、中度中毒1例、轻度中毒18例、刺激反应10例,另有14例医护人员因受固体光气污染出现刺激反应.结论该次毒气泄漏事故主要毒物是光气和固体光气,由于抢救及时,处理得当,没有造成严重后果.     

Children Who Are Medically Fragile in North Carolina: Using Medicaid Data to Estimate Prevalence and Medical Care Costs in 2004

Objectives: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0–19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. Methods: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. Results: 1,914 children ages 0–19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0–19. Conclusions: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.     

铅中毒儿童各年龄期血锌、钙、铁分析

目的 探讨铅中毒儿童各年龄期血锌、钙、铁水平,为防治铅中毒、合理补充微量元素提供临床指导。方法 随机选择儿保门诊儿童铅中毒组140例,非铅中毒组140例,分幼儿期、学龄前期、学龄期三个年龄期进行分析。血铅、锌、钙、铁测定采用原子吸收光谱法。结果 铅中毒组儿童各年龄期血铅水平无明显差异,其均值均在轻度铅中毒范围。铅中毒组儿童各年龄期血锌、钙水平明显降低,血锌、钙缺乏检出率明显升高。铅中毒组幼儿期儿童血铁水平明显降低,学龄前期、学龄期儿童血铁水平无明显降低。结论 防治儿童铅中毒应加强锌、钙营养,幼儿应适当加强铁营养。     

Unintentional insecticide poisoning by age: an analysis of Queensland Poisons Information Centre calls

Objective: Data from the Queensland Poisons Information Centre (QPIC) was assessed to determine mechanisms of acute insecticide poisoning in young children (<5 years) and whether age affects insecticide‐poisoning patterns. Methods: Records of all insecticide‐related calls placed to QPIC in 2014 were obtained. A stratified analysis of call patterns by age was conducted. Results: Of 743 insecticide‐related calls received by QPIC 364 (49.0%) were for young children. The number of calls peaked in children aged one. Ant and cockroach baits accounted for 39.0% of calls. Sprays, which were found to contain not only pyrethroids, pyrethrins and/or piperonly butoxide but also the organophosphate diazinon, accounted for 25.8% of calls. Mouthing or ingesting a pest‐control product and consuming an item/insect after treatment were common mechanisms for children under the age of two. Topical exposure to sprays, via direct application, typically by the child or an older sibling, peaked in children aged two. In 12.3% of calls medical attention for the child was already sought or advised by QPIC. Conclusion: Normal behaviours associated with child development, particularly mouthing behaviours, explained the peak of exposure in one‐year‐olds. This finding should guide strategies to minimise poisonings in this vulnerable population.     

儿童血铅水平及相关因素研究

目的:掌握武汉市儿童血铅值水平,分析导致血铅水平增高的影响因素,制定降低儿童血铅水平的干预措施。方法:采取分层随机抽取1家医疗保健机构出生的新生婴儿;1个城区2条街道所有0～3岁儿童;6所不同等级幼儿园所有3岁以上在园儿童作为研究对象。对儿童母亲进行问卷并填写调查表,采集儿童手指血,用原子吸收光谱仪测定血铅值。结果:儿童铅中毒发生率9.80%,男童发生率明显高于女童(P<0.01),随着年龄的增长血铅值水平不断提高,呈显著正相关,儿童血铅值水平高低与父母年龄、父亲文化程度有关,与居住楼层、居屋离干道距离、家庭装修时间、居屋附近有无铅作业工厂及个人在马路上行走时间、与近期进食爆米花类、膨化食品类和钙锌铁剂类有显著性关系;多因素逐步回归分析筛选影响血铅值的因素是破坏性强、学习困难、常吃爆米花、家庭成员吸烟。结论:现阶段对儿童进行健康教育,调整营养膳食,养成良好的生活行为习惯不失为一种减少儿童铅中毒的最有效和经济实用的方式。