Depressive Symptoms in Women With Physical Disabilities: Identifying Correlates to Inform Practice

Objective

To examine correlates of depressive symptomatology in a sample of women with diverse physical disabilities to inform practice of modifiable risk factors that warrant attention and intervention.

Design

Interview survey.

Setting

Outpatient chronic care clinics.

Participants

Racially and ethnically diverse women (N=415) aged 18 to 64 years living with physical disabilities.

Interventions

Not applicable.

Main Outcome Measure

Center for Epidemiologic Studies Depression Scale.

Results

Depressive symptoms were high with more than half the women exceeding an established cutoff for clinically significant depressive symptomatology. In hierarchical multiple regression analyses, demographic, disability, and health variables explained significant variance in depressive symptoms; however, modifiable variables (pain interference, social support, abuse) contributed significantly to depression scores over and above demographic, disability, and health variables. Analyses examining predictors of depression classification revealed similar findings.

Conclusions

Depression is a significant problem for many women with physical disabilities. Modifiable contributors to depressive symptoms may provide intervention opportunities for researchers and clinicians. Clinicians need to attend closely to pain, particularly perceptions of pain interference; social support and social isolation; and abuse among women with physical disabilities. It may be valuable to include pain self-management, social networking and social skill development, and safety and abuse prevention training when designing depression intervention programs for this population.     

Exposure to bullying behaviors as a predictor of mental health problems among Norwegian nurses: Results from the prospective SUSSH-survey

Background

The relationship between workplace bullying and mental health problems are well documented in previous cross-sectional studies, but knowledge on how this relationship develops over time is still scarce.

Objectives

The aim of this study was to explore the prospective relationship between exposure to bullying behaviors at baseline, and increased symptoms of mental health problems (anxiety, depression, fatigue) one year later. Furthermore, the reverse relationship was investigated.

Design

This is a prospective longitudinal study, where members of the Norwegian Nurses Organization answered identical questions regarding workplace bullying and mental health problems, at baseline (2008–2009) and follow-up (2010).

Participants

Altogether, 1582 nurses completed both questionnaires.

Results

Hierarchical regression analyses indicated that exposure to bullying behaviors at baseline predicted subsequent increased symptoms of anxiety and fatigue, after adjusting for baseline symptoms of anxiety and fatigue respectively, age, gender, night work and job demands. Moreover, symptoms of anxiety, depression and fatigue at baseline predicted increased exposure to bullying behaviors one year later, after adjusting for exposure to bullying behaviors at baseline, age, gender, night work and job demands.

Conclusion

In this study we find support for a reciprocal relationship between exposure to bullying behaviors and symptoms of anxiety and fatigue, respectively. Thus, the results may indicate a vicious circle where workplace bullying and mental health problems mutually affect each other negatively.     

The impact of gender,culture, and sexuality on Mauritian nursing: Nursing as a non-gendered occupational identity or masculine field? Qualitative study

Background

International studies have generally defined nursing as a female-dominated occupation. The almost absence of male nurses seems universal, except as a privileged minority occupying positions within nursing specialties (‘islands of masculinity’). Nursing is associated with relatively low status owing to gender and income, and is also influenced by cultural perceptions of social status, the nature of the work and sexuality.

Objective

This study aims to describe and analyse how gender and cultural perceptions influenced the development of nursing in Mauritius. This paper examines why nursing in Mauritius became gendered in different ways due to the impact of gender equivalence in the work force, the gendered segregation in clinical practice and the absence of caring feminisation in nursing.

Design and setting

This qualitative study is based on in-depth, semi-structured interviews and convenience sampling. The sample includes nurses working at five hospitals. They all come from the central and southern part of Mauritius. The data were collected over a five-month period during 2006.

Participants

Individual qualitative interviews were conducted with 47 nurses, both men (27) and women (20), of different grades, ages, religions and ethnic backgrounds.

Results

Nursing practice is gender segregated, influenced and supported by cultural traditions and perceptions of gender relations, sexuality and touch in nursing. However, the professional identity and role is considered non-gendered, implied by the title of ‘nursing officer’ and the presence of male nurses who constitute almost 50 percent of the work force. Male nurses do not face similar barriers deterring them from entering nursing profession. Nursing did not develop the image of women's work and a low status job in Mauritius.

Conclusions

The nursing profession in Mauritius has been shaped by a different ‘history of origin’, social, cultural and societal conditions on the basis of the absence of gender imbalance in the work force and caring feminisation in nursing. Moreover, the increase of men's presence in nursing influenced its name, status and perception, shifting nursing into a masculine sphere with advantageous impacts on nursing.     

Relationships between childhood sexual abuse and substance use and sexual risk behaviors during adolescence: An integrative review

Background

Childhood sexual abuse (CSA) is thought to be a precursor to substance use and sexual risk behaviors during adolescence. To inform adolescent prevention efforts, information is needed to explicate the nature of the relationships between CSA and these health risks. The aim of this study was to summarize the current literature on the associations between a history of CSA and substance use and sexual risk behaviors during adolescence.

Methods

We conducted a systematic literature search and an integrative review.

Results

Current evidence implicates CSA as a robust precursor to the use of a wide variety of substances and multiple sexual risk behaviors during adolescence.

Conclusion

Screening for CSA in adolescents at risk and incorporating strategies that enhance CSA recovery in adolescent prevention programs are warranted. Future research that includes longitudinal designs, uses multiple methods of assessment, and identifies pathways between CSA and adolescent health risks is recommended.     

‘Isn’t it all Whites?’ Ethnic diversity and the physiotherapy profession

Aim

To explore physiotherapists’ perceptions, views and experiences of ethnic diversity in relation to the physiotherapy profession.

Design

Qualitative research study, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed verbatim and the data were analysed using thematic analysis. Several verification procedures were incorporated into the design to ensure quality.

Setting

Venues chosen by the participants in North West England.

Participants

A purposive sample of 22 physiotherapists (five students, seven clinicians and 10 academics) with a range of ethnicities.

Findings

Most participants’ experiences and perceptions were of a lack of ethnic diversity within the profession. Further findings related to the impact of this included: the perception that physiotherapy is a White profession; some Black and Minority Ethnic (BME) physiotherapists felt ‘out of place’ on occasions; and failure to meet patients’ needs. The potential benefits of increased ethnic diversity and the possible risks of valuing BME staff solely in terms of their ethnicity were also illuminated by the findings.

Conclusions

This study of the perceptions and experiences of physiotherapists identified a lack of ethnic diversity within the profession. It is argued that a lack of ethnic diversity may result in a failure to meet patients’ needs. A workforce that is reflective of the population it serves can have greater cultural knowledge, and is more likely to understand and respond to patients’ needs.     

The role of Catholic nurses in women's health care policy disputes: A historical study

Background

The Catholic Church oversees the nation's largest group of not-for-profit health care facilities, and in certain areas a Catholic hospital is the only hospital available. Recently, Catholic hospitals' provision of health care services to women in the areas of reproductive procedures has come under scrutiny.

Purpose

This article examines the role of Catholic sister nurses in health policy for women.

Methods

Using historical analysis, this article focuses on the tensions between Catholic religious priests and sister nurses over access to health care.

Discussion

A historical examination of Catholic hospitals' influence on health policy offers a vehicle to contemplate the role that religion plays in the area of women's health.

Conclusion

Catholic sister nurses used the Catholic Church's organizational power to influence health policy that affected their hospitals. However, they exercised due restraint in their advocacy efforts, always having to be mindful of ecclesiastical barriers they could not abridge, particularly those that pertained to reproduction. This has significantly affected health policy for women.     

Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation

Objectives

To investigate the perceptions of doctors, nurses and physiotherapists of emergency department physiotherapy for acute patients, and explore the scope of its contribution in an otherwise nontraditional allied health setting in Australia.

Design

Qualitative investigation using semi-structured interviews.

Setting

A large, metropolitan tertiary hospital with a well-established emergency department physiotherapy/allied health network in place.

Participants

Two emergency department doctors, two emergency department nurses and two senior physiotherapists working in an emergency department were recruited purposefully from the study hospital.

Interventions

Semi-structured interviews lasting from 20 minutes to 1 hour were conducted with each participant by the lead investigator. Data were analysed using NVivo software, coded manually and verified with member checking, facilitating constant case comparisons.

Results

Issues explored included defining the role of physiotherapists, uncovering organisational themes from the introduction of physiotherapy into the established emergency department setting, and conflicts around preserving and expanding an allied health identity in a highly-medicalised clinical environment.

Conclusions

Participants described the benefits of having physiotherapists located in the emergency department, and the physiotherapists were eager to advance their roles and responsibilities, but were, at times, restricted by a complicated organisational landscape influencing professional autonomy and capacity for professional advocacy. Ongoing evidence supporting the breadth of physiotherapy practice in the emergency department is needed to further advocate the usefulness of the profession in this acute setting.     

The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey

Background

The importance of transformational leadership for nurses’ well-being is increasingly acknowledged. However, there is a paucity of research examining the mechanisms that may explain the relationships between transformational leadership and nurses’ quality of work life.

Objectives

First, to examine two possible psychological mechanisms that link transformational leadership behaviors to nurses’ quality of work life. Second, to study the relationship between nurses’ quality of work life and their work engagement.

Design

Cross-sectional study design.

Settings

The study took place in 47 different hematology, oncology, and hematology/oncology units in France. Participants were nurses and auxiliary nurses.

Participants

343 nurses completed the questionnaire. Surveys were sent to all nurses working in the units. 95% were female, the average age was 36.30 years.

Methods

Nurses were asked to rate their supervisor's transformational leadership style and their perceptions of distributive and interactional justice in the unit. They were also asked to evaluate their own level of quality of work life and their work engagement.

Results

Distributive justice and interactional justice were found to fully mediate the relationship between transformational leadership and nurses’ quality of work life. In addition, nurses’ quality of work life positively related to their work engagement.

Conclusions

Transformational leaders may help ensure nurses’ quality of work life which in turn increases their work engagement. These leadership practices are thus beneficial for both employees and organization.     

Cultural Competencies in Emergency Medicine: Caring for Muslim-American Patients from the Middle East

Background

Cultural competency is crucial to the delivery of optimal medical care. In Emergency Medicine, overcoming cultural barriers is even more important because patients might use the Emergency Department (ED) as their first choice for health care. At least 2.2 million Muslims from Middle Eastern background live in the United States.

Objective

We wanted to create a succinct guideline for Emergency care providers to overcome cultural barriers in delivering care for this unique population.

Method

A compensative search on medical and health databases was performed and all the articles related to providing healthcare for Muslim-Americans were reviewed.

Result

The important cultural factors that impact Emergency care delivery to this population include norms of modesty; gender role; the concept of God's will and its role in health, family structure, prohibition of premarital and extramarital sex; Islamic rituals of praying and fasting; Islamic dietary codes; and rules related to religious cleanliness.

Conclusions

The Muslim-American community is a fast-growing, under-studied population. Cultural awareness is essential for optimal delivery of health care to this minority. We have created a succinct guideline that can be used by Emergency Care providers to overcome cultural barriers. However, it is important to consider the heterogeneity and diversity of this population and to use this guideline on an individual basis.     

Incidence and impact of physician and nurse disruptive behaviors in the emergency department

Background

Disruptive behaviors have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events.

Objectives

To assess the status of disruptive behaviors and staff relationships in the ED setting.

Methods

A 23-question survey tool was distributed to a regional group of ED physicians, nurses, and staff members to assess their perceptions as to the incidence of discipline-specific occurrences, types and impact of disruptive behaviors on staff behaviors, communication efficiency, and patient outcomes of care.

Results

A total of 370 surveys were received. Fifty-seven percent witnessed the disruptive behaviors by physicians, 52% witnessed the disruptive behaviors by nurses; 32.8% of the respondents felt that disruptive behavior could be linked to the occurrence of adverse events, 35.4% to medical errors, 24.7% to compromises in patient safety, 35.8% to poor quality, and 12.3% to patient mortality. Eighteen percent reported that they were aware of a specific adverse event that occurred as a direct result of disruptive behavior.

Conclusion

Disruptive behaviors in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognize the significance of disruptive behaviors and implement appropriate policies and protocols to address this issue.     

Life is lived forwards and understood backwards – Experiences of being affected by acute coronary syndrome: A narrative analysis

Background

Patients affected by acute coronary syndrome (ACS) report several symptoms subsequent to their discharge from hospital. These symptoms prolong their sick leave and complicate their return to the normal activities of everyday life. To improve health outcomes and establish quicker recovery for these patients, there is a need to better understand patients’ perceptions of their illness.

Objective

To explore patients’ experiences of ACS during their hospital stay.

Design

A qualitative interpretative interview study was conducted among patients during their hospitalization for ACS.

Setting

The study was performed in two designated coronary care units at a hospital in Sweden.

Participants

Twelve participants (five women and seven men; age range, 45–72 years), hospitalized with a diagnosis of ACS, were included in this study.

Methods

Patient narratives were recorded and transcribed. The records were later analyzed using a phenomenological hermeneutic approach.

Results

Patient experiences of ACS were formulated into one main theme: “awareness that life is lived forwards and understood backwards”. Two minor themes predominated in this main theme. The first was a sense of “struggling to manage the acute overwhelming phase”, which included four sub-themes: onset of life-threatening symptoms; fear and anxiety; being taken by surprise; and experiencing life as a hazardous adventure. The second theme was “striving to obtain a sense of inner security”, which also included four sub-themes: searching for and processing the cause and its explanation; maintaining a personal explanation; dealing with concern and uncertainty; and having a readiness to negotiate with life-pattern activities.

Conclusions

Hospitalized patients affected by ACS consider the cause of the onset and prepare to optimize their future health. These patients construct personal models to explain their disease, which may persist throughout continuum of care. One way to improve health outcomes for patients with ACS is to establish a shared knowledge about the illness and formulate personal care plans that cover the hospital stay as well as possibly extending into primary care after discharge, based on the patients’ point of view.     

Consumer Characteristics and Perceptions of Chiropractic and Chiropractic Services in Australia: Results From a Cross-Sectional Survey

Objective

The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia.

Methods

This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services.

Results

A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40 000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received.

Conclusions

The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.     

Evaluation of simulation-based training on the ability of birth attendants to correctly perform bimanual compression as obstetric first aid

Background

Maternal mortality from postpartum hemorrhage remains high globally, in large part because women give birth in rural communities where unskilled (traditional birth attendants) provide care for delivering mothers. Traditional attendants are neither trained nor equipped to recognize or manage postpartum hemorrhage as a life-threatening emergent condition. Recommended treatment includes using uterotonic agents and physical manipulation to aid uterine contraction. In resource-limited areas where Obstetric first aid may be the only care option, physical methods such as bimanual uterine compression are easily taught, highly practical and if performed correctly, highly effective. A simulator with objective performance feedback was designed to teach skilled and unskilled birth attendants to perform the technique.

Objectives

To evaluate the impact of simulation-based training on the ability of birth attendants to correctly perform bimanual compression in response to postpartum hemorrhage from uterine atony.

Methods

Simulation-based training was conducted for skilled (N = 111) and unskilled birth attendants (N = 14) at two regional (Kumasi, Tamale) and two district (Savelugu, Sene) medical centers in Ghana. Training was evaluated using Kirkpatrick's 4-level model.

Results

All participants significantly increased their bimanual uterine compression skills after training (p = 0.000). There were no significant differences between 2-week delayed post-test performances indicating retention (p = 0.52). Applied behavioral and clinical outcomes were reported for 9 months from a subset of birth attendants in Sene District: 425 births, 13 postpartum hemorrhages were reported without concomitant maternal mortality.

Conclusions

The results of this study suggest that simulation-based training for skilled and unskilled birth attendants to perform bi-manual uterine compression as postpartum hemorrhage Obstetric first aid leads to improved applied procedural skills. Results from a smaller subset of the sample suggest that these skills could potentially lead to improved clinical outcomes and additional study is merited.     

Posterolateral Hip Muscle Strengthening Versus Quadriceps Strengthening for Patellofemoral Pain: A Comparative Control Trial

Objective

To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP).

Design

Comparative control trial.

Setting

Rehabilitation facility.

Participants

Persons with a diagnosis of PFP (N=36; 18 men, 18 women).

Interventions

Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk).

Main Outcome Measures

Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up.

Results

Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05).

Conclusions

Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.     

Psychometric Properties of the Brief Fatigue Inventory in Community-Dwelling Older Adults

Objective

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

Design

Cross-sectional validation study.

Setting

Community based.

Participants

Subjects (N=302) were nondemented older adults (mean age, 76.44y; 54% women).

Interventions

Not applicable.

Main Outcome Measures

BFI total, severity, and interference summation scores.

Results

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

Conclusions

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.     

Comparing Multicomponent Interventions to Improve Skin Care Behaviors and Prevent Recurrence in Veterans Hospitalized for Severe Pressure Ulcers

Objective

To compare a multicomponent motivational interviewing (MI)/self-management (SM) intervention with a multicomponent education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers (PrUs).

Design

Single-blinded, prospective, randomized controlled trial.

Setting

Six Veterans Affairs SCI centers.

Participants

Veterans admitted for a severe (stage III/IV) PrU were followed up to 6 months postdischarge.

Intervention

Telephone-based individual MI counseling plus SM skills group (SM+MI; n=71) versus an active control group of telephone-based individual educational counseling plus group education (n=72).

Main Outcome Measures

Self-reported skin-protective behaviors, objective skin worsening.

Results

Intention-to-treat analyses found nonsignificant increases in skin behaviors in the SM+MI versus education control intervention arms at 3 and 6 months. The difference in behaviors used between SM+MI and education control intervention participants was 4.6% (95% confidence interval [CI], −11.3 to 2.7) (0–3mo) and 3.0% (95% CI, –8.7 to 3.9) (0–6mo). High rates of skin worsening were observed (n=74, 51.7%), usually within 3 months postdischarge and most frequently within the month postdischarge. Skin worsening, skin-related visits, and readmissions did not differ by study arm. Study limitations are presented.

Conclusions

For persons with chronic SCI and severe PrUs, complicated by multiple comorbidities, a primary focus on improving patient behavior is likely insufficient to address the complex problem of PrUs in SCI. More health care systems–level changes such as collaborative care may be needed to reduce PrU recurrence, especially in this era in which many people are discharged from the hospital unhealed or with little sitting tolerance.     

Penile angioedema developing after 3 years of ACEI therapy

Background

Angiotensin-converting enzyme inhibitor−related angioedema (ACEI-RA) is a well-described condition, yet isolated genital ACEI-RA is a little-known entity.

Objective

A case of isolated genital angioedema is presented with photographic documentation. Possible complications and therapeutic options are discussed.

Case Report

A 71-year-old man presented with painless, nonpruritic genital swelling of 4 h duration. Medical history included peptic ulcer disease, hypertension, and benign prostatic hypertrophy. His medications included pantoprazole, hydrochlorothiazide, and lisinopril, which he had been taking for 3 years without any recent change in dosing. He was otherwise asymptomatic and previously had been in good health generally. The physical examination was positive only for diffuse, soft, nonpitting edema isolated to the scrotum and uncircumcised penis. The foreskin was only partially retractable. Urinalysis was normal. All symptoms resolved without complications within 48 h of discontinuing lisinopril and had not recurred at follow-up 4 months later. All cases of ACEI-RA isolated to the genitals that have been reported in the literature resolved without complications.

Conclusions

ACEI-RA can present as isolated swelling of the genitals and is a potential cause of genital swelling. Patients who have no evidence of airway compromise, paraphimosis, or urinary retention from complications such as phimosis can be safely discharged with instructions to discontinue the offending agent and to return in case of development of the aforementioned conditions.     

Fetal loss in symptomatic first-trimester pregnancy with documented yolk sac intrauterine pregnancy

Background

The possibility of spontaneous miscarriage is a common concern among pregnant women in the emergency department (ED).

Objective

This study sought to determine fetal outcomes for women following ED evaluation for first-trimester abdominopelvic pain or vaginal bleeding who had an intrauterine pregnancy (IUP) on ultrasound before a visible fetal pole (“yolk sac IUP”).

Methods

A retrospective chart review of consecutive ED charts from December 2005 to September 2006 identified patients with a yolk sac IUP. Demographic data, obstetric/gynecologic history, and presenting symptoms were obtained. Outcomes were determined via computerized records. Fetal loss was diagnosed by falling β-human chorionic gonadotropin or pathology specimen. Live birth was diagnosed by viable fetus at 20-week ultrasound or delivery.

Results

A total of 131 patients were enrolled in this study. Of these, 14 were lost to follow-up (12%), leaving 117 patient encounters. Of the 117 women, 82 carried their pregnancies to at least 20-week gestation. Thirty-five patients miscarried. Fetal loss rate by chief complaint were as follows: 8 of 46 patients presenting with pain only, 14 of 34 presenting with vaginal bleeding only, and 13 of 37 with both vaginal bleeding and pain.

Conclusion

Seventy percent of women diagnosed with a yolk sac IUP in the ED carried their pregnancy to at least 20 weeks. The remaining women (30%) experienced fetal loss. Vaginal bleeding (with or without pain) increased the rate of fetal loss compared with women with pain only. These data will assist the emergency physician in counseling women with symptomatic first-trimester pregnancies.     

Ramelteon ingestions reported to Texas poison centers, 2005-2009

Background

The only data that currently exist on ramelteon (Rozerem^®; Takeda Pharmaceuticals North America, Inc., Deerfield, IL) ingestions is from clinical trials. To fill this gap, data on ramelteon ingestions reported to Texas poison centers during 2005–2009 were collected and analyzed.

Objectives

The objective of this study was to describe how reported ramelteon ingestions were handled by Texas poison center staff and when known, the patient’s final medical outcome. In cases where the dosage was significant enough to refer the patient to a health care facility, adverse clinical reactions and treatments are also described.

Methods

Cases were analyzed for selected demographic and clinical factors. Of 222 total patients, 67.6% were women and 73.9% were over the age of 19 years. Cases were analyzed by motivating factors (e.g., unintentional, intentional), management site, adverse reactions, and final medical outcome.

Results

Of the ramelteon ingestions reported to Texas poison centers, 67.6% involved adult women and were suspected attempted suicides; 75% of ramelteon ingestions not involving other substances were managed at a health care facility. However, 88.3% of these ingestions resulted in no significant clinical effect.

Conclusion

The management strategies used by Texas poison centers for the 56 cases reported in this study were adequate.