Understanding The Profiles Of Adolescents Engaged In Intentional Self-Poisoning With Suicidal Intent And The Role Of Primary Care In Early Intervention In Vermont

Suicide prevention is a top public health priority in Vermont. It is a complex issue, requiring a multi-faceted response from many different public and private stakeholders. Because intentional self-poisoning with suicidal intent is rarely lethal, it presents a particularly good opportunity for secondary interventions in the primary care setting. Extensive research has been done on intentional self-poisoning with suicidal intent and its relationship to subsequent risk of death by suicide, but gaps exist in research utilizing poison center data in the primary care setting. This dissertation employs an explanatory sequential mixed method research design to (a) develop a profile of Vermonters under the age of 20 who intentionally self-poison with suicidal intent, and (b) explore primary care interventions that could be implemented in Vermont. The dissertation study uses data from the Northern New England Poison Control Center (NNEPCC) and a focus group of primary care physicians to answer the research questions. Findings from the study point to implications for how this research can build off of the Consolidated Framework for Implementation Research and be utilized to develop an implementation strategy for one specific intervention in primary care

CHARACTERIZATION AND ECONOMIC BURDEN ASSOCIATED WITH PEDIATRIC OPIOID EXPOSURES AND POISONINGS

Introduction The main objectives of this study were: 1) to examine the prevalence and characteristics of opioid exposures, 2) to estimate the economic costs associated with opioid poisonings, and 3) to examine the characteristics associated with opioid poisoning-related health care resource use (HCRU) and costs in children. Methods Data from the National Poison Data System from January 1, 2010 to December 31, 2014 were utilized to examine the prevalence and characteristics of opioid exposures and poisonings in children \u3c18 years. Economic costs were estimated using the 2012 Nationwide Emergency Department Sample, Kids’ Inpatient Database, Multiple Cause-of-Death file and other published sources, applying a societal perspective. Direct costs included costs associated with ED visits, hospitalizations and ambulance transports. Indirect cost included productivity costs due to caregivers’ absenteeism and premature mortality among children. Results There were a total of 83,418 pediatric opioid exposures and nearly half of them resulted in poisoning. The epidemiology of opioid exposures differed considerably by age. Opioid exposures were more prevalent and mainly accidental in young children. Exposures in adolescents were more likely to be intentional and severe. The total economic costs of pediatric opioid poisonings in the United States were calculated at $230.8 million in 2012. Total direct costs were estimated to be over$21.1 million. Total productivity costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Conclusions Opioid exposures and poisonings in children continue to occur and impose an economic burden on the society

Morbidade e mortalidade relacionadas a medicamentos : revisão sistemática e meta-análise de estudos observacionais

Orientador: Prof. Dr. Cassyano Januário CorrerCo-orientador: Prof. Dr. Roberto PontaroloDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmaceuticas. Defesa: Curitiba, 04/03/2013Bibliografia: fls. 227-274Resumo: A segurança do paciente relacionada aos medicamentos é tema central de centenas de estudos publicados na literatura científica. Entretanto, a estimativa de valores de prevalência ou incidência dos danos ocasionados por medicamentos continua sendo um desafio, dada a grande heterogeneidade entre os estudos, diversidade de métodos de determinação utilizados, subpopulações estudadas e definições e classificações terminológicas adotadas. Nesse sentido, o presente estudo teve como objetivo analisar a prevalência, as causas, os grupos farmacológicos as características da morbidade e mortalidade relacionadas a medicamentos e os fatores de risco populacionais que condicionam o seu surgimento. Para tanto, realizou-se uma revisão sistemática e meta-análise de estudos observacionais sobre os danos ocasionados por medicamentos. O delineamento da pesquisa seguiu as recomendações da declaração PRISMA e da Colaboração Cochrane. Foram incluídos 573 estudos (285 transversais, 261 coortes, 20 caso-controle e 7 caso-controle aninhado), totalizando uma população de aproximadamente 839 milhões de pacientes. Os resultados demonstraram que a morbimortalidade relacionada a medicamentos acomete principalmente a população idosa na atenção primária à saúde e comunidade. Os métodos que detectam a maior prevalência de danos foram a revisão de prontuários e as entrevistas com os pacientes. No Brasil, os estudos mostram resultados de prevalência superiores aos dados internacionais e há importantes lacunas em termos de investigação nesta área. Os principais grupos farmacológicos envolvidos foram o dos medicamentos que atuam no sistema nervoso central, antineoplásicos e imunomoduladores, anti-infecciosos e medicamentos cardiovasculares. Os principais fatores de risco foram idade acima de 65 anos, idade abaixo de 2 anos, presença de comorbidades e uso de mais que quatro medicamentos. A análise das causas da alta heterogeneidade entre os estudos permitiu o delineamento de recomendações para pesquisas futuras neste campo. A alta prevalência de morbimortalidade relacionada a medicamentos nos diversos pontos de atenção à saúde exige medidas de avaliação e estratificação de risco populacional, além de ações preventivas e de intervenção precoce. Medidas para a gestão clínica eficiente dos medicamentos devem ser adotadas a partir desta perspectiva, a fim de contribuir para redução do impacto social e econômico dos danos ocasionados por medicamentos.Abstract: Patient and medication safety is the central theme of various studies published in scientific literature. However, the estimate of prevalence or incidence of harms caused by medications remains a challenge, given the large heterogeneity between studies, different measurement methods employed, subpopulations studied and terminology adopted. Thus, the present study aimed to analyze the prevalence, causes, pharmacological groups and characteristics of drug-related morbidity and mortality and its risk factors. Therefore, we carried out a systematic review and meta-analysis of observational studies evolving drug-related morbidity or mortality. The study design followed the recommendations of the PRISMA statement and the Cochrane Collaboration. We included 573 studies (285 cross-sectional, 261 cohort, 20 case-control and 7 nested case-control), with a total population of approximately 839 millions of patients. The results showed that drug-related morbidity and mortality mainly affects elderly population in the primary health care and community. The methods that showed higher prevalence results were medical records review and patient interview. In Brazil, the studies often showed higher results of prevalence in relation with international data and there are several gaps of knowledge in this theme. The pharmacological groups that most often caused harm were central nervous system drugs, antineoplastic and immunomodulating agents, anti-infective and cardiovascular drugs. The main risk factors were age over 65, children under 2 years old, comorbidities presence and use of more than four medications. The analysis of the high heterogeneity among the studies allowed the proposition of recommendations to future research in this field. The high prevalence of drug-related morbidity and mortality in different settings of health care system requires the adoption of population screening and risk stratification strategies, besides preventive and early intervention. Actions for an efficient medication therapy management should be taken from this perspective, in order to contribute to reducing the social and economic impact of drug-related morbidity and mortality