Children’s Vulnerability Related to Chlorine Exposure, Container Confusion, and Mixing Household Cleaners – Florida, 2006-2008

Acute and chronic effects of exposure to chlorine and chloramines can result in the irritation of the skin and mucous mem- branes, often leading to airway edema resulting in respiratory difficulties, burning in the throat, eyes and nose. Ingestion of bleach or bleach-containing products often results in adverse gastrointestinal effects. Data captured by the three centers com- prising the Florida Poison Information Center Network (FPICN) between 2006 and 2008 was examined to characterize the extent oftoxic effects from chlorine gas exposures related to misuse ofhousehold cleaners. A known outcome was determined in 48.4% of the 5315 cases. Of those with a known outcome, 0.2% (6) had a major effect. Children two and younger were the most frequently exposed population (22.7%). Children 19 and under accounted for 39.1% (2079), whereas children 2 and under accounted for 22.7% (1204) of the chlorine exposure population. Container confusion accounted for 12%, and mixing cleaning products accounted for 17% of the cases reviewed in 2006. The most common route of exposure in cases reviewed in 2006 was by-mouth and the most common symptom was gastrointestinal (GI). Fact sheets and educational outreach related to reducing the mixing of household cleaners, reading manufacturers safety instructions carefully, and storing the chemical clean- ers safely away from children and in original containers is warranted to reduce chlorine exposures in children

A Knowledge-based Clinical Toxicology Consultant for Diagnosing Multiple Exposures

Objective: This paper presents continued research toward the development of a knowledge-based system for the diagnosis of human toxic exposures. In particular, this research focuses on the challenging task of diagnosing exposures to multiple toxins. Although only 10% of toxic exposures in the United States involve multiple toxins, multiple exposures account for more than half of all toxin-related fatalities. Using simple medical mathematics, we seek to produce a practical decision support system capable of supplying useful information to aid in the diagnosis of complex cases involving multiple unknown substances. Methods: The system is automatically trained using data mining techniques to extract prior probabilities and likelihood ratios from a database managed by the Florida Poison Information Center (FPIC). When supplied with observed clinical effects, the system produces a ranked list of the most plausible toxic exposures. During testing, the system diagnosed toxins at three levels: identifying the substance, identifying the toxin’s major and minor categories, and identifying the toxin’s major category alone. To enable comparison between these three levels, accuracy was calculated as the percentage of exposures correctly identified in top 10% of trained diagnoses. Results: System evaluation utilized a dataset of 8,901 multiple exposure cases and 37,617 single exposure cases. Initial system testing using only multiple exposure cases yielded poor results, with diagnosis accuracies ranging from 18.5-50.1%. Further investigation revealed that the system’s inability to diagnose multiple disorders resulted from insufficient data and that the clinical effects observed in multiple exposures are dominated by a single substance. Including single exposures when training, the system achieved accuracies as high as 83.5% when 2 diagnosing the primary contributors in multiple exposure cases by substance, 86.9% when diagnosing by major and minor categories, and 79.9% when diagnosing by major category alone. Conclusions: Although the system failed to completely diagnose exposures to multiple toxins, the ability to identify the primary contributor in such cases may prove valuable in aiding medical personnel as they seek to diagnose and treat patients. As time passes and more cases are added to the FPIC database, we believe system accuracy will continue to improve, producing a viable decision support system for clinical toxicology

A Knowledge-based Clinical Toxicology Consultant for Diagnosing Single Exposures

Objective: Every year, toxic exposures kill twelve hundred Americans. To aid in the timely diagnosis and treatment of such exposures, this research investigates the feasibility of a knowledge-based system capable of generating differential diagnoses for human exposures involving unknown toxins. Methods: Data mining techniques automatically extract prior probabilities and likelihood ratios from a database managed by the Florida Poison Information Center. Using observed clinical effects, the trained system produces a ranked list of plausible toxic exposures. The resulting system was evaluated using 30,152 single exposure cases. In addition, the effects of two filters for refining diagnosis based on a minimum number of exposure cases and a minimum number of clinical effects were also explored. Results: The system achieved accuracies (calculated as the percentage of exposures correctly identified in top 10% of trained diagnoses) as high as 79.8% when diagnosing by substance and 78.9% when diagnosing by the major and minor categories of toxins. Conclusions: The results of this research are modest, yet promising. At this time, no similar systems are currently in use in the United States and it is hoped that these studies will yield an effective medical decision support system for clinical toxicology

Vicarious Exposure to Trauma and Growth in Therapists: The Moderating Effects of Sense of Coherence, Organisational Support and Empathy

Therapists who work with traumatised individuals can experience psychological growth following this vicarious exposure to trauma. The purpose of the present study is to examine the variables that may moderate such vicarious posttraumatic growth. Therapists (N=118) completed measures of vicarious exposure to trauma and growth, as well as empathy, sense of coherence and perceived organisational support. Results showed that having a strong sense of coherence negatively predicted growth whereas empathy was a positive predictor. Empathy also moderated the exposure to growth relationship when growth involved relating to others. Organisational support did not predict growth. This has implications for the recruitment, training and supervision of therapists working with individuals who have experienced trauma

Risk of vicarious trauma in nursing research:a focused mapping review and synthesis

AIMS AND OBJECTIVES: To provide a snapshot of how vicarious trauma is considered within the published nursing research literature. BACKGROUND: Vicarious trauma (secondary traumatic stress) has been the focus of attention in nursing practice for many years. The most pertinent areas to invoke vicarious trauma in research have been suggested as abuse/violence and death/dying. What is not known is how researchers account for the risks of vicarious trauma in research. DESIGN: Focused mapping review and synthesis. Empirical studies meeting criteria for abuse/violence or death/dying in relevant Scopus ranked top nursing journals (n = 6) January 2009 to December 2014. METHODS: Relevant papers were scrutinised for the extent to which researchers discussed the risk of vicarious trauma. Aspects of the studies were mapped systematically to a pre-defined template, allowing patterns and gaps in authors' reporting to be determined. These were synthesised into a coherent profile of current reporting practices and from this, a new conceptualisation seeking to anticipate and address the risk of vicarious trauma was developed. RESULTS: Two thousand five hundred and three papers were published during the review period, of which 104 met the inclusion criteria. Studies were distributed evenly by method (52 qualitative; 51 quantitative; one mixed methods) and by focus (54 abuse/violence; 50 death/dying). The majority of studies (98) were carried out in adult populations. Only two papers reported on vicarious trauma. CONCLUSION: The conceptualisation of vicarious trauma takes account of both sensitivity of the substantive data collected, and closeness of those involved with the research. This might assist researchers in designing ethical and protective research and foreground the importance of managing risks of vicarious trauma. RELEVANCE TO CLINICAL PRACTICE: Vicarious trauma is not well considered in research into clinically important topics. Our proposed framework allows for consideration of these so that precautionary measures can be put in place to minimise harm to staff

Poison Center Data for Public Health Surveillance: Poison Center and Public Health Perspectives

OBJECTIVE: To describe the use of poison center data for public health surveillance from the poison center, local, state, and federal public health perspectives and to generate meaningful discussion on how to address the challenges to collaboration. INTRODUCTION: Since 2008, poisoning has become the leading cause of injury-related death in the United States (US); since 1980, the poisoning-related fatality rate in the US has almost tripled.1 Many poison-related injuries and deaths are reported to regional poison centers (PCs) which receive about 2.4 million reports of human chemical and poison exposures annually.2 Federal, state, and local public health (PH) agencies often collaborate with poison centers and use PC data for public health surveillance of poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, CDC conducts public health surveillance for exposures and illnesses of public health significance using the National Poison Data System (NPDS), the national PC reporting database. Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs has been hindered by numerous challenges. To address these challenges and bolster collaboration, the Poison Center and Public Health Collaborations Community of Practice (CoP) was created in 2010 by CDC as a means to share experiences, identify best practices, and facilitate relationships among federal, state and local public health agencies and PCs. To date, the Poison Center and Public Health Collaborations CoP includes over 200 members from state and local public health, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the Environmental Protection Agency (EPA). A leadership team was created with representatives of the many stakeholders of the community to drive its direction and oversee activities. METHODS: The panel will consist of 4 presenters and 1 moderator, who are members of the Poison Center and Public Health Collaborations CoP leadership team. Each presenter will bring a unique perspective of the use of PC data for PH practice and surveillance: CDC, state department of health, a local department of health, and a PC. Royal Law from the CDC National Center for Environmental Health will present on using PC data for identification of exposures and illnesses of public health significance identified from NPDS data collected from all 57 PCs. Dr. Jay Schauben from the Florida/USVI Poison Information Center - Jacksonville will discuss PC participation in surveillance and use of PC data for tracking and mitigation of PH events in Florida. Dr. Prakash Mulay from the Florida Department of Health will discuss utilization of PC data to enhance ESSENCE-based chemical-associated exposure and illness surveillance in Florida. Katherine Wheeler from the New York City (NYC) Department of Health and Mental Hygiene will discuss NYC’s use of PC data in surveillance of potential emerging issues, from energy drinks to synthetic marijuana. Each presenter will discuss the use of PC data for PH practice and surveillance in his or her organization and jurisdiction, the successes of using PC data, and their challenges. RESULTS: The moderator will engage the audience by facilitating discussion of the successes and challenges to using PC data for PH practice and surveillance with the audience. Sample questions: What are your current capacities and collaborative activities between your state/local health department and your poison center? What non-funding related barriers hinder the collaboration between your state/local health department and poison center? If more funding were available, how would you use this funding to increase the level of interactivity with the poison center and state/local health department

Increase in Adverse Health Effects Related to Synthetic Cannabinoid Use

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