Study of direct costs of children hospitalized with opium poisoning: a case study of Iran

Preventing childhood poisoning is an important injury-control priority, requiring a multi-strategy approach. However, there remains a wide void between what is recommended by prevention programs and the evidence, and what is acted upon in the day-to-day family environment. This paper seeks to probe behind aspects of this void by examining parental perceptions in relation to childhood poisoning within a Health Belief Model framework. Data were collected through telephone interviews from 200 randomly selected Western Australian parents/guardians of children aged 0-4 years. The uptake of poisoning prevention strategies was associated with the perceived susceptibility and seriousness of poisoning from different common household products. In particular, those products considered most fatally poisonous (workshop/garden chemicals) and a common cause of childhood poisoning were the most likely to be locked up and kept out of reach of children. Conversely, over-the-counter medicines were not considered by the majority of parents as fatally poisonous or as a common cause of poisoning, and were less likely to be locked up and placed out of reach. However, such medicines are the most common cause of unintentional childhood poisoning. The results suggest that perceptions of susceptibility and seriousness need to be targeted as part of efforts to encourage parents to reduce household risks of childhood poisoning. This is particularly warranted in relation to those common household products (e.g. medicines) where there is a misperception of lower likelihood of serious poisoning occurring.

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning.

Background: Acute poisoning is a common medical emergency in the pediatric unit. It is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than five years of age is accidental. This study aimed to determine the associated factors and clinical profile of childhood poisoning.
 Material & Methods: A cross-sectional descriptive study was carried out among 69 children aged six months to 12 years with a history of poisoning over six months. History, clinical examination, and details of the poisoning were obtained by using a structured questionnaire during admission. Analysis was done through standard statistical tests.
 Result: Among the 69 children of poisoning, 92.8% were accidental, and 7.2% were suicidal. Most cases (79.7%) were from the 6 - 59 months age group with male-female ratio 1.7:1. Most of the fathers (65.2%) and mothers (75.4%) had primary education, and 75.4% were poor. The most common cause of the poisoning was insecticide (60.9%), and the poison was stored at an available site (91.3%) in an unsealed container (47.8%). Accidental poisoning was more common in younger age group (<5 years) in male (70.31%) patients with normal family relationships (78.1%), whereas suicidal poisoning was more common in older age group (>10 years) in females (80%) patient with h/o familial disharmony (60%).
 Conclusion: Insecticides and kerosene were the common cause of poisoning. Most of the materials were stored in an unsafe place and stored in an attractive bottle. Poison should be stored in a safe home with a sealed container. Simple and active family preventive measures can reduce accidental poisoning.
 TAJ 2022; 35: No-2: 75-82

Despite the importance of sex differences in substance-related issues, regional studies have paid little attention to their impact on opioid poisoning. This study aimed to assess this disparity in patients with opioid and stimulant poisoning. The cross-sectional study was conducted at a referral poisoning center in Isfahan, Iran. Medical records of patients admitted between December 2014 and October 2016 with opioid and stimulant poisoning were retrospectively reviewed. A total of 1243 patients with opioid poisoning and 94 with stimulant poisoning were evaluated, with a majority being male (70.9% and 79.8%, respectively). Methadone poisoning was the most common opioid substance (49.7%), followed by tramadol (18.4%), and methamphetamine was the most common cause of stimulant poisoning(52.1%). Among both sexes, methadone from the opioid class and methamphetamine from the stimulant class were the most frequent causes of intoxication. Males were more likely to have a history of addiction and a criminal record compared to females in both types of poisoning. No significant differences in outcomes were observed between the sexes. Males were about 3.92 times more likely to experience multiple opioid poisonings compared to females (OR: 3.92, 95% CI 1.39-11.09). Sex disparities in opioid and stimulant poisoning were identified, highlighting the importance of considering sex-specific educational programs when developing strategies for opioid and stimulant use prevention.

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

To estimate the societal economic burden and the governmental budgetary impact of the following visual disorders among US adults aged 40 years and older: visual impairment, blindness, refractive error, age-related macular degeneration, cataracts, diabetic retinopathy, and primary open-angle glaucoma. We estimated 3 components of economic burden: direct medical costs, other direct costs, and productivity losses. We used private insurance and Medicare claims data to estimate direct medical costs; epidemiologic evidence from multiple published sources to estimate other direct costs, such as nursing home costs; and data from the Survey of Income and Program Participation to estimate productivity losses. We used budgetary documents and our direct medical and other direct cost estimates to approximate the governmental budgetary impact. We estimated that the annual total financial burden of major adult visual disorders is $35.4 billion ($16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses) and that the annual governmental budgetary impact is $13.7 billion. Major visual disorders among Americans older than 40 years result in substantial economic costs for the US economy. Well-designed public health programs may have the ability to reduce this burden in the future.

BackgroundAlthough the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.MethodsFrom April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.ResultsOur data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient’s disposable household income, making it a catastrophic expenditure for the household.ConclusionHepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers’ understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.

Introduction: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals.Methods: A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007–2013. We examined trends, medicines responsible and subsequent management. Medicines were coded using ICD10-AM diagnosis codes (T36-50).Results: Over 2007–2013, pharmacological poisonings accounted for 67,816 PIC calls, 7739 ED presentations and 2082 admissions. Rates (per 10,000 children) of PIC calls declined from 220 to 178; ED presentations were stable (∼22–24), with a decrease in emergency cases offset by an increase in semi- or non-urgent presentations; hospital admissions declined (8–5). Most PIC calls related to “non-opioid analgesics” (25%), and “topical agents” (18%). Nearly every day, one child aged <5 years was admitted to hospital for poisoning. “Benzodiazepines”, “other and unspecified antidepressants”, “uncategorised antihypertensives”, and “4-aminophenol derivatives” accounted for over one-third of all admissions. Most PIC calls (90%) were advised to stay home, 6% referred to hospital. One-quarter of ED presentations resulted in admission.Conclusions: Poisonings reported to PIC and hospitals declined, however, non-urgent ED presentations increased. Strategies to reduce therapeutic errors and access to medicines, and education campaigns to improve Poisons Centre call rates to prevent unnecessary ED presentations are needed.

Lupus and the Bottom Line: Why we Need to Talk About the Economic Impact

Introduction:Intentional and unintentional poisoning are among the most common reasons for referrals to emergency department (ED). Therefore, the present study was designed to evaluate epidemiologic features and effective risk factors of intentional and unintentional poisoning in children. Methods:This prospective cross-sectional study was carried out in ED of Loghman Hakim Hospital, greatest referral poison center of Iran, Tehran during March to August 2014. Demographic data, medical history, history of psychiatric disease in child, the cause of poisoning, parents’ educational level, household monthly income, location of residence, history of addiction or divorce in family, and the poisoning intentionality were gathered. Data were analyzed using SPSS 18 and appropriate statistical tests based on the purpose of study. Results:414 participants with the mean age of 4.2 ± 3.43 years were included (57.5% male). Children in the 0-4 year(s) age range had the most frequency with 281 (67.9%) cases. 29 (7%) cases were intentional (62% female, 76% in the 10-14 years old group). Methadone with 123 (29.7%) cases was the most frequent toxic agent in general and in unintentional cases. 10-14 years of age (p = 0.001), and the history of psychiatric disease in children (p <0.001), had a direct correlation with probability of intentional poisoning. While, history of addiction in the family showed an indirect correlation with this probability (p = 0.045). Conclusion:Based on the results of this study, most cases of poisoning in the children were unintentional methadone intoxication in boys in the 0-4 age range with a history of a psychiatric disease, and those who had a history of addiction in the family. In addition, the most powerful risk factor for the children’s intentional poisoning was their history of psychiatric disease. The history of addiction in the child’s family had indirect correlation with intentional intoxications.

A study was carried out to determine the incidence of accidental poisoning in children admitted to Riyadh Governmental Hospitals during 1988. Drugs were the most common poisoning agent and accounte...

BACKGROUND: Among the different drugs involved in pediatric exposures and poisonings, opioids are the most important, given their rise in nonmedical use. Opioid poisonings in children can result in serious symptoms or complications, including respiratory disorders such as apnea, respiratory failure, and respiratory depression; psychiatric or nervous system disorders such as agitation, seizures, and coma; and cardiac disorders such as tachycardia, bradycardia, and cardiac arrest. Opioid poisonings in children can have delayed onset of symptoms as well as severe and prolonged toxic effects. Many studies have examined the economic burden of opioid poisoning in the general population, but very little is known about the pediatric population. OBJECTIVE: To estimate the economic burden associated with pediatric prescription opioid poisonings. METHODS: This study examined opioid poisonings in pediatric patients, defined as patients aged less than 18 years, for the 2012 base year. Costs were estimated using the 2012 Nationwide Emergency Department Sample (NEDS), Kids' Inpatient Database (KID), Multiple Cause-of-Death (MCOD) file, and other published sources, while applying a societal perspective. The Bottom Up approach was used to estimate the total cost of pediatric prescription opioid poisonings. Direct costs included costs associated with emergency department (ED) visits, hospitalizations, and ambulance transports. Indirect costs were estimated using the human capital method and included productivity costs due to caregivers' absenteeism and premature mortality among children. Descriptive statistics were employed in calculating costs. RESULTS: The total costs of pediatric prescription opioid poisonings and exposure in the United States were $230.8 million in 2012. Total direct costs were estimated to be over $21.1 million, the majority resulting from prescription opioid poisoning-related inpatient stays. Total indirect (productivity) costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Pediatric prescription opioid poisoning-related ED visits, inpatient stays, and deaths were most common in patients aged 13-17 years and those in mid to large urban areas. Most were unintentional. CONCLUSIONS: Pediatric prescription opioid poisonings resulted in direct and indirect costs of $230.8 million in 2012. While these costs are low in comparison with the costs of prescription opioid poisoning in the general population, the number of pediatric poisonings represents only a small fraction of total poisonings. Quantified costs associated with pediatric prescription opioid poisonings can help decision makers to understand the economic trade-offs in planning interventions. DISCLOSURES: This research had no external funding but was funded by an unrestricted research grant made to the Department of Pharmacotherapy & Outcomes Science by kaléo Pharma, maker of a naloxone product. The authors declare no conflicts of interest or financial interests. Portions of this study were presented as an abstract at the 22nd Annual ISPOR Meeting; May 22, 2017; Boston, MA.

Case Reports1 March 1961KEROSENE PNEUMONITIS TREATED WITH ADRENAL STEROIDSROBERT L. MAYOCK, M.D., F.A.C.P., NOURALLAH BOZORGNIA, M.D., HARRY F. ZINSSER, M.D., F.A.C.P.ROBERT L. MAYOCK, M.D., F.A.C.P.Search for more papers by this author, NOURALLAH BOZORGNIA, M.D.Search for more papers by this author, HARRY F. ZINSSER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-3-559 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptCrude oil and the various fractions derived from it, such as gasoline and kerosene, have toxic properties on inhalation and ingestion that involve principally the central nervous system, liver, kidneys, lungs, and heart.1Many cases of kerosene poisoning—and frequent deaths—have been reported as a result of accidental ingestion. Bain2 reported that 25% of accidental poisoning deaths in the United States in 1949 and 1950 were due to kerosene; however, this syndrome occurs usually in children in rural areas3 where kerosene is more in use.The subject of this report is an adult male who developed a pneumonitis with liver damage...Bibliography1. Steiner MM: Syndromes of kerosene poisoning in children. J. Dis. Child. 74: 32, 1947. MedlineGoogle Scholar2. Bain K: Death due to accidental poisoning in young children. J. Pediat. 44: 616, 1954. CrossrefMedlineGoogle Scholar3. Gershon-CohenBringhurstByrne JLSRN: Roentgenography of kerosene poisoning (chemical pneumonitis). Amer. J. Roentgenol. 69: 557 (Apr.) 1953. Google Scholar4. Graham JR: Pneumonitis following aspiration of crude oil and its treatment by steroid hormones. Trans. Amer. Clin. Climat. Ass. 67: 104, 1955-56. MedlineGoogle Scholar5. Page RC: Health of the petroleum worker. Arch. Industr. Health 11: 126, 1955. MedlineGoogle Scholar6. GleasonGosselinHodge MNREHC: Clinical toxicology of commercial products. The Williams and Wilkins Co., Baltimore, pp. 150-157, 1957. Google Scholar7. Pinkerton H: The reaction to oils and fats in the lung. Arch. Path. 5: 380, 1928. Google Scholar8. Waring JI: Pneumonia in kerosene poisoning. Amer. J. Med. Sci. 185: 325, 1933. CrossrefGoogle Scholar9. LesserWeensMcKey LIHSJD: Pulmonary manifestations following ingestion of kerosene. J. Pediat. 23: 352, 1943. CrossrefGoogle Scholar10. RichardsonPratt-Thomas JAHR: Toxic effects of varying doses of kerosene administered by different routes. Amer. J. Med. Sci. 221: 531, 1951. CrossrefMedlineGoogle Scholar11. FoleyDreyerSouleWoll JCNBABE: Kerosene poisoning in young children. Radiology 62: 817, 1954. CrossrefMedlineGoogle Scholar12. DeichmannKitzmillerWitherupJohansmann WBKVSR: Kerosene intoxication. Ann. Intern. Med. 21: 803 (Nov.) 1944. LinkGoogle Scholar13. BolognaWoody NANC: Kerosene poisoning. New Orleans M. and S. J. 101: 256, 1948. MedlineGoogle Scholar14. Heacock CH: Pneumonia in children following the ingestion of petroleum products. Radiology 53: 793, 1949. CrossrefMedlineGoogle Scholar15. NunnMartin JAFM: Gasoline and kerosene poisoning in children. J. A. M. A. 103: 472, 1934. CrossrefGoogle Scholar16. ReedLeikinKerman ESSHD: Kerosene intoxication. J. Dis. Child. 79: 623, 1950. Google Scholar17. Nassau VE: Über Die Behandlung der Asperation von Petroleum mit Cortisone. Ann. Paediat. 178: 181 (Mar.) 1952. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Received for publication November 30, 1959.From the Pulmonary Disease Section, Edward B. Robinette Foundation, and Medical Clinic, Hospital of the University of Pennsylvania; and the Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.†Present address: Tehran, Iran.Requests for reprints should be addressed to Robert L. Mayock, M.D., Associate Professor of Clinical Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia 4, Pennsylvania.†According to Dr. Robert J. Bower, Medical Director of The Atlantic Refining Company, the composition of Ultrasene is as follows: "Ultrasene is a heavily acid treated, narrow boiling range, kerosene material. Boiling range of 400 to 500° F. It has an average composition of: 70% paraffins, 28% naphthenes, 2% aromatics, .01 to .02% sulfur; specific gravity, 0.783; 60° F." PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPulmonary Function 8 to 10 Years after Hydrocarbon PneumonitisAdrenocorticosteroid treatment of hydrocarbonpneumonia in children—a cooperative studyEffects of Drugs and Hyperbaric Oxygen Environment on Experimental Kerosene PneumonitisAdrenocortical Steroids in the Treatment of Kerosene Pneumonia 1 March 1961Volume 54, Issue 3Page: 559-566KeywordsHospital medicineIngestionInhalationLiverOilsPneumonitisPulmonary diseasesSteroid therapySteroidsTrachea ePublished: 1 December 2008 Issue Published: 1 March 1961 PDF downloadLoading ...

Maternal Substance Use Disorders and Accidental Drug Poisonings in Children

Rotavirus is a major cause of gastroenteritis in children throughout Europe and the world. In addition to causing morbidity and mortality in children, rotavirus gastroenteritis (RVGE) creates a major economic burden on health care systems and families in Europe. The costs of hospital admissions for RVGE and nosocomial infections generate significant medical treatment costs throughout the region. Less information is available on the costs associated with less severe episodes and the costs borne by families, including lost time from work. The availability of rotavirus vaccines presents an effective opportunity to prevent RVGE and these associated economic costs, as well as providing protection to each child and hence benefiting the child's family. The adoption of rotavirus vaccine by health authorities in Europe will require a comparison of the costs and benefits. Economic evaluations that compare the costs of vaccination to the economic benefits of rotavirus vaccination will provide an estimate of its financial impact on health care systems and society. However, to provide a complete picture, economic evaluations of rotavirus vaccines will need to account for both the reduced costs and the reduced morbidity from prevented RVGE. Cost-effectiveness analyses based on quality-adjusted life years (QALYs) provide a systematic approach for assessing vaccination as a health investment, comparing the incremental costs associated with rotavirus vaccination and the reduced morbidity and mortality. QALYs provide a standardized approach for quantifying and comparing reductions in health-related quality of life and premature mortality. Although methodologic limitations exist in applying the QALY approach to childhood vaccines, their use in cost effectiveness analyses allows decision makers to consider the full health benefits of rotavirus and other vaccines.