Abuse Admissions Research Articles

Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000–2009

To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time. Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure. Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007). Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.

Evolución de los ingresos por maltrato infantil durante 15 años

AimTo measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. MethodsRetrospective review of children diagnosed with maltreatment over 15years in a third level hospital. ResultsA total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). ConclusionsThe increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family.

Growing Internet Use May Help Explain The Rise In Prescription Drug Abuse In The United States

The rising availability through the Internet of commonly abused prescription drugs has raised public health concerns. We examined whether the growth of US prescription drug abuse may be explained by the parallel growth in high-speed Internet use. We find that for every 10 percent increase in high-speed Internet use at the state level, associated treatment facility admissions for prescription drug abuse rose by 1 percent. Admissions for abuse of alcohol, cocaine, and heroin, which are not readily purchased online, had minimal or negative growth during the same period. The results suggest that better surveillance of online prescription drug sales is warranted, and aggressive efforts to curb illegitimate online pharmacies may be necessary.

Prescription Drug Monitoring Programs—Lack of Effectiveness or a Call to Action?

Prescription opioid pain relievers play an essential role in improving the quality of life for millions of Americans each year. However, over the last decade, the legitimate use as well as the misuse and abuse of prescription opioids have increased dramatically. From 1997 to 2007, the milligram per person use of prescription opioids in the United States increased from 74 mg to 369 mg per person, an increase of 402% [1]. In addition, the health and economic consequences of opioid abuse are exacting a significant toll—with over five million Americans, 12 years of age and older, reporting nonmedical use of prescription opioids in 2009 [2]. From 2004 to 2008, there was a 111% increase in emergency room visits for misuse or abuse of prescription opioids [3], and this was paralleled with a fourfold increase in treatment admissions for abuse of opioids over the last decade [4]. Most alarming is a nearly 300% increase in opioid-related deaths between 1999 and 2007 [5]. Prescription drug abuse is a public health epidemic, and comprehensive policies must be developed to minimize abuse while ensuring legitimate access to these medications. Prescription drug monitoring programs (PDMPs) are a promising tool to assist health care providers in clinical decision-making and to identify patients who may be misusing or abusing prescription drugs. Although studies have shown that PDMPs shorten investigation times [6] and reduce the supply of certain Schedule II controlled …

Prescription and over-the-counter drug treatment admissions to the California public treatment system

Prescription and over-the-counter (OTC) drug abuse has become a focal point of public health policy, prevention, and control efforts. Adolescents represent one of the fastest growing segments of the general population abusing prescription and OTC drugs as represented by national surveys. This article reports on treatment admission data to the California addiction public system for prescription and OTC drugs among two age subgroups: adolescents 12–17 years and adults 18 years and older. Of the 6,841 admissions for primary abuse of prescription and OTC drugs in California (during 2006–2007), most adolescent admissions (12–17) were for stimulant prescription and OTC drugs (45.3% and 32.1%, respectively), whereas opioid prescription drugs (88.9%) were most common for adults 18 years and older. Differences in psychosocial, treatment, and substance use characteristics between these two age subgroups are described. Results from this study offer useful treatment admission information about prescription and OTC drug abuse within the California public addiction treatment system.

Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. A RETROSPECTIVE ECOLOGICAL COHORT STUDY COMPARING STATE PRESCRIPTION OPIOID SHIPMENTS (SOURCE: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997-2003. From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764-0.785). PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible "chilling effect" on physician prescribing.

Changing Profile of Abused Substances by Older Persons Entering Treatment

This study evaluated whether there were increasing admissions for illicit drug abuse treatment among older persons from 1992 to 2005 in the United States and describes the characteristics, number, and type of substances most commonly abused in this population over this 14-year period. Analyses used public data files from the Treatment Episode Data Set, which tracks federally and state funded substance abuse treatment admissions. From 1992 to 2005, admissions for illicit drug abuse increased significantly; in 2005, 61% of admissions age 50 to 54 years old and 45% of admissions age 55 years and older reported some type of illicit drug abuse, most commonly heroin or cocaine abuse. Criminal justice referrals for drug abuse admissions have increased over time and daily substance use remains high. Efforts to determine best practices for prevention, identification, and treatment of illicit drug abuse in older persons are indicated.

Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public health

In the past decade, methamphetamine has become increasingly a drug of concern globally. The purpose of this study is to describe the changing trends in treatment admissions for methamphetamine abuse in Cape Town, South Africa and to highlight the implications of these changes for policy, practice and research. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance and information on prior treatment. The results indicate that between 2004 and 2006 a dramatic increase in treatment admissions for methamphetamine abuse occurred, a large proportion of the methamphetamine patients are adolescents and that the drug is almost exclusively smoked. The rapid increase in admissions for methamphetamine abuse is of great concern, particularly as the drug has a number of serious, often chronic, side effects and that a large proportion of the patients are adolescents. The implications for public health are discussed.

Trends in nonheroin opioid abuse admissions: 1992-2004

This study examines trends for treatment admissions for nonheroin opioid abuse from 1992 to 2004. Databases from the Substance Abuse Mental Health Services Administration (SAMHSA, U.S.A.): Treatment Episode Data Set (TEDS) were used to examine the changing characteristics of admissions to treatment for nonheroin opioid abuse. Data are collected annually from each state on characteristics of admissions to treatment for all substances abused in the United States. Using the Mann-Kendall test for examining annual trends, we determined any significant trend changes by modeling data for every 2years of TEDS information from 1992 to 2004. We found significant changes for admissions to substance abuse treatment from 1992 to 2004. Overall, nonheroin opioid admissions to treatment have increased, specifically among adolescents. Other significant trends included an increase in the never-married group admitted, a higher rate of psychiatric problems for nonberoin opioid abuse admissions, changes in the treatment services and significant associations between age of first use of marijuana and methamphetamine, and subsequent nonheroin opioid abuse admissions. Characteristics of admissions to treatment are changing over time and identify an admitted treatment group that is historically different from heroin abusers. These findings will give providers information about who is seeking treatment for nonheroin opiate abuse. Altered treatment strategies that target the changing population who seek treatment for nonheroin opioid abuse need to be universally available.

Pancreatitis

To determine the prevalence of pancreatitis and associated risk factors among heavy-drinking veterans. At a large Veterans Administration Outpatient Detoxification Program (ODP) that systematically collects risk information, 1409 black and white male veterans with International Classification of Diseases, Ninth Revision codes for alcohol abuse enrolling in the ODP from January 2002 to December 2003 were identified. Among these patients, pancreatitis at any time (before the ODP admission or occurring through June 2005) was identified using International Classification of Diseases, Ninth Revision codes. Cases were verified by chart review. Logistic regression analyses were used for multivariable analyses. Overall, history of smoking (89.6%) and current or past drug use (90.1%) were very common, whereas intravenous drug use (22.3%) was less so. Although 87 (6.2%) subjects had pancreatitis codes (acute, 50; chronic, 15; both, 22), chart review verified only 42 cases (acute, 29; chronic, 5; both, 8) for a 3% prevalence. Alcohol appeared to be the definite etiology in 39 of these 42 patients. In bivariate analyses, patients with pancreatitis were older, had more substance abuse admissions, reported a significantly heavier current alcohol use, and lower drug dependence (each P < 0.05). In multivariable models, alcoholic pancreatitis was associated positively with age (odds ratio, 1.08; 95% confidence interval, 1.04-1.12) and number of substance abuse admissions (odds ratio, 1.08; 95% confidence interval, 0.995-1.18; P = 0.06). In this high-risk population of heavy drinkers, the prevalence of pancreatitis is at least 3%. Our study provides preliminary data regarding potential cofactors for pancreatitis in heavy drinkers.

PREVALENCE OF AND RISK-FACTOR PROFILE FOR PANCREATITIS IN MALE VETERANS WITH MIXED ALCOHOL AND DRUG ADDICTION

Background and Aims: To determine the prevalence of and risk factor profile for pancreatitis among high-risk veterans. Methods: The study population consisted of 1409 black or white men with alcohol-related ICD-9 codes (291, 303, 305.00, 305.01, 305.02, 305.03) attending a large VA Outpatient Detoxification Program (1/2002-12/2003) who had systematically collected risk-factor information on alcohol use, drug use and smoking. Pancreatitis (at anytime through 6/2005) among study subjects was identified using ICD-9 codes (acute pancreatitis [AP] - 577.0, chronic pancreatitis [CP] - 577.1). Clinical records of all subjects with pancreatitis codes (n = 87) and 214 controls within this population (no ICD-9 codes for pancreatitis) were reviewed in a blinded fashion to verify pancreatitis diagnosis. Definite AP was diagnosed by presence of typical abdominal pain with amylase ± lipase elevation ≥3 times normal or imaging evidence of pancreatitis, and alcoholic CP based on the International workshop on CP criteria for definite diagnosis (Pancreas 1997;14:215-221). Results: Most subjects were middle aged (median 48 yrs, IQR 44-53) and 43.5% were whites. History of smoking (90%), current or past drug use (90%) and IV-drug use (22.3%) was common. Although 6.2% subjects had pancreatitis codes (n = 87, AP-50, CP-15, both-22), chart review verified only 3% cases (n = 42, AP-29, CP-5, both-8). After excluding 3 patients who also had gallstones on imaging, definite alcoholic pancreatitis was present in 39 of these 42 patients. The prevalence of pancreatitis increased to 4.2% if milder criteria to diagnose AP (typical abdominal pain with any enzyme elevation and negative imaging study) and CP (clinical picture consistent with CP but no morphological changes of CP as included in the definite criteria) were used. On bivariate analyses, compared to controls (no pancreatitis), pancreatitis subjects were significantly older (median age 53 vs. 48 yrs, p < 0.001), had more admissions to substance abuse program (median 4 vs. 2, p < 0.01), reported higher current alcohol use (median 17 vs. 12 drinks/d, p < 0.05) and lower drug dependence (p < 0.05). In multivariable logistic regression analyses, alcoholic pancreatitis associated positively with age (OR = 1.08, 95% CI = 1.04-1.12, p < 0.001) and number of substance abuse admissions (OR = 1.08, 95% CI = 0.995-1.18, p = 0.06). Conclusions: Pancreatitis prevalence in this high-risk population is at least 3%, but likely ranges between 3-6%. Many behavioral factors associate with pancreatitis. Our study provides preliminary data for future studies focusing on risk factor associations for pancreatitis in high-risk populations.

Risk Factors Associated with Emergency Room Drug Abuse Admissions in Urban Taiwan, 1998–1999

The present study examined the risk factors associated with admissions for drug abuse among patients who visited an accident and emergency (A & E) department at a large metropolitan teaching hospital in Taipei, Taiwan. Two hundred and fifty-four consecutive patients reporting problems related to suspected intentional drug poisoning or acute intoxication from drugs of misuse were matched to 254 patients with internal medicine conditions unrelated to drug abuse by age within three years. Risk factors and drug use information was obtained by questionnaire. Between December 1998 and November 1999, 272 (0.7%) patients had visited the A & E for treatment of drug-related problems. Among these patients, 254 (93%) completed questionnaires and were enrolled in this study. Major reasons for hospital visits were suicide (51%), and acute drug poisoning (49%); primary drugs used were sedatives/hypnotics (81.7%) and narcotics (4.7%); most drugs came from pharmacies and drug stores (47.2%), hospitals and clinics (25.2%),...

Urbanization and hospital admission rates for alcohol and drug abuse: a follow-up study of 4.5 million women and men in Sweden.

This study analyses whether the level of urbanization is associated with hospital admissions for alcohol and drug abuse, after adjustment for individual demographic and socio-economic characteristics. Follow-up study from 31 December 1996 to 31 December 1999. Sweden. The entire Swedish population aged 25-64 yeras, in total 4.5 million women and men. Hospital admission rates for alcohol abuse (12,812 events) and drug abuse (6459 events). Level of urbanization was defined by population density and divided into quintiles. Cox proportional hazard models were used to analyse the data. The results showed an apparent gradient for both women and men; with increasing level of urbanization the hospital admission rates for alcohol abuse and drug abuse increased sharply. After adjustment for age, marital status, education and immigrant status, the hazard ratios for hospital admission for alcohol abuse were 1.76 [confidence interval (CI) = 1.58-1.96] for women and 1.71 (CI = 1.60-1.82) for men in the most densely populated areas (quintile 5). For drug abuse the corresponding hazard ratios were 1.89 (CI = 1.67-2.15) for women and 2.38 (CI = 2.12-2.67) for men. A high level of urbanization was associated with increased hospital admission rates for alcohol abuse and drug abuse. The level of urbanization should be considered in the distribution of resources for prevention and treatment of alcohol and drug abuse.

Analysis of perpetrator admissions to inflicted traumatic brain injury in children.

Scientific and courtroom debate exists regarding the timing of onset of symptoms and the mechanism of injury in infants and children with inflicted traumatic brain injury (ITBI). To determine the time interval between ITBI and the onset of symptoms and to explore the mechanism of ITBI. Retrospective review of all cases of pediatric ITBI admitted between January 1, 1981, and July 31, 2001, to a large academic medical center and cases admitted to 2 additional academic institutions between January 1, 1996, and August 31, 2000, and January 1, 2001, and July 31, 2001, comparing 81 cases of ITBI in which perpetrators admitted to abuse with 90 cases in which no abuse admission was made. The patients with perpetrator admissions to ITBI consisted of 53 boys (65%) and 28 girls (35%). Their ages ranged from 2 weeks to 52 months. Characteristics associated with perpetrator admissions to ITBI in children. Shaking was the most common mechanism of injury among all cases with perpetrator admissions: 55 (68%) of the 81 perpetrators admitted to shaking the children. Impact was not described in 44 (54%) of the 81 cases. In cases in which only impact was described, 60% (12/20) of the children showed skull or scalp injury, compared with 12% (4/32) with skull or scalp injury in the shake only group. In 52 (91%) of 57 cases in which the time to the onset of symptoms was described, symptoms appeared immediately after the abuse. In 5 cases (9%), the timing of symptoms was less clear, but they occurred within 24 hours. None of the children were described as behaving normally after the event. The symptoms of inflicted head injury in children are immediate. Most perpetrators admitted to shaking without impact. These data, combined with the relative lack of skull and scalp injury, suggest that shaking alone can produce the symptoms seen in children with ITBI.

Duodenal injuries in children: beware of child abuse

Purpose It is frequently overlooked that child abuse may result in significant intraabdominal injury, particularly to the duodenum. The authors hypothesized that a significant number of duodenal injuries in young children would be the result of nonaccidental trauma. Methods An 8-year (1995 through 2002) retrospective review of a pediatric level I trauma center database was performed after Institutional Review Board approval was obtained, and information regarding patients with duodenal injury was abstracted. Demographic variables, injury severity, length of stay, mortality rate, and mechanism of injury were examined. Statistical analysis was performed using descriptive statistics and Student’s t test. Statistical significance was defined as P less than .05. Results Over the 8-year study period, 8,968 patients were admitted, 2,179 (24%) were less than 3 years of age. Thirty children (0.3%) suffered injury to the duodenum, with 20 hematomas and 10 perforations. Patients were overwhelmingly boys (80%), with an average age of 7.6 ± 4.4 years and Injury Severity Score (ISS) of 14 ± 10. No patients died. Children were injured by a variety of mechanisms, including collisions involving motor vehicles (n = 9), bicycles (n = 4), and ATVs (n = 2). However, all children less than 4 years of age (n = 8) were victims of nonaccidental trauma, 2.8% of all child abuse admissions. Three of these children suffered perforations of the duodenum. Among the entire population, those children who suffered perforations had a significantly higher ISS (23.7 ± 7.2 v 9.6 ± 7.3; P < .0003) and longer length of stay (27.1 ± 15.3 v 12.6 ± 11.7; P < .007) than those with hematomas Conclusions Injury to the duodenum is unusual in the pediatric trauma patient but does result in significant injury severity and prolonged hospitalization. In the young child, one must maintain a high index of suspicion regarding the etiology of the injury, because a large percentage is potentially the result of child abuse.

Outpatient cocaine abuse treatment: predictors of success.

In 1990 more than 238,000 patients in the United States entered treatment, with cocaine as their primary diagnosis. This represented 36 percent of the treatment admissions for substance abuse. This research project uses data from the U.S. Army's Alcohol and Drug Abuse Prevention and Control Program to analyze which treatment and demographic variables have an effect on cocaine treatment outcomes. The sample included 3602 soldiers entered into treatment between 1983 and 1992 for cocaine abuse. The logistical regression results suggested the following treatment variables had an effect on outcomes: the type of treatment provided, the length of time in treatment, the number of different types of drugs being abused prior to treatment, and the length of time since the patient had abused cocaine prior to entering treatment. Race of the patient had an impact on treatment outcomes, but gender, educational level, age, rank of the soldier, marital status, and length of time in the military did not have an impact on treatment outcomes.

His Bright Light: The Story of Nick Traina • The Outsider: A Journey Into My Father's Struggle With Madness • Ordinary Paradise

His Bright Light: The Story of Nick Traina • The Outsider: A Journey Into My Father's Struggle With Madness • Ordinary Paradise

STATEWIDE GEOGRAPHIC VARIATION IN GERIATRIC PSYCHIATRIC ADMISSIONS

Purpose: The study of geographic practice variation in medicine and surgery has caused significant changes in health care policy and the regulation of clinical practice, but studies of psychiatric practice variation are minimal. The purpose of this study was to determine the major sources of statewide geographic variation in geriatric psychiatric admissions. Methodology: The Louisiana 1995 fiscal year Medicare over 65 psychiatric admission rates were calculated from the HCFA MEDPRO database and analyzed using six variables: prospective payment stays (PPS), psychiatric hospital vs. acute general hospital stays, first admissions vs. readmissions, depression admissions, substance abuse admissions, transfers after medical/surgical admissions. Results: High admission rate areas were associated with psychiatric hospitalizations after a medical/surgical hospitalization, the use of acute general hospitals, the use of non PPS stays, and depression admissions. Readmissions and substance abuse admissions were not statistically related to high admission areas. Conclusions: The strongest association with higher geographic admission rates was the use of non-PPS beds in acute general hospitals. This finding in geriatric psychiatric admissions is consistent with the small area analysis literature on medical and surgical admissions. P6

Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates.

This study compares substance use disorder (SUD) patients with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD) on their use of addiction and psychiatric services over the 6-month period before an inpatient substance abuse admission. Compared with non-PTSD patients, PTSD patients had a greater number of hospital overnights for addiction treatment. Given no significant between-groups differences on any substance use indexes, PTSD patients apparently overuse costly inpatient addiction services. Despite their greater rates of psychiatric comorbidity, PTSD patients did not receive treatment for psychiatric problems at greater rates than did non-PTSD patients. Among PTSD patients, use of PTSD treatment was low. Assessment of psychiatric comorbidity and referral to treatment targeting co-occurring PTSD and other disorders are suggested as possible ways to reduce the high treatment costs associated with SUD-PTSD comorbidity.

Comorbid Affective Disorders and Personality Traits in Alcohol Abuse Inpatients at an Air Force Medical Center

A retrospective chart review of 2 years of admissions (1995-1996) for alcohol abuse and alcohol dependence patients on an inpatient substance abuse unit showed the prevalence of comorbid affective disorders, personality disorders/subsyndromal personality traits, and the combination of all three diagnoses to be 8.2, 17.5, and 9.6%, respectively. The available literature on these additional diagnoses in substance abusers is reviewed and compared with the findings of the current study. Patients identified for inpatient substance abuse treatment need full psychiatric evaluation for other Axis I and Axis II comorbidity that may greatly affect their treatment plans and clinical prognoses.