Intentional Abuse Research Articles

Identifying and quantifying exposures involving counterfeit opioid analgesic products

Introduction The increasing presence of counterfeit opioid drugs in the United States can contaminate data collection systems and confound estimates derived from surveillance of the opioid epidemic. Data sources and analyses that can quantify the contribution of counterfeit opioid products are needed to provide accurate and timely data to inform public health responses. We describe a novel approach to identify and quantify intentional abuse and misuse exposures involving suspected counterfeit opioid products in United States poison center data. Methods An ecological study was performed using data, including narrative case notes, reported to participating United States Poison Centers of the Researched Abuse, Diversion and Addiction Related Surveillance System between 2009-Quarter 1 and 2021-Quarter 4. A machine learning natural language processing approach was used to develop a predictive model. Results Sensitivity for detecting suspected non-counterfeit-involved exposures by the predictive model was 92%, specificity was 73%, and the area under the receiver operating characteristic curve was 92%. Overall, only 2.1% of intentional abuse and misuse exposure calls were predicted to be suspected counterfeit-involved during 2009–2021; however, we observed an exponential increase in suspected counterfeit exposures over this time period. There was a 7-fold increase in the estimated number of suspected counterfeit exposures from 2009 to 2021, and 23.7% of all opioid analgesic intentional abuse and misuse exposures were suspected counterfeit-involved in 2021. Discussion We demonstrate the feasibility and reliability of using machine learning natural language processing to identify exposures involving suspected counterfeit opioid products in United States poison center data. Results suggest that suspected counterfeits have had a meaningful influence on rates of intentional abuse exposures to opioid analgesics in more recent years. Conclusions The increasing presence of counterfeit opioid drugs can contaminate data collection systems and compromise the reliability of the data.

Epidemiological Study of Pediatric and Adolescent Poisoning Cases in a Rural Tertiary Care Centre in South India

Pediatric poisoning covers the entire spectrum of cases from accidental ingestion in toddlers to intentional abuse in teenagers. Epidemiological surveillance of oral ingestion of poisonous substances in children and adolescents in a particular area is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. This was a retrospective, observational study including all pediatric poisoning patients (between the age of 0 to 19 years) received at the Trichy SRM Medical college & Research Centre, Irungalur, Trichy during the 2 year period from May 2021 to April 2023. A total of 52 cases were received in the casualty department of our hospital during the study period. Out of this, Male patients were predominant (53.85%). Most of the cases belonged to the age group between 16- 19 Years . Most of the cases were from the Rural areas (82.69%).Accidental Poisoning (61.54%) is more common followed by suicidal poisoning (38.46%). The substances involved in Poisoning are Kerosene(19%),Rat Killer (10%), Paracetamol(10%), Oleander(8%), ant-killer (8%), Organo-phosphorus Poisoning(6%) among many others. Most of the time the poisoning happened inside Home(65%) followed by area surrounding home(17%). Oral route (88%) was the most common way of taking poison. Most cases took less than 4 hours (71%) to reach the hospital. Vomiting was the most common symptom in most of the cases. 23 cases (44%) were requiring intensive care of which only 8 cases (15%) needed more than 3 days of ICU care.

Gender Role Mindset and Beliefs about Own Personal Goals as a Guide for Young People's Behaviors towards the Romantic Partner.

Dating violence (DV) is a form of intentional abuse carried out in young couples, which over the years has increasingly gained attention for its pervasiveness and high frequency. The present study represents an effort to expand and deepen the literature on factors associated with DV perpetration. The sample consisted of 225 Italian young people who completed an online survey. A model was tested, in which DV perpetration is affected by the presence of gender stereotypes and personal values oriented to power and dominance (i.e., self-enhancement) and to universalism and interest in others (i.e., self-transcendence) through the mediation of the perception of the romantic relationship quality, controlling for age. Sex was also considered in the model. The findings showed that self-enhancement and self-transcendence were, respectively, linked positively and negatively to a negative perception of the relationship quality, which in turn explained DV perpetration. The results also suggested that hostile sexism, self-enhancement and being male were directly linked to DV perpetration, thus representing potential risk factors for it. The study suggests the importance of working on gender role beliefs and personal orientation to power, which guide the way people perceive their romantic relationships and behave toward their partners, providing interesting insights for the implementation of DV prevention programs. Moreover, the findings highlight the importance of working with families and other educational agencies to foster a change in cultural terms.

Quasi-Gel Polymer Electrolyte Interfaced with Electrodes through Solvent-Swollen Poly(ethylene oxide) for High-Performance Lithium/Lithium-Ion Batteries.

Solid polymer electrolytes (SPEs) are regarded as a superior alternative to traditional liquid electrolytes of lithium-ion batteries (LIBs) due to their improved safety features. The practical implementation of SPEs faces challenges, such as low ionic conductivity at room temperature (RT) and inadequate interfacial contact, leading to high interfacial resistance across the electrode and electrolyte interfaces. In this study, we addressed these issues by designing a quasi-gel polymer electrolyte (QGPE), a blend of poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP), poly(ethylene oxide) (PEO), and succinonitrile (SN), with the desired mechanical strength, ionic conductivity, and interfacial stability through a simple solution casting technique. The QGPE features a thin solvated PEO layer on its surface, which wets the electrode, reducing the interfacial resistance and ensuring a homogeneous Li-ion flux across the interface. The optimized QGPE exhibits a good lithium-ion conductivity of 1.14 × 10-3 S cm-1 with a superior lithium-ion transference number of 0.7 at 25 °C. The Li/QGPE/Li symmetric cell exhibits a highly reversible lithium plating/stripping process for over 1300 h with minimal voltage polarization of ∼20 mV. The Li/QGPE/LiFePO4 full cell demonstrates good rate capability and excellent long-term cycling performance at a 0.1 C rate at 25 °C, maintaining a specific discharge capacity of 148 mAh g-1 over 200 cycles. The effectiveness of QGPE for LIBs is proven using a graphite/QGPE/LiFePO4 4 × 4 cm pouch cell, showcasing outstanding flexibility and tolerance against intentional abuse.

The Plight of the Child in Charles Dicken’s Oliver Twist and John Nkemngong Nkengasong’s Achakasara

This paper examines the ordeal of the Victorian English and Postcolonial Cameroonian children through the lenses of Charles Dickens’ Oliver Twist and John Nkemngong Nkengasong’s Achakasara. Child abuse cuts across universality, timelessness, racial and gender constructs. The child in these two societal backgrounds undergoes untold suffering perpetrated by adults and their fellow children. They are exploited for commercial purposes, at the expense of their education and wellbeing. They experience physical assault through undeserved beating under the guise of domestic correction with pending eventualities being psychological trauma. A continuity of intentional abuse consciously impacts the child to view his place of birth and development as a problem. That child sees the streets as a better option. Very high probability abounds that these streets are not suitable for the developmental processes of the child but at that point, his/her actions are shaped by convictions. Dickens and Nkengasong take interest what happens to a child, in their respective societies. They pen with certainty that conventional Victorian England and contemporary Postcolonial Cameroonian societies are fraught with different shades of injustices, jeopardising the future of the younger generations. This paper is vehiculated by the Psychoanalytic theory, with focus on Anna Freud’s dimension of Psychoanalysis. Anna Freud is a child psychoanalyst concerned with the upbringing of children. The purpose of this paper is to portray the various abuses experienced by the child as demonstrated in Dickens’ Oliver Twist and Nkengasong’s Achakasara.

The unmet promise of trustworthy AI in healthcare: why we fail at clinical translation.

Artificial intelligence (AI) has the potential to revolutionize healthcare, for example via decision support systems, computer vision approaches, or AI-based prevention tools. Initial results from AI applications in healthcare show promise but are rarely translated into clinical practice successfully and ethically. This occurs despite an abundance of "Trustworthy AI" guidelines. How can we explain the translational gaps of AI in healthcare? This paper offers a fresh perspective on this problem, showing that failing translation of healthcare AI markedly arises from a lack of an operational definition of "trust" and "trustworthiness". This leads to (a) unintentional misuse concerning what trust (worthiness) is and (b) the risk of intentional abuse by industry stakeholders engaging in ethics washing. By pointing out these issues, we aim to highlight the obstacles that hinder translation of Trustworthy medical AI to practice and prevent it from fulfilling its unmet promises.

Characterization of Emergency Department Poisoning Epidemiology in Belize

Objective: Little is known about the epidemiology of poisonings in Belize. The purpose of this study was to characterize poisonings presenting to Karl Heusner Memorial Hospital, Department of Accident and Emergency in Belize City, Belize. Methods: Charts were reviewed for patients with possible toxicologic exposures, presenting between May 31, 2016 – December 31, 2018. Variables of interest included patient age and sex, type and route of poisoning, reason for exposure, and disposition. Results: Of the 60,310 patient visits during the study period, 768 patients, 1.3%, presented after a toxicologic exposure. The age distribution of poisoned patients varied with the largest proportion being between 19-30 years of age, 29.3%. There was a male predominance of patients, 60.4%. Approximately 44% of all poisonings involved ethanol only. Marijuana was the most common drug of abuse. Other common inhalation and ingested exposures included cleaning agents, household agents, acetaminophen, NSAIDs, pesticides, organophosphates, sedating medications, antibiotics, and ciguatera poisoning. Nearly 48 % of intoxication cases were due to intentional abuse, while about eight percent were from suicide attempts. Of identified poisoned patients, 84.4% were ultimately discharged, 13.8% were admitted, 1.6% were “self-discharged,” 0.13% were transferred, and 0.13% died. Conclusions: This study illustrates that poisoning is an important cause of Accident and Emergency visits in Belize, whose patterns may differ from those in other countries. Understanding the current state of poisonings in Belize can aid in the development of treatment protocols, antidote stocking, and educational activities for poisoning prevention.

Tindak Pidana Penganiayaan Sebagaimana Diatur dan Diancam Pidana Dalam Pasal 351 ayat 1 KUHP (Studi Putusan PN Medan Nomor 1621/Pid.B/2023/PN Mdn

One of the most common crimes in society is child abuse. Article 351 paragraph (1) of the Penal Code (KUHP) regulates and threatens criminal offenses in Indonesian criminal law. Medan District Court Decision No. 1621/Pid.B/2023/PN Mdn, regarding criminal abuses, will be discussed in this article. This study analyzes events and court decisions. Research methods include analysis of court decisions and legal analysis of criminal behavior. Research results show that, according to the provisions of the Penal Code, abuse crimes can be classified into many types, including general abuse, mild abuse, intentional abuse and severe abuse. Important. Preventive and repressive measures are necessary to combat criminal acts. Criminal law is used to solve problems in society, while non-criminal methods focus on prevention. To bring justice to victims and all parties involved, law enforcement must understand the behavioral factors associated with criminal abuse. 

The Potential Mechanisms behind Loperamide-Induced Cardiac Arrhythmias Associated with Human Abuse and Extreme Overdose.

Loperamide has been a safe and effective treatment for diarrhea for many years. However, many cases of cardiotoxicity with intentional abuse of loperamide ingestion have recently been reported. We evaluated loperamide in in vitro and in vivo cardiac safety models to understand the mechanisms for this cardiotoxicity. Loperamide slowed conduction (QRS-duration) starting at 0.3 µM [~1200-fold (×) its human Free Therapeutic Plasma Concentration; FTPC] and reduced the QT-interval and caused cardiac arrhythmias starting at 3 µM (~12,000× FTPC) in an isolated rabbit ventricular-wedge model. Loperamide also slowed conduction and elicited Type II/III A-V block in anesthetized guinea pigs at overdose exposures of 879× and 3802× FTPC. In ion-channel studies, loperamide inhibited hERG (IKr), INa, and ICa currents with IC50 values of 0.390 µM, 0.526 µM, and 4.091 µM, respectively (i.e., >1560× FTPC). Additionally, in silico trials in human ventricular action potential models based on these IC50s confirmed that loperamide has large safety margins at therapeutic exposures (≤600× FTPC) and confirmed repolarization abnormalities in the case of extreme doses of loperamide. The studies confirmed the large safety margin for the therapeutic use of loperamide but revealed that at the extreme exposure levels observed in human overdose, loperamide can cause a combination of conduction slowing and alterations in repolarization time, resulting in cardiac proarrhythmia. Loperamide's inhibition of the INa channel and hERG-mediated IKr are the most likely basis for this cardiac electrophysiological toxicity at overdose exposures. The cardiac toxic effects of loperamide at the overdoses could be aggravated by co-medication with other drug(s) causing ion channel inhibition.

(S)Talking women: portrayal of females in online discourse of social media in Albania

The aim of this paper is to explore Albanian social media discussion threads, prioritizing the way women are portrayed. The development of social media discourse has been empowered through the increasing influence of digital media, permeating all areas of life recently. ‘Privacy is no longer a social norm’, and intentional abuse of media-derived power has led to malicious intentions infiltrating online social media discourse, threatening loyal and straightforward communication, and giving rise to denigration, negativity, and dismay. Based on the current view of scholars in the field of language and digital communication that text-based studies need to move forward by incorporating other modes of communication and the fact that all human communication is, after all, multimodal, we intend to bring examples to illustrate the choice of language and images by Albanians in online social media in reaction to current popular events. The common thread that unites all examples is related to the depiction of females, unfortunately, in derogatory terms, and gendered culpability. It is hoped that the paper will raise awareness about such dominating problematic approaches toward females in Albania, as manifested in the language used.

Clinical Presentation and Management of Acute Dystonia from Drug Abuse or Misuse in Adolescents and Young Adults: A Retrospective Cohort Study in Bangkok, Thailand.

To describe the clinical presentation of acute dystonia (AD) from drug abuse or misuse, as well as the emergency department (ED) management and outcomes in adolescents and young adults. This was a retrospective cohort study of patients aged 10-25 years who were admitted to the ED for AD due to intentional abuse or misuse from January 1, 2014, to June 30, 2017. Data were collected from electronic medical records by three investigators with excellent interrater reliability (0.87). Sixty-two cases met the criteria with male predominance (85.5%); the mean age was 16.7 years. Perphenazine was the most common cause of AD (38.7%), followed by haloperidol (32.2%). The most common AD manifestations were torticollis (51.6%), oromandibular dystonia (45.2%), and oculogyric crisis (22.6%). Intravenous (IV) diazepam combined with oral trihexyphenidyl and IV diazepam alone were the most frequently used first treatment in our ED (41.7% and 35.0%, respectively). Overall, the improvement rates from IV diazepam alone or combined with trihexyphenidyl ranged from 46.2%-75.0%. These rates were inferior to those observed with IV benztropine (100%) alone or combined with trihexyphenidyl. All patients were treated on an outpatient basis, except for one who was admitted to a pediatric ward. In recent years, drug-induced AD caused by intentional abuse among adolescents and young adults has become a concern in Thailand. The most common suspected drugs of abuse were first-generation antipsychotics, perphenazine, and haloperidol. The most effective treatment was benztropine.

Poe in Cyberspace: Web 1, 2, 3 . . .

Poe in Cyberspace: Web 1, 2, 3 . . .

Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000-2020

Context Childhood and adolescent misuse and abuse exposures remain a serious public health challenge in the United States. This study aimed to describe recent trends and patterns of intentional substance misuse and abuse exposures among school-aged children and adolescents in the United States. Methods This study was a retrospective cohort study of intentional misuse and abuse exposures in children 6 through 18 years reported to the National Poison Data System (NPDS) from January 1, 2000, through December 31, 2020. Demographic trends, reported clinical effects, treatments, management sites, and health outcomes were assessed overall and within four age categories: 6–9, 10–12, 13–15, and 16–18. Results Between 2000 and 2020, there were 338,727 cases regarding intentional misuse and abuse exposures for children ages 6 through 18 years old. Overall, misuse/abuse ingestions fluctuated over time, with a peak in 2011. The majority of intentional misuse/abuse ingestions occurred in males (58.3%), and more than 80% of all reported exposure cases occurred in youth aged 13 to 18. 32.6% of ingestions resulted in worse than minor clinical outcomes. Older age groups had a greater number of severe medical outcomes compared to younger age groups. Major or life-threatening exposures (including those resulting in death) were more common in males. Overall, deaths were rare (n = 450), 0.1%). Male sex, older age, abuse ingestions, exposure site of a public area or other residence, and multiple ingested substances were other factors associated with increased mortality. Marijuana exposure rates had the highest average monthly increase overall, with the most dramatic rise occurring from 2017 to 2020. Edible marijuana preparations accounted for the highest increase in call rates compared with all other forms of marijuana. Discussion and Conclusion With over 330,000 poison center cases reported during the 20-year study period, intentional substance misuse and abuse exposures substantially impact the pediatric population. The substances most commonly misused/abused are more widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth. Differences in age and sex were evident, with males and adolescents more likely to abuse and misuse substances. Our study describes an upward trend in marijuana misuse/abuse exposures among youth, especially those involving edible products. These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.

Social impact and governance of AI and neurotechnologies

Advances in artificial intelligence (AI) and brain science are going to have a huge impact on society. While technologies based on those advances can provide enormous social benefits, adoption of new technologies poses various risks. This article first reviews the co-evolution of AI and brain science and the benefits of brain-inspired AI in sustainability, healthcare, and scientific discoveries. We then consider possible risks from those technologies, including intentional abuse, autonomous weapons, cognitive enhancement by brain–computer interfaces, insidious effects of social media, inequity, and enfeeblement. We also discuss practical ways to bring ethical principles into practice. One proposal is to stop giving explicit goals to AI agents and to enable them to keep learning human preferences. Another is to learn from democratic mechanisms that evolved in human society to avoid over-consolidation of power. Finally, we emphasize the importance of open discussions not only by experts, but also including a diverse array of lay opinions.

A different challenge with Benadryl: adolescent diphenhydramine ingestions reported to National Poison Database System, 2007–2020

Background The US Food and Drug Administration released a warning related to potential adverse effects related to intentional misuse or abuse ingestions of diphenhydramine in September 2020. We sought to evaluate adolescent-aged (13–19 y) diphenhydramine ingestions reported to US poison control centers to characterize these exposures, adverse effects, outcomes, and trends in outcomes and reasons for ingestion. Methods The US National Poison Database System was queried for all exposures to diphenhydramine between January 1, 2007 and December 31, 2020. Results 47,644 ingestions were included for analysis. An increase in the number of ingestions, percentage of cases due to an intentional reason for ingestion and suspected suicide was observed. More serious outcomes, cardiac complications, seizures, and deaths were more common following intentional ingestions and specifically suspected suicide over misuse or abuse. Conclusions Adolescent ingestions of diphenhydramine increased between 2007 and 2020. More serious outcomes, intentional reasons, and suspected suicide also increased over the study interval. Suspected suicide was associated with cardiac complications, seizures, coma, and death at higher rates than misuse or abuse. While misuse and abuse remain a concern, public health interventions focusing on the risk that diphenhydramine pose as an agent of suicide attempt may be of higher impact.

Vulnerabilities in Discovery Tech

Recent technological advances are changing the litigation landscape, especially in the context of discovery. For nearly two decades, technologies have reinvented document searches in complex litigation, normalizing the use of machine learning algorithms under the umbrella of “Technology Assisted Review” (TAR). But the latest technological developments are placing discovery beyond the reach of attorney understanding and firmly in the realm of computer science and engineering. As lawyers struggle to keep up, a creeping sense of anxiety is spreading in the legal profession about a lack of transparency and the potential for discovery abuse. Judges, attorneys, bar associations, and scholars warn that lawyers need to closely supervise the technical aspects of TAR and avoid the dangers of sabotage, intentional hacking, or abuse. But none of these commentators have defined with precision what the risks entail, furnished a clear outline of potential dangers, or defined the appropriate boundaries of debate. This Article provides the first systematic assessment of the potential for abuse in technology-assisted discovery. The Article offers three contributions. First, our most basic aim is to provide a technical but accessible assessment of vulnerabilities in the TAR process. To do so, we use the latest computer science research to identify and catalogue the different ways that TAR can go awry, either due to intentional abuse or mistakes. Second, with a better understanding of how discovery can be subverted, we then map potential remedies and reassess current debates in a more helpful light. The upshot is that abuse of technology-assisted discovery is possible but can be preventable if the right review processes are in place. Finally, we propose reforms to improve the system in the short and medium term, with an emphasis on improved metrics that can more fully measure the quality of TAR. By exploring the technical background of discovery abuse, the Article demystifies the engineering substrate of modern discovery. Undertaking this study shows that lawyers can safeguard technology-assisted discovery without surrendering professional jurisdiction to engineers.

Abuse of Chemical Substances Cause Poisoning in Dogs and Cats: A Review

Chemical substances are used worldwide as rodenticides, insecticides and herbicides, and also to protect animals against ectoparasites. Poisoning from chemical substances can occur in dogs and cats from both non-accidental and accidental causes. Non-accidental causes include the intentional abuse of chemical substances. This is regarded as animal cruelty and is illegal in many countries. By contrast, accidental causes result from animals ingesting poisonous substances unintentionally such as baits containing rodenticides or eating dead or alive poisoned rodents. Knowledgeable use of poisonous chemicals is vital for the safety of pets. Clinical signs of poisoning in dogs and cats depend on the type of chemical substances, species, lethal dose (LD50) and duration after exposure. This review summarises the common chemical substances that can endanger dogs and cats including rodenticides, insecticides, molluscicides, herbicides, paracetamol and antifreeze chemicals (ethylene glycol)

Toxic alcohol poisoning characteristics and treatments from 2000 to 2017 at a United States regional poison center.

Toxic alcohol exposures are an ongoing concern in the United States. In the US, few studies characterize the local epidemiology of toxic alcohols over time. The objective was to examine the incidence of toxic alcohol ingestions and changes in management over time. This retrospective cohort study evaluates toxic alcohol ingestion phone calls to a regional poison center in the United States covering four states. Data were queried for this poison center from the National Poison Data System (NPDS) using generic codes for each toxic alcohol. Inclusion criteria were ingestion of toxic alcohol, age ≥ 13years, from January 1, 2000 to Dec 31, 2017. Exclusion criteria were unrelated effects coded in the medical outcome, duplicate data, or incomplete demographic data. Of 926 subjects (adults and teenagers), 71.5% were male, and the mean age was 34.5years. Toxic alcohol ingestion was more common in individuals younger than 40years, with a significant relationship between age and intentional abuse or misuse (p = 0.001). There was also a significant relationship between age and reason for ingestion, with younger patients more likely to be suicidal (p < 0.001). Ethyleneglycol was the most common toxic alcohol. There was no change in the incidence of toxic alcohol ingestions over the study period. The mortality rate was 1.7%, and 31.2%of patients were hospitalized in a critical care unit. Major effects and death were more common in younger patients (p < 0.001). There was a significant difference in medical outcomes based on the type of toxic alcohol(p = 0.03). Fomepizole was the most common treatment. A Poisson regression model found no change in fomepizole use during the study period (p = 0.1). Ethanol administration over the study period increased (p = 0.02), while hemodialysis decreased (p = 0.02). Data obtained from a single regional United States poison center showed low mortality related to toxic alcohol ingestions. The most prevalent toxic alcohol was Ethylene glycol. In all cases, toxic alcohol ingestion was higher in the 20-29-year-old age group. Reasons for ingestion, in most cases, were suicidal. Fomepizole was the most common treatment, ethanol administration as an antidote is rising, and hemodialysis utilization is decreasing. Data may not be nationally representative.

Exposures in pregnant patients reported to United States Poison Centers

Background Limited data describe poisoning exposures in pregnant women. Previous studies are limited to inpatient populations, those seen only by toxicologists, or single poison centers. This study aimed to describe poison exposures reported to U.S. poison control centers in pregnant patients compared to non-pregnant controls. Methods This was a retrospective observational study of exposures reported to the American Association of Poison Control Centers National Poison Data System from 2000 through 2019. Pregnant patients were included from 15–44 years along with a random sampling of 5:1 age and year matched control group of non-pregnant exposures. Demographics, primary substance, and known medical outcomes were described. Chi square analysis was performed for comparisons. Results From 2000 to 2019, a total of 131,619 pregnant cases and 658,095 non-pregnant controls were identified. The median age was 27 years (IQR: 22, 31) for the matched groups. For known trimester of pregnancy: 29.8, 37.0, and 28.2% were in the first, second, and third trimester, respectively. Most common exposures were analgesics and cleaning products. Intentional exposures were more common in non-pregnant compared to pregnant cases (41.2 vs 21.9%; OR 2.71, 95% CI 2.67–2.75), mostly self-harm attempts (31.5 vs. 15.8%). Notably, there was a large discrepancy in the proportion of environmental exposures, with fewer in non-pregnant controls compared with pregnant cases (3.8 vs. 12.1%; OR 0.29, 95% CI 0.28–0.29). More non-pregnant cases had multiple substance exposures compared with pregnant cases (22.2 vs. 10.9%; OR 2.34, 95% CI 2.29–2.38). There were more moderate effect outcomes in non-pregnant compared with pregnant cases (13.2 vs. 6.3%; OR 2.25, 95% CI 2.20–2.30). Conclusions Outcomes of poisoning exposures in pregnant patients reported to U.S. poison centers are less serious compared to non-pregnant controls, likely due to the lower rates of intentional abuse and self-harm exposures and greater number of minimally toxic environmental exposures.

Injuries from alleged accidental minor head trauma in a prospective cohort of children aged 0-3 years in an emergency department.

Minor head trauma in the child, whether accidental or inflicted, is a frequent reason for seeking medical attention. Our aim is to describe the characteristics of minor head trauma in children aged 0-3 years and the resulting injuries. This in order to help the clinician to suspect and thelegal expert to confirm intentional abuse. Children aged from 0 to 3 years with minor head trauma and attending the pediatric emergency department were included in the study between January 2013 and June 2014. The correlation between the characteristics of trauma and the resulting injuries was analyzed using a prospective data collection questionnaire completed by the physicians who cared for the child. A total of 709 children with minor head trauma were included in the study. In nearly 90% of cases, fall height was less than 1 m. Only one-third of children aged less than 6 months had external head injury. Low-intensity trauma, such as a low-velocity fall from a height of less than 1.5 m does not cause intracranial injury. External injuries were more frequent in children who had a fall with an anterior impact, while internal injuries were found only in posterior and lateral impacts. In the context of minor head trauma, the physician must be vigilant and must ask for a full and clear description of the trauma, its mechanisms and other characteristics, when external or internal head injuries are observed in children aged less than 6 months.