Caracterización de la intoxicación exógena en niños y adolescentes en Sogamoso, Boyacá durante el período de 2010 a 2013 / Characterization of exogenous poisoning in children and teenagers at Sogamoso, Boyacá, during the period 2010 to 2013

Introducción: las intoxicaciones exógenas han adquirido paulatinamente la condición de problema de salud pública, particularmente en el área pediátrica, dado que son causantes de hasta un 10% de todos los ingresos a la Unidad de Cuidado Intensivo pediátrica. Objetivo: caracterizar los patrones epidemiológicos generales de la intoxicación exógena aguda ocurrida en niños y adolescentes de menos de 18 años, ingresados al servicio de urgencias del Hospital Regional de Sogamoso, Boyacá, durante el período comprendido entre enero de 2010 y junio de 2013. Materiales y Métodos: estudio observacional descriptivo. Se realizó una revisión sistemática de 143 historias clínicas de menores de 18 años ingresados al servicio de urgencias con diagnóstico de intoxicación exógena; se evaluaron variables como edad, género, agente, vía de administración, motivo, sitio de ocurrencia y desenlace. Resultados: media de edad 10,5 años (SD=5,6); 56,6% de los casos ocurrieron en pacientes de sexo femenino. Se identificaron dos patrones temporales de intoxicación: uno accidental en menores de cinco años y otro con motivación suicida en adolescentes, más frecuente en mujeres. La mayoría de eventos ocurrieron en casa y las sustancias más frecuentemente involucradas fueron medicamentos y productos de higiene y aseo como plaguicidas y desinfectantes; alta prevalencia de intoxicación accidental por alimentos contaminados; en 5,9% de los casos se encontró como comorbilidad el abuso sexual. Conclusiones: es recomendable el diseño e implementación de acciones educativas dirigidas a padres y cuidadores, así como la de intervenciones de vigilancia y control de situaciones propiciadoras de la conducta suicida como los estados depresivos y el estrés en adolescentes. (MÉD.UIS. 2014;27(1):9-15).

Introduction: exogenous poisoning has gradually acquired the status of a public health problem, particularly in the pediatric area, since they are causing up to 10% of all admissions to the Pediatric Intensive Care Unit. Objective: to characterize the general epidemiological patterns of acute exogenous poisoning, occurred in children and teenagers aged less than 18 years, admitted to the emergency department of the Hospital Regional de Sogamoso, Boyacá, during the period between january 2010 and june 2013. Materials and Methods: descriptive observational study. We conducted a systematic review of 143 medical records of children aged less than 18 years, admitted to the emergency department with a diagnosis of exogenous intoxication. There were evaluated variables such as age, gender, agent, route of administration, motive, site of occurrence and final outcome. Results: mean age 10.5 years (SD = 5.6), 56.6% of cases occurred in girls. It was present two temporal patterns of intoxication, one accidental in children aged equal or less than five years and another motivated by suicidal ideation in teenagers, more common in female. Most events occurred at home and the substances most frequently involved were medicaments and hygiene products and cleaning as pesticides and disinfectants. There was high prevalence of accidental poisoning from contaminated food. In 5.9% of cases was found sexual abuse comorbidity. Conclusions: it's recommendable the design and implementation of educational activities aimed to parents and caretakers, as well as monitoring and control interventions on cases with propitiating situations of suicidal ideation such as depression and stress in teenagers. (MÉD.UIS. 2014;27(1):9-15).

Associated factors for the occurrence of unintentional injuries in children from a low-income community in northeastern Brazil / Fatores associados para a ocorrência de injúrias não-intencionais com crianças em comunidade de baixa renda no nordeste do Brasil

Unintentional injuries reach high levels within the scope of morbidity and mortality worldwide, and have an impact on the quality of life of children and family members. This study depicts the socio-demographic profile of families in a community and identifies the factors associated with unintentional injuries in children. This is a cross-sectional study, developed with 362 families from a community in Fortaleza (Ceará State), by applying a questionnaire to the responsible adult in the family; the data were subjected to descriptive statistics by applying Pearson's chi-square (x 2) test, with p ≤ 0.05. From the results, 78% resided in the business area of the community, 71% survived with income up to the minimum wage, 62.7% were part of a nuclear family, and most residences showed risk factors for unintentional injuries. The data corroborate the literature by reaffirming the relationship between the socio -demographic and economic profile of families living in areas of socio-environmental vulnerability with the occurrence of unintentional injuries at home.

As injúrias não-intencionais registram índices elevados no quadro da morbidade e mortalidade mundial e repercutem na qualidade de vida da criança e de seus familiares. O estudo retrata o perfil sociodemográfico de famílias moradoras de uma comunidade e identifica os fatores associados para a ocorrência de injúria não-intencional em criança. Trata-se de um estudo transversal, desenvolvido com 362 famílias residentes em uma comunidade de Fortaleza, Estado do Ceará, mediante aplicação de questionário ao responsável pela família; os dados foram submetidos à estatística descritiva com realização de teste qui-quadrado de Pearson (x2) com valor de p ≤ 0,05. Dentre os resultados, 78% residiam na área comercial da comunidade, 71% sobreviviam com até um salário mínimo, 62,7% tinham família nuclear e a maioria dos domicílios apresentou fatores de risco para injúrias não-intencionais. Os dados corroboram a literatura na medida em que reafirma a relação entre o perfil sociodemográfico e econômico de famílias residentes em áreas de vulnerabilidade socioambiental, com a ocorrência de injúrias não-intencionais em crianças nos domicílios.

Transorbital penetrating wound to contralateral hemisphere: case report / Ferimento penetrante transorbital com lesão no hemisfério contralateral: relato de caso

There are few reports in the literature of transorbital penetration brain damage. We reported a transorbital craniocerebral injury caused by a barbecue skewer in a child in the context of domestic-accident. A 7-year-old male child accidentally fell and a barbecue skewer penetrated his right orbit. The object was pulled out immediately by the boy?s father. On admission, he demonstrated disproportioned right hemiparesis and Axial CT images showed no evidence of fracture of orbital wall on the right side and a small hematoma and traumatic subarachnoid hemorrhage on the left hemisphere. Surgery was not indicated, antibiotics were administered for 14 days, his neurological impairment recovered completely on seven days. On the 12th post-admission day, a CT was done which showed no hematoma. At the time of discharge, the boy was alert without any physical sequelae or complication. Children are frequently harmed during play and are mainly jeopardized by accidents at home, and it is necessary more governmental investment to objectively lowering penetrating wounds to the head in children and divulgated for general population that foreign body penetrating the intracranial cavity must be removed only during surgery.

Existem na literatura poucos relatos de traumatismo cranioencefálico causados por penetração transorbital. Será descrito o caso de uma criança do sexo masculino, de 7 anos de idade, que caiu acidentalmente em casa e um espeto de churrasco penetrou na sua órbita direita. O objeto foi imediatamente retirado pelo pai. Na admissão ao Hospital, a criança apresentava-se com hemiparesia direita desproporcionada e na tomografia de crânio evidenciavam-se contusão cerebral e hemorragia subaracnoide traumática no hemisfério esquerdo, entretanto não havia sinais de fraturas. Não foi necessário procedimento cirúrgico, e o menor permaneceu internado para administração de antibióticos por 14 dias, obtendo melhora do déficit após sete dias do internamento. Com 12 dias de hospitalização, foi realizada nova tomografia, sem evidências de hematomas. Na alta, ele encontrava-se ativo, alerta e sem déficits motores. Crianças são frequentemente feridas durante jogos e brincadeiras, e esses acidentes acontecem principalmente no ambiente doméstico. Torna-se necessário maior investimento governamental para diminuir ferimentos penetrantes em crianças e divulgação, para a população em geral, sobre acidentes com penetração craniana, que devem ser encaminhados imediatamente ao hospital, devendo os objetos ser removidos somente durante o procedimento cirúrgico.

Fatores de risco que contribuem para o envenenamento pediátrico / Risk factors contributing to childhood poisoning

OBJETIVO: Investigar se a falta de conhecimento dos agentes tóxicos nos domicílios é fator de risco de evento tóxico individual acidental na infância. MÉTODOS: Grupo caso (n = 25) é composto por cuidadores de crianças com menos de 60 meses, do município de Porto Alegre (RS), que sofreram evento tóxico acidental oral, atendidas em dois hospitais de referência e com registro no Centro de Informação Toxicológica. O controle (n = 25) é formado por cuidadores de crianças pareadas por sexo, idade e presença nos domicílios de agente tóxico igual ao do caso, que buscaram atendimento médico emergencial nos mesmos hospitais, mas por outras causas. Foi aplicado um questionário próprio, estruturado, verificando-se as questões: sociodemográficas, história clínica, antecedentes comportamentais dos cuidadores, armazenamento dos agentes tóxicos, história pregressa de acidente toxicológico. RESULTADOS: A idade média das crianças foi de 31,8 meses (±0,97) e a estatura média, de 93 cm (±11). As famílias, nos dois grupos, apresentaram conhecimento da ação tóxica de agentes existentes nos domicílios, contudo, cuidadores do grupo-controle apresentaram duas vezes mais chances de possuir conhecimento em comparação ao grupo caso. Distração apresentou 15 vezes mais chances de ocorrer por parte de cuidadores de crianças que sofreram evento tóxico em comparação ao grupo-controle. A altura do agente tóxico estar abaixo de 150 cm apresentou aproximadamente 17 vezes mais chances de ocorrer no grupo de crianças que sofreram evento tóxico em comparação às crianças do grupo-controle. CONCLUSÕES: Falta de conhecimento da ação tóxica de agentes existentes nos domicílios não é um fator de risco para evento tóxico na infância. Os riscos atribuíveis descritos neste estudo indicaram que a eliminação de outros fatores, como distração ou armazenamento abaixo de 150 cm de altura, acarretariam a prevenção de 13 e 19 por cento de eventos tóxicos na infância, respectivamente.

OBJECTIVE: To investigate whether the lack of knowledge of toxic agents in households is a risk factor for individual unintentional childhood poisoning. METHODS: The case group (n = 25) was composed of caregivers of children under 60 months of age who underwent accidental oral poisoning and were treated at two reference hospitals in Porto Alegre, southern Brazil, and recorded in the Toxicology Information Center database. The control group (n = 25) was composed of caregivers of children matched for sex, age, and presence in their homes of the same toxic agents found in the case group, who sought emergency medical care at the same hospitals, but for other reasons. A structured questionnaire was administered to verify the following questions: sociodemographic data, clinical history, behavioral antecedents of caregivers, storage of toxic agents, history of previous poisoning accidents. RESULTS: The children's mean age was 31.8 months (±0.97) and mean height was 93 cm (±11). Families, in both groups, were aware of the toxic action of agents available in their homes; however, caregivers in the control group were twice as likely to have such knowledge compared to the case group. Distraction was 15 times more likely to occur among caregivers of children who underwent poisoning compared to the control group. Storage of toxic agents below 150 cm was approximately 17 times more likely to occur in the group of children who underwent poisoning compared to children in the control group. CONCLUSIONS: Lack of knowledge of the toxic action of agents stored in households is not a risk factor for childhood poisoning. The attributable risks described in this study indicated that the elimination of other factors, such as distraction and storage below 150 cm, would lead to the prevention of 13 and 19 percent of poisonings in childhood, respectively.

Patterns of Unintentional Domestic Injuries in Korea / 예방의학회지

OBJECTIVES: To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

Educational Needs of Homemakers Regarding Emergency Situations in the Home: Focused on Differences in Educational Needs based on the General Characteristics of Homemakers and Differences between Homemakers and Emergency Physicians

PURPOSE: To investigate the educational needs and attitudes of homemakers regarding emergency situations in the home and to compare differences in perceptions about emergency situations according to the general characteristics of homemakers and differences between homemakers and emergency physicians METHODS: Using a written survey of a randomly selected sample, we questioned 69 emergency physicians and 450 homemakers over a 5 month period from November 2008 to March 2009. The survey consisted of 8 medical conditions and 16 injury-related conditions. It contained questions (using a Likert scale) about the need for education about each condition (the higher the score, the greater the need). We also determined homemakers' general characteristics: their age, educational background, number of children, gender of their children, age of their children, the existence of older families, and prior training in the process of resuscitation. RESULTS: A total of 346(77%) homemakers responded. For most conditions, the average scores were higher (greater need) among homemakers than among emergency physicians. There were significant differences between these two groups, especially for seizure, fever, dyspnea, bleeding, contusions (of the head, face, extremities, cervical spine and other areas), wounds (of the head, face, oral cavity and extremities), amputated tissue control, injury to teeth, burns, foreign body ingestion, intoxication, and electrical shock. According to the general characteristics of homemakers, the educational background affected the educational needs for homemakers for dyspnea, and for contusions of the head, face, and cervical spine. CONCLUSION: The need for education regarding emergency conditions in the home are higher in the eyes of homemakers than in the eyes of emergency physicians. General characteristics of homemakers affects educational needs. The subject of educational program about first aid will be chosen according to general characteristics of homemakers. according to general characteristics of homemakers.