Determinants of U.S. poison center utilization.

CONTEXT: High poison center utilization has been associated with decreased emergency department usage and hospitalization rates. However, utilization requires awareness of the poison center. Penetrance, defined as the number of human poison exposures reported to a poison center per 1,000 population, has been used as a marker of poison center awareness. OBJECTIVES: To identify factors that influence poison center penetrance to optimize the life- and cost-saving benefits of poison control centers. METHODS: Human poison exposures that were reported to the National Poison Data System in 2001 were analyzed to identify and rank factors affecting poison center penetrance. RESULTS: Overall penetrance correlated with pediatric penetrance (R(2) = 0.75, p < 0.01). As pediatric penetrance increased, there was a significant decline in the percent of children reported to a poison center that were already in or en route to a healthcare facility at the time of the call to the poison center (R(2) = 0.41, p < 0.01). Larger poison center service populations were associated with lower penetrance (R(2) = 0.23, p < 0.01). Inverse predictors of penetrance included inability to speak English well, Black/African American race, and distance from the poison center (multiple regression). Positive predictors included the percentage of the population younger than 5 years, the percentage of the adult population with a bachelor's degree, poison center certification, poison center educator FTEs (full time equivalents), Asian population percentage, and population density. DISCUSSION: The inverse correlation between pediatric penetrance and healthcare facility utilization supports prior observations of excessive healthcare utilization when a poison center is not called. Since race, language and distance are barriers to poison center utilization, and since healthcare utilization increases when poison center penetrance declines, low penetrance suggests a lack of awareness of the poison center rather than a low incidence of poisonings. CONCLUSION: Strategies to raise penetrance should be informed by an understanding of the barriers to utilization - language, Black/African American race, distance from the poison center, poverty, and lower education levels.

Disease and illness in U.S. mining, 1983-2001.

OBJECTIVES: We describe inconsistencies in disease and illness reporting in U.S. mining, identify under-reporting of disease and illness in U.S. mining, and summarize selected disease and illness in U.S. mining from 1983 through 2001. METHODS: We summarized information on mining-related disease and illness data for the years 1983-2001 from the Mining Safety and Health Administration database (MSHA). RESULTS: Discrepancies exist in types of information collected by the Centers for Disease and Control, the National Institute for Occupational Safety and Health, and the Mining Safety and Health Administration database. Several factors, including a worker's fear of losing his or her job, health insurance, or other job-related benefits contribute to under-reporting of disease and illness information in the US mining industry. CONCLUSIONS: Since 1997, both number of workers employed in mining and disease and illness rates have decreased; however, the highest disease and illness rates in mining continue to be coal worker's pneumoconiosis and hearing loss.