Poison control

About: Poison control is a research topic. Over the lifetime, 394709 publications have been published within this topic receiving 15781638 citations.

The role of secondary brain injury in determining outcome from severe head injury.

Abstract: As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. Hypoxia and hypotension were independently associated with significant increases in morbidity and mortality from severe head injury. Hypotension was profoundly detrimental, occurring in 34.6% of these patients and associated with a 150% increase in mortality. The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension. Improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension. Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.

Does correctional treatment work? a clinically relevant and psychologically informed meta-analysis *

Abstract: Careful reading of the literature on the psychology of criminal conduct and of prior reviews of studies of treatment effects suggests that neither criminal sanctioning without provision of rehabilitative service nor servicing without reference to clinical principles of rehabilitation will succeed in reducing recidivism. What works, in our view, is the delivery of appropriate correctional service, and appropriate service reflects three psychological principles: (1) delivery of service to higher risk cases, (2) targeting of criminogenic needs, and (3) use of styles and modes of treatment (e.g., cognitive and behavioral) that are matched with client need and learning styles. These principles were applied to studies of juvenile and adult correctional treatment, which yielded 154 phi coefficients that summarized the magnitude and direction of the impact of treatment on recidivism. The effect of appropriate correctional service (mean phi = .30) was significantly (p <.05) greater than that of unspecified correctional service (.13), and both were more effective than inappropriate service (−.06) and non-service criminal sanctioning (−.07). Service was effective within juvenile and adult corrections, in studies published before and after 1980, in randomized and nonrandomized designs, and in diversionary, community, and residential programs (albeit, attenuated in residential settings). Clinical sensitivity and a psychologically informed perspective on crime may assist in the renewed service, research, and conceptual efforts that are strongly indicated by our review.

A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?

Abstract: Context Despite improvements in mental health services in recent decades, it is unclear whether the risk of mortality in schizophrenia has changed over time. Objective To explore the distribution of standardized mortality ratios (SMRs) for people with schizophrenia. Data Sources Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists, and communication with authors. Study Selection Population-based studies that reported primary data on deaths in people with schizophrenia. Data Extraction Operationalized criteria were used to extract key study features and mortality data. Data Synthesis We examined the distribution of SMRs and pooled selected estimates using random-effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest SMR (12.86); however, most of the major causes-of-death categories were found to be elevated in people with schizophrenia. The SMRs for all-cause mortality have increased during recent decades (P = .03). Conclusions With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.

Economic Shocks and Civil Conflict: An Instrumental Variables Approach

Abstract: Estimating the impact of economic conditions on the likelihood of civil conflict is difficult because of endogeneity and omitted variable bias. We use rainfall variation as an instrumental variable for economic growth in 41 African countries during 1981–99. Growth is strongly negatively related to civil conflict: a negative growth shock of five percentage points increases the likelihood of conflict by one‐half the following year. We attempt to rule out other channels through which rainfall may affect conflict. Surprisingly, the impact of growth shocks on conflict is not significantly different in richer, more democratic, or more ethnically diverse countries.