Information de reference pour ce titreAccession Number: | 00002256-200611000-00009.
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Author: | Bateman, D. N.; Gorman, D. R. 1; Bain, M. 2; Inglis, J. H. C. 3; House, F. R. 4; Murphy, D. 2
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Institution: | NPIS Edinburgh (Scottish Poisons Information Bureau), Royal Infirmary of Edinburgh, UK (Bateman) (1)Consultant in Public Health Medicine, NHS Lothian, UK (2)NHS National Services Scotland, Information Services, UK (3)NHS Health Scotland, UK (4)Statistician, Edinburgh, UK
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Title: | |
Source: | British Journal of Clinical Pharmacology. 62(5):573-581, November 2006.
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Abstract: | Aims: To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland.
Methods: A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol.
Results: The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years.
Conclusions: Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.
Copyright (C) 2006 Blackwell Publishing Ltd.
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Author Keywords: | co-proxamol; paracetamol poisoning; self-harm; suicide.
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References: | 1 Inglis JHC. Restricting sales of paracetamol tablets: effect on deaths and emergency admissions for poisoning in Scotland 1991-2002. Scot Med J 2004; 49: 142-3.
2 Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM. Poisoning with paracetamol, ibuprofen and aspirin. How much is due to prescribed medication. J R Coll Physicians Edin 2003; 33: 258-61.
3 Bateman DN, Bain M, Gorman D, Murphy D. Changes in paracetamol, antidepressants and opioid poisoning in Scotland during the 1990s. Q J Med 2003; 96: 125-32.
4 Hawton K. United Kingdom legislation on pack size of analgesics: background, rationale, and effects on suicide and deliberate self-harm. Suicide Life Threat Behav 2002; 32: 223-9.
5 Hawton K, Townsend E, Deeks J, Appleby L, Gunnell D, Bennewith O, Cooper J. Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study. BMJ 2001; 322: 1203-7.
6 Turvill JL, Burroughs AK, Moore KP. Change in occurrence of paracetamol overdose in UK after introduction of blister packs. Lancet 2000; 355: 2048-9.
7 Robinson D, Smith AMJ, Johnson GD. Severity of overdose after restriction of paracetamol availability: retrospective study. BMJ 2000; 321: 926-7.
8 Prince MI, Thomas SHL, James ONW, Hudson M. Reduction in incidence of severe paracetamol poisoning. Lancet 2000; 355: 2047-8.
9 Hawton K, Simkin S, Deeks J, Cooper J, Johnston A, Waters K, Arundel M, Bernal W, Gunson B, Hudson M, Suri D, Simpson K. UK legislation on analgesic packs: before and after study of long term effect on poisonings. BMJ 2004; 329: 1076-81.
10 Sheen CL, Dillon JF, Bateman DN, Simpson KJ, Macdonald TM. Paracetamol related deaths in Scotland, 1994-2000. Br J Clin Pharmacol 2002; 54: 430-2.
11 Newsome PN, Bathgate AJ, Henderson NL, MacGilchrist AJ, Plevris JN, Masterton G, Garden OJ, Lee A, Hayes PL, Simpson KJ. Referral patterns and social deprivation in paracetamol-induced liver injury in Scotland. Lancet 2001; 358: 1612-3.
12 McCullagh P, Nelder J. Generalized Linear Models, 2nd edn. London: Chapman & Hall 1989.
13 R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing. Available at http://www.R-project.org2004- ouverture dans une nouvelle fenêtre (last accessed: March 2006).
14 Morgan O, Majeed A. Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. J Public Health 2005; 27: 12-8.
15 Committee on the Safety of Medicines. Available at http://www.mhra.gov.uk2005- ouverture dans une nouvelle fenêtre (last accessed: March 2006).
16 Kisely SR, Lawrence D, Preston NJ. The effect of recalling paracetamol on hospital admissions for poisoning in Western Australia. Med J Aust 2003; 178: 1612-3.
17 Balit CR, Isbister GK, Peat J, Dawson AH, Whyte IM. Paracetamol recall: a natural event influencing paracetamol poisoning. Med J Aust 2002; 176: 162-5.
18 Prior MJ, Cooper K, Cummins P, Bowen D. Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther 2004; 11: 443-52.
19 Bateman DN, Good AM, Afshari R, Kelly CA. Effects of licence change on prescribing and poisons enquiries for antipsychotic agents in England and Scotland. Br J Clin Pharmacol 2003; 55: 596-603.
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Language: | English.
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Document Type: | Pharmacoepidemiology.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0306-5251
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NLM Journal Code: | au9, 7503323
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