Ingestion of wild and potentially toxic mushrooms is common in the United States and many other parts of the world. US poison centers have been logging cases of mushroom exposure in The National Poison Data System (NPDS) annual publications for over 30 years. This study compiles and analyzes US mushroom exposures as reported by the NPDS from 1999 to 2016. Over the last 18 years, 133 700 cases (7428/year) of mushroom exposure, mostly by ingestion, have been reported. Cases are most frequently unintentional (83%, P < 0.001); cause no or only minor harm (86%, P < 0.001); and in children <6 years old (62%, P < 0.001). Approximately 704 (39/year) exposures have resulted in major harm. Fifty-two (2.9/year) fatalities have been reported, mostly from cyclopeptide (68-89%)-producing mushrooms ingested by older adults unintentionally. The vast majority of reported ingestions resulted in no or minor harm, although some groups of mushroom toxins or irritants, such as cyclopepides, ibotenic acid, and monomethylhydrazine, have been deadly. Misidentification of edible mushroom species appears to be the most common cause and may be preventable through education.

Data on the use of antimicrobial drugs was collected by means of an inquiry to 30 hospitals in Belgium (15 in Dutch sectors and 15 in the French sectors), 21 hospitals in Germany and 20 hospitals in the Netherlands. The use of these drugs was expressed as the number of defined daily doses (DDD) per 100 bed days by the anatomical therapeutical chemical classification system. The total use of antimicrobial agents was significantly (p < 0.001) higher in both parts of Belgium (55.6 and 52.0 DDD per 100 bed days) than in Germany (37.9 DDD) or the Netherlands (34.1 DDD). In particular, amoxicillin-clavulanic acid, the first- and second-generation cephalosporins, aminoglycosides and fluoroquinolones were used more in Belgium than in either of the other countries. At least part of the differences observed in antimicrobial drug use could be explained by differences in written antibiotic policy.

: Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.

Most mountain climbers had no formal wilderness medicine training and did worse on the medical knowledge assessment than those who did have training. Consistent with previous studies, participants performed poorly on the medical knowledge assessment. As such, ways to improve wilderness medical knowledge among outdoor recreationalists should be sought. The low rate of helmet use on Colorado's technical peaks represents an important area for education and injury prevention.