TRENDS OF ORGANOPHOSPHATE POISONING IN URBAN ZIMBABWE. X. Dong 1 , M.A. Simon 2 ; 1 Yale University, New Haven, Connecticut; 2 Yale Medical Center, New Haven, CT PURPOSE: There have been 3 million reported pesticide poisonings and 200,000 deaths worldwide. In developing countries, poisonings are mostly associated with prescription medications, agrochemicals and household chemicals which have posed major global heath problems. Organophosphates are the most commonly formulated, packaged and used pesticides in Zimbabwe. However, there are no studies elucidating the current trends of organophosphate poisoning. The objectives of this study were to examine the mortality, trends and causes of organophosphate poisoning in an urban hospital in Zimbabwe. METHODS: We conducted a cross sectional descriptive study to examine the occurrence and trends of admissions for organophosphate poisoning in Parirenyatwa, one of the two major urban hospitals in Harare, Zimbabwe. We examined a total 185,828 patients' records and 599 cases on organophosphate poisoning from January 1995 through November 2000. Trends in admissions of the organophosphate poisoning were recorded. Other variables such as sex, age, season and geographic area were examined. Total mortality rates were calculated. The intent of the poisoning was also compared. RESULTS: These data reveal a steady increase in organophosphate poisoning during these years with the exception of 1999. The numbers of admissions for organophosphate poisoning have increased by more than 320% compared to six years ago. There is no difference in the male and female ratio for admission(48% vs. 52%). The majority of the cases admitted were below age thirty-one (82%)and were from urban settings (86%). Suicide is the predominant reason for poisoning (74%). There was a marked peak in the number of cases of children under age eleven (62%) that were due to accidental organophosphate poisoning. Mortality of organophosphate poisoning is 8.3% over the last six years. CONCLUSION: These results reveal startling realities. Organophosphate poisoning has been escalating throughout the world, especially in developing countries, such as Africa, South America and Asia, where agriculture demands large supplies of pesticides. Our data, although representing a very small microcosm of the extent of poisoning and in particular organophosphate poisoning, are consistent with multiple prior studies. Organophosphate poisoning is increasing uncontrollably and is being used at high rates as a suicidal agent in the young urban population, and contribute to the accidental ingestion in the pediatric population. Further research should concentrate on behaviors and situations that lead to poisoning. PURPOSE: Patients with medically unexplained symptoms (MUS) present a major problem for healthcare, yet they have not been adequately described. Physician perspective is especially important in providing the context for these patients' health perceptions, behaviors and outcomes. METHODS: A focus group of 6 internal medicine resident physicians was conducted to provide preliminary data for subsequent focus groups of primary care physicians of a panel of managed care patients with MUS. The discussion was tape-recorded, transcribed and analyzed via content analysis. RESULTS: Participants defined high utilization in terms of time and resource utilization and high physician emotional investment and not number of visits. Most participants described a typical high utilizing patient as one with multiple visits for uncontrolled organic disease or chronic, MUS. These patients were considered extremely difficult, demanding and unpleasant with a sense of entitlement. They believed that patients with somatization were often condescending, unappreciative and litigious. Interaction with these patients left the participants feeling frustrated, helpless, inadequate and powerless. Other emotions expressed include anger, guilt and apprehension about the possibility of missing an organic disease. Participants reported positive reactions to high utilizing patients (defined as more than 8 visits/year) with transient, minor acute illness. These patients were described as nice people with simple, straightforward problems, which got better regardless of what they did. Although they believed that the real motivation behind their visit was something other than their physical complaints, (such as stress, or the need for support and validation), they neither saw these patients' visits as problematic nor perceived a real need to address their possible underlying problems. Some participants considered these patients a major source of practice income and not high consumers of resources. Caring for high utilizing patients with organic disease was most gratifying. Most participants would rather not see patients with somatization; and the possibility of having to care for these patients as primary care physicians is a major factor in choosing to pursue subspecialization. CONCLUSION: This group of internal medicine residents did not consider high utilizing patient with MUS to be problematic if they had multiple transient minor acute illnesses. Conversely they found chronic somatization patients to be extremely problematic and would rather not care for them. Caring for patients with documented organic disease was gratifying regardless of utilization.