Burn patterns of Asian ethnic minorities living in West Yorkshire, UK

Exploring what is important during burn recovery: a qualitative study investigating priorities of patients and healthcare professionals over time

OBJECTIVES

This qualitative study aimed to investigate: (1) priorities of patients and healthcare professionals during recovery from a burn injury, (2) how priorities change over time and (3) how priorities map to outcomes currently reported in burns research.

DESIGN

Semi-structured interviews were conducted. Interviews were audio recorded, transcribed and analysed thematically.

SETTING, PARTICIPANTS

A total of 53 patients and healthcare professionals were recruited from four National Health Service (NHS) burn services across England and Wales across England and Wales. Patient participants (n=32) included adults, adolescents and parents of paediatric patients, with a variety of burn injuries in terms of severity and cause of burn injury. Healthcare professionals (n=21) were NHS staff members involved in burn care and included professionals with a range of clinical experience and roles (eg, nurses, surgeons, occupational therapists, physiotherapist, administration).

RESULTS

Ten themes relating to priorities (outcomes) during recovery from a burn injury were identified for patients and professionals. Of those, six were identified for patients and professionals ('pain and discomfort', 'psychological well-being', 'healing', 'scarring', 'function', 'infection'), three were unique to professionals ('patient knowledge, understanding and support', 'sense of control', 'survival') and one was unique to patients ('uncertainty'). Results highlighted that importance of these priorities changes over time (eg, 'survival' was only a concern in the short term). Likewise, priorities differed between patients and professionals (eg, 'pain' was important to patients throughout their recovery, but not for professionals). Seven out of 10 themes overlapped with outcomes commonly assessed in burn research.

CONCLUSION

Professionals' and patients' priorities (important outcomes) change over time after burn injury and differ between those groups. Burn care research should consider measuring outcomes at different time points during the recovery from a burn injury to accurately reflect complexity of burn recovery.

Comparison of Disease Patterns and Outcomes Between Non-Japanese and Japanese Patients at a Single Tertiary Emergency Care Center in Japan

BACKGROUND

Japan's historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation.

METHODS

A secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or intensive-care unit or high-care unit admission to the emergency department at the Tokyo Medical and Dental University medical hospital from 2010 through 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted.

RESULTS

Non-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio [aOR] 2.7; 95% confidence interval [CI], 1.7-4.4) and infectious disease diagnoses (aOR 2.2; 95% CI, 1.3-3.7), and marginally more burn diagnoses (aOR 2.3; 95% CI, 0.96-5.3) than Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment.

CONCLUSION

There were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.

Incidence of medically attended paediatric burns across the UK

Objective

Childhood burns represent a burden on health services, yet the full extent of the problem is difficult to quantify. We estimated the annual UK incidence from primary care (PC), emergency attendances (EA), hospital admissions (HA) and deaths.

Methods

The population was children (0–15 years), across England, Wales, Scotland and Northern Ireland (NI), with medically attended burns 2013–2015. Routinely collected data sources included PC attendances from Clinical Practice Research Datalink 2013–2015), EAs from Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI, 2014) and National Health Services Wales Informatics Services, HAs from Hospital Episode Statistics, National Services Scotland and Social Services and Public Safety (2014), and mortality from the Office for National Statistics, National Records of Scotland and NI Statistics and Research Agency 2013–2015. The population denominators were based on Office for National Statistics mid-year population estimates.

Results

The annual PC burns attendance was 16.1/10 000 persons at risk (95% CI 15.6 to 16.6); EAs were 35.1/10 000 persons at risk (95% CI 34.7 to 35.5) in England and 28.9 (95% CI 27.5 to 30.3) in Wales. HAs ranged from 6.0/10 000 person at risk (95% CI 5.9 to 6.2) in England to 3.1 in Wales and Scotland (95% CI 2.7 to 3.8 and 2.7 to 3.5, respectively) and 2.8 (95% CI 2.4 to 3.4) in NI. In England, Wales and Scotland, 75% of HAs were aged <5 years. Mortality was low with 0.1/1 000 000 persons at risk (95% CI 0.06 to 0.2).

Conclusions

With an estimated 19 574 PC attendances, 37 703 EAs (England and Wales only), 6639 HAs and 1–6 childhood deaths annually, there is an urgent need to improve UK childhood burns prevention.

Knowledge and practice of first aid among parents attending Primary Health Care Centers in Madinah City, Saudi Arabia, A Cross Sectional Study

Background

Rapid and right intervention of parents can limit disability and increase the chances of survival of the injured child and make a big difference in the outcome.

Objectives

The objective of this study is to assess the knowledge and practice of first aid among parents attending PHCs in Al-Madinah city, 2017.

Methods

A cross-sectional study was conducted in governmental primary healthcare centers in Al-Madinah Al-Munawwarah city (Saudi Arabia) during the year 2017. A representative sample of Saudi parents who live in Madinah and came to family medicine clinic in PHC was included. A pre-validated and self-administered questionnaire was used for data collection.

Results

The study included 390 parents. More than half of them (55.6%) were males. The age of 40% of them ranged between 31 and 40 years whereas that of 31.5% ranged between 20 and 30 years. Majority of the parents (97.2%) were aware of first aid. The most commonly reported source of information about first aid was mass media (59%). Majority of the parents (93.3%) believe there must be training in first aid, and only 34.6% of them claimed that they attended a training course in first aid. The highest average knowledge percentage was observed regarding the first aid of diabetes mellitus (68.8%), followed by epilepsy (49.7%), incidents (37.5%) and finally injuries/fractures (36.7%). Higher educated parents, those with a moderate number of children (4-6), those reported nurses as the main source of information, those previously attended training in first aid, and those who had experience with incidents among their children expressed higher significantly first aid knowledge compared to their counterparts.

Conclusions

First aid of various illnesses among parents in Al-Madinah city is not satisfactory, particularly regarding incidents, injuries, and fractures. However, the majority of them were willing to attend training courses in first aid at primary healthcare centers.

Mothers' perspectives on the delivery of childhood injury messages: a qualitative study from the growing up in Wales, environments for healthy living study (EHL)

BACKGROUND

Childhood injury is the second leading cause of death for infants aged 1-5 years in the United Kingdom (UK) and most unintentional injuries occur in the home. We explored mothers' knowledge and awareness of child injury prevention and sought to discover mothers' views about the best method of designing interventions to deliver appropriate child safety messages to prevent injury in the home.

METHODS

Qualitative study based on 21 semi-structured interviews with prospective mothers and mothers of young children. Mothers were selected according to neighbourhood deprivation status.

RESULTS

There was no difference in awareness of safety devices according to mothers' deprivation status. Social networks were important in raising awareness and adherence to child safety advice. Mothers who were recent migrants had not always encountered safety messages or safety equipment commonly used in the UK. Mothers' recommended that safety information should be basic and concise, and include both written and pictorial information and case studies focus on proactive preventive messages. Messages should be delivered both by mass media and suitably trained individuals and be timed to coincide with pregnancy and repeated at age appropriate stages of child development.

CONCLUSIONS

The findings suggest that timely childhood injury-related risk messages should be delivered during pregnancy and in line with developmental milestones of the child, through a range of sources including social networks, mass media, face-to-face advice from health professionals and other suitably trained mothers. In addition information on the safe use of home appliances around children and use of child safety equipment should be targeted specifically at those who have recently migrated to the United Kingdom.

Cooling properties of everyday liquids

OBJECTIVE

To examine the cooling properties of a variety of 'everyday' hot liquids within the context of scald injuries in the United Kingdom.

METHODS

The temperature of common hot liquids, including water, tea, coffee and various other liquids (i.e. takeaway coffees, "Indian tea", chicken curries, hot milk and oil) were recorded over a time period, using digital cooking thermometers.

RESULTS

Minimal difference was detected between the cooling rates of hot water, coffee and tea. Indian tea cooled at a slower rate. The speed at which milk cooled was less than other liquids and the higher the fat content the slower it cooled. Takeaway beverages had a lower starting temperature and retained heat for substantially longer periods. The assessment of cooking oil revealed intense heat production and prolonged cooling.

CONCLUSION

The authors propose that if a patient is exposed to a 'common' scalding agent that has been cooling for 10 min or less then the temperature of that fluid is likely to be greater than 60°C and therefore capable of causing a burn within seconds of exposure. Furthermore, most liquids tested take between 15 and 30 min to reach a "safe temperature" below 53°C.

Unintentional injuries in children of Danish and foreign-born mothers

Aims: Unintentional injuries in children of foreign-born mothers were studied and compared with those in children of Danish-born mothers. Methods: A population of 173,504 children living in 32 municipalities in Denmark was followed from 1998 to 2003. Detailed information on childhood unintentional injuries from hospital records was linked to register data on parents’ education, country of origin, income, family type, etc. Poisson regression was used to analyse differences in injury risk between children of different origins. Results: We found 133,649 injuries, of which 15,389 occurred in children of foreign-born mothers. The injury rates in children of Western and non-Western origin were 0.83 (0.70—0.98) times and 0.84 (0.79— 0.90) times that of children of Danish-born mothers, respectively. The difference was largest in children of families with unemployed parents. The injury rate in girls of non-Western origin was 29% lower than in girls of Danish origin, while the rate in boys of non-Western origin was only 5% lower than in boys of Danish origin. This gender difference was particularly pronounced for sports and traffic injuries. Children of non-Western origin had a three-fold higher rate of burns caused by hot water, tea or oil than children of Danish origin. Conclusions: Prevention of injuries in children of non-Western origin should especially focus on scalds from tea, oil, and hot water.

A 1 year study of burn injuries in a British Emergency Department

OBJECTIVES

To determine the number of patients attending an Emergency Department with burns and to establish the epidemiology, management and outcome of these cases.

METHOD

A retrospective study of all patients attending an Emergency Department with a diagnosis of "burn" during 2004.

RESULTS

Seven hundred and eighty-five patients presented with a diagnosis of burns, accounting for 1% of all attendances. Fifty-three percent of patients were male and most were young adults of working age. Scalds and flame injuries were the most common causes of injury. Only 30% of patients performed adequate first aid. The majority of burns were small and did not require admission to hospital. Assessment and documentation by the Emergency Department staff was found to be generally poor and this may reflect a lack of experience in managing burns.

CONCLUSION

Burns remain a relatively uncommon presenting complaint in the Emergency Department, even in a hospital accepting tertiary referrals. Most injuries are minor and are managed within the department. This study suggests that there is a role for better education of less experienced staff in the management of burns. There remains a need for public education in the prevention and first aid of burns.