A burn prevention program as a long-term investment: trends in burn injuries among Jews and Bedouin children in Israel

Analysis of Trauma Injuries Among the Minority Population in Southern Israel-a District-Wide Study

BACKGROUND

We compared characteristics of traumatic injury between the Bedouin subpopulation, the largest minority group in southern Israel, and the other residents in this region.

METHODS

We assessed all the patients admitted with traumatic injuries during 2014-2018 to the only regional hospital in southern Israel.

RESULTS

The cohort comprised 10,734 patients, 4553 (42.5%) of Bedouin origin. Compared to the non-Bedouin subpopulation, in the Bedouin subpopulation, the proportion of injuries that occurred in males was higher, 74.3% vs. 53.7%, P < 0.001, and the proportion of burn injuries that occurred in children aged 0-14 years was higher, 84% vs. 49%. Among the Bedouin and non-Bedouin patients, the respective proportions with penetrating injuries were 10.7 and 5.4%; the respective proportions who arrived at the hospital by private vehicles were 62.0 and 33.1%. In multivariate analysis, the variables that were significant for increased odds for severe trauma were Bedouin origin, male gender, and arrival to the emergency room at night.

CONCLUSION

This study highlights the lack of access to basic infrastructure and healthcare among Bedouins in southern Israel. The high proportion of penetrating injuries in this subpopulation is apparently due to explosions of unexploded ordnance. The unavailability of electricity and waste removal in unrecognized villages contributes to burn injuries among Bedouin children. Poor accessibility of healthcare facilities and emergency medical transportation necessitates travel to hospitals by private car. The findings should direct trauma prevention programs to reduce burn and penetrating injuries and to increase accessibility to healthcare.

Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel

BACKGROUND

Child injury is prevalent in the Bedouin community of southern Israel, with higher injury rates compared with the general population. Bedouin children aged 0-4 were twice as likely as children from other population groups to suffer any injury, and for example, incidence of burns in Bedouin children was 0.91/1000 children, compared with 0.46/1000 in Jewish children.

METHODS

A multifaceted injury prevention intervention was developed based on best practice methods, culturally adapted and implemented in nine Bedouin towns in collaboration with local authorities. Intervention elements included a youth leadership scheme, workshops for mothers in maternal child health centres, home safety visits, a preschool intervention and a media campaign. Outcome assessment of change following home visits was conducted. Process evaluation included a survey of mothers and focus groups with youth participants.

RESULTS

High participation was demonstrated indicating acceptability of the programme. Assessment of home visits showed an improvement in the level of household safety between first and second visits, as measured by a checklist. Youth participants expressed satisfaction in the programme, which gave them confidence and practical tools.

CONCLUSION

A multifaceted intervention programme was conducted in the Bedouin community in southern Israel and found to be acceptable, with high participation levels. Collaboration between national and local authorities improved implementation, and multiple programmes in different settings enabled broad exposure to the programme.

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel

BACKGROUND

Child injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in children in and around the home was run in nine Bedouin communities in Southern Israel during 2014-2018. The aim of the study was to evaluate the effect of the intervention on injuries among children aged 0-4 by comparing emergency room (ER) visits and hospitalisations before and after the intervention.

METHODS

Child injury data (ages 0-4, 5-17) for 2013-2018 were obtained from Soroka Medical Center, including ER visits and hospitalisations. Further data on reason for hospitalisation and injury severity score (ISS) were obtained from the National Centre for Trauma Research for 2011-2018. Reach was assessed by calculating the per cent of participants from the total relevant population in each town. Poisson regression was used to assess change over time, from preintervention (2013) to postintervention (2018).

RESULTS

A high proportion of educational institutions took part in the intervention, and around 20% of relevant households received a home visit (n=6334). There was a significant reduction in ER visits (7.6%) in children aged 0-4 in 2018 compared with 2013. Hospitalisations did not decrease significantly, although the number of admissions for burns and falls was reduced significantly at follow-up.

CONCLUSIONS

This multifaceted intervention programme resulted in reduced injury in children aged 0-4 years in the Bedouin community. The use of simultaneous multiple intervention methods was effective in increasing child safety.

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21-30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11-20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.

A Case Series of Candle Wax Burns during the Lantern Festival in Hong Kong

Every year there was significant number of burn cases during the Lantern (Mid-Autumn) Festival in Hong Kong because children liked to play with fire on that day. They would either burn the lantern or boil the wax from candles in a pot over a fire. When the wax has melted, they poured cold water into it, causing a small explosion with water vapour and wax droplets. Children and adolescents were more common than adults to be burnt by the hot vapour, fire or hot wax. The majority sustained partial thickness burns involving the face. Such burn injuries should be preventable by education and legislation.

To everything there is a season: impact of seasonal change on admissions, acuity of injury, length of stay, throughput, and charges at an accredited, regional burn center

PURPOSE

Although previous studies have investigated the impact of weather and temporal factors on incidence of trauma admissions, there is a paucity of data describing the effect of seasonal change on burn injury. The purpose of this study was to examine the impact of the changing seasons on admissions to and resource utilization at an accredited burn center, with the goal of optimizing patient throughput and matching supply with demand.

METHODS

We performed a retrospective review of all burn admissions to an accredited, regional burn center, from Summer 2009 through Spring 2010. Patients were segregated into the seasonal cohorts of Summer, Fall, Winter, and Spring, based on admission date. Patient demographics included age, gender, mechanism of injury, and total body surface area (TBSA) injured. Main outcome measures included length of intensive care unit (ICU) stay, length of stay (LOS), and hospital charges, which served as a proxy for resource utilization (nursing, wound, and critical care; access to operating room (OR); inpatient rehabilitation). Groups were compared by T tests, with statistical significance assigned to P values <0.05.

RESULTS

Seven hundred thirty patients were admitted to the burn center during this annual period, with a mean age of 31.6 years and a TBSA of 8.9%. Although Spring had the greatest the number of admissions at 219 (30%), patients from Summer and Winter had the largest burns, longest length of ICU and hospital stays, and highest hospital charges (P < 0.05). Furthermore, variability of these parameters, as measured by standard deviation, was greatest during Summer and Winter, serving to reduce throughput via uneven demand on resources. Highest throughput occurred during the Spring, which had the highest admission-to-LOS ratio. No differences were observed in age, gender, and incidence of electrical injuries, across the 4 seasons.

CONCLUSIONS

Summer and winter were the peak seasons of resource utilization at our burn center, in terms of length and variability of ICU and hospital stays, as well as total hospital charges. Such seasonal change may be related to acuity of burn injury but not number of burn admissions. To improve operational efficiency and maximize patient throughput, resource allocation should be structured to anticipate seasonal changes, so that supply of services matches demand.

Self-inflicted burn injuries in southwest Iran

Self-inflicted burns are among the most devastating of all burn injuries with serious physical, psychological, and financial effects on the individual, the patient's family, and society. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of burn patients who were admitted to a major burn center in the Fars province. In a longitudinal prospective design, from April 2003 to March 2005, all burn patients that were admitted to Ghotb-eddin Shirazi Hospital were evaluated. Data in regard to patients' social demographics, burn injury, and outcome measures were collected. Suicide attempts by burning accounted for 231 (24.8%) of all burn patients admitted to hospital. Suicidal burns occurred predominantly in the age group 15 to 24 years (49.1%). Most (71.4%) self-burning cases were female. Deliberate self-burn patients have significantly larger burned body surface area than accidental burn patients [70% (4-100) vs 28% (1-100); P < .0001]. The case fatality rate for self-inflicted burns (62.3%) was significantly higher than the 27.7% rate observed for accidental burns (P < .0001). Burned body surface area >40% and self-inflicted burns strongly and independently predicted mortality. Self-inflicted burns continue to be a major health problem in this region. Special burn preventive programs should be implemented in primary health care system. A National Committee for Injury and Burn Prevention and Control should be established urgently to coordinate all burn prevention programs and collaborate between different sectors of the society.

Changing Pattern of Adult Burn Referrals to a Regional Burns Centre

The National Burn Care Review prompted us to review trends in adult acute admissions to our unit with the intention to implement the guidelines of referral set down in the report. We had recently also adopted a more open admissions policy in keeping with these recommendations. This was achieved by a retrospective casenote analysis with the years 1981, 1991, and 2001 used as reference snapshot years to outline trends. The results showed an increase in the number of patients, a decrease in the depth and extent of burns, a decrease in the number of inpatient days and crude mortality rate. There was also a slight decrease in the age of patients.

Burns in Sweden: An analysis of 24538 cases during the period 1987–2004

Burn care is always progressing, but there is little epidemiological information giving a clear picture of the current number of treated burns in Sweden. This study was conducted to provide an update of patients admitted to hospital with burns in Sweden. Data were obtained for all patients who were admitted to hospitals with a primary or secondary diagnosis of burns (ICD-9/10 codes) from 1 January 1987 to 31 December 2004; 24,538 patients were found. Most of the patients were male (69%), giving a male:female ratio of 2.23:1. Children in the age-group 0-4 years old predominated, and accounted for 27% of the study material. The median length of stay was 3 days. Throughout the period 740 patients (3%) died of their burns. Significant reductions in mortality, incidence, and length of stay were seen during the study, which correlates well with other studies. However, most of the reductions were in the younger age-groups. Men accounted for the improved mortality, as female mortality did not change significantly. We think that the improvement in results among patients admitted to hospital after burns is a combination of preventive measures, improved treatment protocols, and an expanding strategy by which burned patients are treated as outpatients.

Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention

Burn prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs), such as the United States, due to sustained research on the descriptive epidemiology and risk factors, the same cannot be said of developing or low- and middle-income countries (LMICs). To move from data to action and assist preventive efforts in LMICs, a review of the available literature was conducted to assess the current status of burn preventive efforts. A MEDLINE search (1974-2003) was conducted on empirical studies published in English on the descriptive epidemiology, risk factors, treatment, and prevention of burns in LMICs. Review of the 117 identified studies revealed basically the same descriptive epidemiological characteristics but slightly different risk factors of burns including the presence of pre-existing impairments in children, lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding as well as several treatment modalities and preventive efforts including immediate application of cool water to a burned area. Continuous evaluation of promising interventions and those with unknown efficacy that have been attempted in LMICs, along with testing interventions that have proven effective in HICs in these LIMC settings, is needed to spearhead the move from data to action in preventing burns in LMICs.

Paediatric rehabilitation in Israel: unique problems, exceptional solutions

Mind the gap: Israel straddles the gap between Western medicine and Middle-Eastern cultural and political challenges. Maintaining state-of-the-art paediatric rehabilitation in an era of economic and political constrictions is described and analysed in this review.

Home accidents in Arab Bedouin children in southern Israel

Home accidents are a major health problem; no data about the specific types of home accidents in the pediatric Bedouin population of southern Israel is available. We sought to delineate the specific types of home accidents in Arab Bedouin children in southern Israel. The study was conducted in a primary care clinic in an Arab Bedouin town in southern Israel. An interview of every patient or parent who presented to the clinic for a home accident in a child from December 2000 until mid November 2001 was conducted. A total of 235 accidents were recorded from 219 patients (153 males and 66 females). The most prevalent injury was burns (85 cases--36.1%) followed by falls (67 cases--28.5%), contusions, (31 cases--13.2%), lacerations (29 cases--12.3%), and nail penetrations (19 cases--8%). Thirteen patients were hospitalized, 6 with burns and 7 due to falls. A total of 209 days of hospitalization were recorded, 195 days due to burn and 14 days due to falls, (p < 0.05). Burn rates were highest in children younger than 2 years of age, 39/57 (68.4%), and an increased risk for burns was significantly correlated to younger age (p < 0.0001). We conclude that in our study population, burns represent the most prevalent home accident and that burns cause a much longer hospital stay than any other type of accident. The risk for burns is correlated to younger age. A burn prevention plan is needed.

Burn patients in Portugal: analysis of 14,797 cases during 1993-1999

The incidence and cause of burns in Portugal are unknown. The present study seeks to collect these data as a basis for future studies in prevention and development of treatment regimes. The data used in this work was obtained from the registries existing in The Direcção Geral de Saúde (General Health Administration) and relates to burn patients admitted to 91 Portuguese hospitals--that serve all the territory--during the period of 1993-1999. All patients selected had at least one diagnosis of burn (ICD-9: 94.###) among all the diagnoses motivating an admission. A total of 14,797 burn patients were obtained. Among all the patients admitted to hospitals, 8731 (59.0%) were male and 6066 (41.0%) were female, with a male/female ratio of 1.44:1. The mean length of in-hospital stay was 15.5+/-21.0 days. Throughout this period, 553 (3.7%) patients died in Portuguese hospitals as a result of burn injury. There were no significant differences in the number of deaths in each year, P=0.45, in contrast to the decrease of burn mortality rates reported in other studies. It is likely that the reason for this situation is the lack of investment in the last years in this area and the delay in opening new Burn Centres.