Still too hot: examination of water temperature and water heater characteristics 24 years after manufacturers adopt voluntary temperature setting

High area deprivation index is associated with increased injury severity in pediatric burn patients

BACKGROUND

Burn injuries play a significant role in pediatric injury-related mortality and morbidity. In this study, we aim to explore the relationship between patient demographics, socioeconomic factos and burn severity in pediatric patients.

METHODS

Patients under age 14 hospitalized at Westchester Medical Center for burn injury between 2015 and 2021 were reviewed. Demographic variables including mechanism of burn, total body surface area (TBSA) involvement, surgical intervention, hospital length of stay (LOS), and LOS per TBSA burn were extracted. The Area Deprivation Index (ADI) was calculated to further assess socioeconomic factors.

RESULTS

We included 399 patients under the age of 14 hospitalized for burn injuries at our institution between 2015 and 2021. The median age was 2 (IQR 1-6) years old, and 42.6% were female. High ADI (p = 0.018), Caucasian race (p = 0.001), and flame mechanism (p < 0.001) were independently associated with burn TBSA> 5%. LOS per TBSA was shorter in the Caucasian population (p = 0.022).

CONCLUSION

In burn injury patients, further research is necessary to investigate modifiable risk factors in individuals of Caucasian race or lower socioeconomic status to target effective prevention campaigns.

Hot towels: The bedrock of Meibomian gland dysfunction treatment - A review

BACKGROUND

Meibomian gland dysfunction (MGD) reduces quality-of-life and hinders work productivity of millions of patients, with high direct and indirect societal costs. Thickened meibum obstructs the glands and disrupts ocular surface health. Heating the eyelids to soften and express meibum from the glands can be beneficial. The most accessible method for eyelid warming uses heated, wet towels. However, the efficacy of this treatment is reliant on the methodology, and evidence-based best-practice recommendations are needed.

PURPOSE

To evaluate the literature on hot towels in MGD treatment and recommend a best-practice protocol for future research and patient treatment.

METHODS

Studies were identified through PubMed on the May 28, 2021, with the search terms: (warm* OR heat* OR thermal* OR towel OR wet towel) AND (meibomian OR MGD OR eyelid OR "dry eye" OR DED). All relevant original articles with English full-text were included.

RESULTS

The search yielded 903 results, of which 22 met the inclusion criteria. Across studies, hot towels were found to be effective at reducing ocular symptoms. However, without reheating, the temperature quickly fell below the therapeutic range, which was deemed to be between 40 °C and 47 °C. Towels heated to around 45 °C and reheated every-two minutes were most effective at increasing eyelid temperature, comparable or better than several commercially available eyelid warming devices. No adverse effects were reported in the studies.

CONCLUSION

Hot towel treatment effectively warms the eyelids and reduces ocular symptoms, but must be standardized, and towels reheated to achieve maximum benefit. Future research should assess patient satisfaction with different hot towel treatment methods that reheat or replace the towel at least every-two minutes, to establish which methods yield the greatest compliance. Guidelines or clinical recommendations that do not mention the need for regular reheating during hot towel compress treatment should be updated to include this.

Lower Risk of Burn Injury in Children and Adolescents with Autism Spectrum Disorder: A Nationwide Population-Based Study

Little research has examined burn injury in the pediatric population with autism spectrum disorder (ASD). We used data from Taiwan's National Health Insurance Research Database to identify 15,844 participants aged <18 years with ASD and 130,860 participants without ASD. Our results revealed that the hazard ratios differed across three age ranges. The ASD group had a lower risk of burn injury than the non-ASD group when they were less than 6 years of age, a higher risk from 6 years to 12 years of age, and no difference when they were older than 12 years of age. More research is required to study the characteristics and causes of burn injury in the pediatric population with ASD.

Behavioural and environmental risk factors for household injuries: semistructured interviews with health professionals and mothers in Iran

BACKGROUND

Injuries are increasing global public health problems, causing disability and death among children. This has considerable financial, emotional and social effects on families and society. This study aimed to investigate the behavioural and environmental factors leading to unintentional home injuries and attempts to highlight the pivotal role of mothers' behaviour and performance to provide a safe place for children at home.

METHODS

The current research is a qualitative study of a directed content analysis type. The data were gathered through semistructured interviews conducted in participants' workplaces, namely universities, research centres and health centres. In some cases, telephone interviews were conducted within 3 months, from February 2021 to May 2021 in Tehran, Iran. The participants were selected through non-probability and purposive sampling. All the recorded interviews and notes were accurately evaluated, and data analysis was performed based on the content analysis. There were 29 interviews in total: 12 interviews with mothers, 9 with treatment and prevention specialists, and 8 with researchers.

RESULTS

A total of 66 factors, 6 subcategories and 2 main categories were extracted after analysing the interviews. The main categories included environmental and behavioural factors. The subcategories included house infrastructure, house equipment/furniture, children's equipment/furniture, provision of precarious conditions, access to hazardous substances and appliances, and unsafe arrangement of furniture.

CONCLUSION

Despite the existing obstacles such as the long-term implementation, financial difficulties and overcomplicated policy-making process, health interventions can make it possible for mothers of children under the age of seven to adopt preventive measures through appropriately designed instructions and optimal use of existing facilities.

Social determinants of health in pediatric scald burns: Is food access an issue?

BACKGROUND

Burn injury risk, severity, and outcomes have been associated with socioeconomic status. Limited data exist to evaluate health access-related influences at a structural population level. This study evaluated factors at the Census-tract level, specifically evaluating food access and social vulnerability in pediatric scald burns.

METHODS

A single-institution retrospective review using the trauma registry and electronic medical record was conducted of pediatric burns between 2016 and 2020. Home address was coded to the Census-tract level and bulk analyzed. Socioeconomic metrics of the home environment were evaluated from publicly available databases, the United States Food and Drug Administration Food Access Research Atlas, and the Centers for Disease Control's Social Vulnerability Index.

RESULTS

There were 840 patients that met inclusion criteria (49.8% scald, N = 418). The mean total body surface area for scalds was 6.6% with an age of 10.2 years; 76% (n = 317) of scalds had Medicaid, and 15% (n = 63) were due to hot noodles. Scalds occurred more in females (45.7%, N = 191 vs 28.0%, N = 118; P < .0001), non-White race (62.7%, N = 262 vs 29.1%, N = 123; P < .0001), and low-income and low-food access populations (39.8%, N = 147 vs 30.4%, N = 116; P = .007). Low-food access Black populations showed increased scald injury (18% [interquartile range 6-35] vs 10% [interquartile range 4-25]), whereas all other populations showed no association. The patients with scalds had a higher overall social vulnerability index (0.67 vs 0.62, P = .008).

CONCLUSION

Often related to poverty, health access, and health equity, population-level social determinants of health like social vulnerability and food access have significant impact on health care and should influence health outreach and systems improvement.

Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey

Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.

Cross-sectional analysis of national electronic injury surveillance system for burn injuries presenting to United States emergency departments 2000-2018

Patients with burns commonly present to Emergency Departments (EDs), in addition to burn centers. Patients at burn centers typically have more severe burns than those at EDs, and previous studies have analyzed burn center databases. To update the overall burn epidemiology in the United States (US), we analyzed burn injury trends and sources across all age groups using the National Electronic Injury Surveillance System (NEISS), which collects all injuries reported to US EDs. A total of 97,986 burn injuries were recorded in NEISS, 2000-2018. We found a downward trend in the pediatric burn rate and an upward trend in the adult burn rate. Almost half of burns were in children (48.41%), especially in those under 5 (29.79%), and slightly more common in men (53.93%). Most were treatable in the ED (87.83%) and hot water was the most common source overall (20.88%), followed by hair curlers for children less than 2 years old, ranges/ovens for 2 to <5 years, microwaves for 5 to <10 years, and cookware for 10 to <18 years and adults ≥18 years. The most common injured region was the hand for all age groups (34.44%). Although most burn injuries were potentially preventable, the overall burn rate did not decrease 2000-2018. Therefore, we offer guidance on prevention strategies for high-risk sources and age groups.

An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines

OBJECTIVES

Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD).

METHODS

This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury.

RESULTS

The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%).

CONCLUSIONS

Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

Using Weather, Lunar Cycles, and Time of Year to Predict Trauma Incidents in an Urban, Level I Pediatric Trauma Center

BACKGROUND

Trauma patterns in adults are influenced by weather conditions, lunar phases, and time of year. The extent to which these factors contribute to pediatric trauma is unclear.

OBJECTIVE

The present study aimed to review patients from a single Level I pediatric trauma center to determine the influence of weather, the lunar cycle, and time of year on trauma activity.

METHODS

A retrospective review of trauma activations (n = 1,932) was conducted from 2015 to 2017. Injury type and general demographics were collected. Weather data and lunar cycles were derived from historical databases.

RESULTS

Days with no precipitation increased the total number of injuries of all types compared with those with precipitation (p < .001). Blunt and penetrating injuries were more likely to occur during full moons, whereas burn injuries were significantly higher during new moons (p < .001). Blunt trauma was significantly higher in September than all other months, F(11, 1,921) = 4.25, p < .001, whereas January had a significantly higher number of burns than all other months (p < .001).

CONCLUSIONS

Pediatric trauma trends associated with external factors such as weather, lunar cycles, and time of year can inform hospital staffing decisions in anticipation of likely injuries and help direct injury prevention efforts.

Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively

Efforts to address misinformation on social media have special urgency with the emergence of coronavirus disease (COVID-19). In one effort, the World Health Organization (WHO) designed and publicized shareable infographics to debunk coronavirus myths. We used an experiment to test the efficacy of these infographics, depending on placement and source. We found that exposure to a corrective graphic on social media reduced misperceptions about the science of 1 false COVID-19 prevention strategy but did not affect misperceptions about prevention of COVID-19. Lowered misperceptions about the science persisted >1 week later. These effects were consistent when the graphic was shared by the World Health Organization or by an anonymous Facebook user and when the graphics were shared preemptively or in response to misinformation. Health organizations can and should create and promote shareable graphics to improve public knowledge.

A state-wide analysis of pediatric scald burns by tap water, 2016-2018

INTRODUCTION

Unsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.

METHODS

We performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student's t-test and spearman's correlation analysis were performed for comparative analyses.

RESULTS

A total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).

CONCLUSIONS

Our results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.

Revisiting John Snow to Meet the Challenge of Nontuberculous Mycobacterial Lung Disease

Nontuberculous mycobacteria (NTM) are ubiquitous components of the soil and surface water microbiome. Disparities by sex, age, and geography demonstrate that both host and environmental factors are key determinants of NTM disease in populations, which predominates in the form of chronic pulmonary disease. As the incidence of NTM pulmonary disease rises across the United States, it becomes increasingly evident that addressing this emerging human health issue requires a bold, multi-disciplinary research framework that incorporates host risk factors for NTM pulmonary disease alongside the determinants of NTM residence in the environment. Such a framework should include the assessment of environmental characteristics promoting NTM growth in soil and surface water, detailed evaluations of water distribution systems, direct sampling of water sources for NTM contamination and species diversity, and studies of host and bacterial factors involved in NTM pathogenesis. This comprehensive approach can identify intervention points to interrupt the transmission of pathogenic NTM species from the environment to the susceptible host and to reduce NTM pulmonary disease incidence.

Child Housing Assessment for a Safe Environment (CHASE): a new tool for injury prevention inside the home

OBJECTIVE

To develop a tool to assess the safety of the home environment that could produce valid measures of a child's risk of suffering an injury.

METHODS

Tool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case-control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee's home, and we compared scores on individual and summary items between cases and controls.

RESULTS

Twenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures.

CONCLUSION

Programmes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.

Unintentional home injuries across the life span: problems and solutions

Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.