Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1036 - файл
.pdf
14
B. T. Stewart
rehabilitation [51, 52]. Additionally, homemakers and informal
workers (e.g., undocumented migrant laborers, lawn
maintenance workers, jacks-of-all-trades) are likely at high
risk given their exposures to hazards and lack of formal
protections, but data around injuries in these contexts are
sparse.
Climate andSeasonality
Colder and high-altitude climates are variably associated with
increased risk of burn injury. Residential fires that occur in
winter months that are not associated with smoking or electrical faults in the United States are most often caused by heating
appliances or cooking-related fires. Energy poverty necessitates the use of hazardous fuels, such as kerosene or open
biomass (e.g., wood) fires to maintain warmth. As example,
Nepal has an annual burn injury epidemic in the winter
months, particularly among populations who live in mountainous and rural areas [46, 53]. In Nepal, like in many cold-climate
countries, older children and women are often responsible for
lighting and tending to fires, managing cookstoves and lamps,
and maintaining warmth. These practices significantly increase
their risk of burn injury and burn- related death.
Conversely, the colder northeastern region of the United
States has a generally lower fire and burn-related mortality
rate (0.97 per 100,000) than the more temperate southeastern region (1.49 per 100,000) [4]. Further, the fire and burn
mortality rate of some of the coldest states in the United
States are lower than the average national rate (1.23 per
100,000). As example, the fire and burn mortality rate in New
Hampshire and Vermont was 0.5 per 100,000 population
compared to Minnesota where it was 0.7 per 100,000.
Nonetheless, Alaska had the highest fire and burn mortality
rate in the United States (2.72 per 100,000). Although temperate climates are not protective, warmer climates in the
United States do seem to have lower fire and burn death
Chapter 1. Epidemiology
rates, as reported in Arizona (0.87 per 100,000) and Florida
(0.84 per 100,000).
In locations with significant seasonal variations of
temperature, burns occur more frequently in the colder
winter months. In some countries and during holidays (e.g.,
the Fourth of July in the United States, Diwali in India and
Nepal, Greek Orthodox Easter in Greece, Hari Raya in
Malaysia, and New Year’s celebrations globally), fireworkrelated injuries become common, particularly among older
male children [54]. Firework injuries often affect the hands,
neck, face, and eyes and are not lethal. As a result, they exact
a disproportionate morbidity for their incidence.
15
Comorbidities
Comorbidities that have been associated with a higher risk of
burn injury include epilepsy, peripheral neuropathy, and
other physical and cognitive disabilities. In low- and middleincome countries where access to medications for epilepsy
and diabetes is often limited, these comorbidities are a common predisposing factor for burn injury. Epilepsy in particular is a common cause of fires, severe burns, and burn-related
fatalities as those suffering from the condition may fall into
an open fire, onto a cookstove, or disrupt an ignition source
[55]. The risk and severity of injury are further exacerbated
by stigma and traditional beliefs about epilepsy. As example,
in some communities the concerns about epilepsy being contagious prevent people from helping to put out the fire or
lending first aid. Epilepsy among people who practice religious fasting, which in some communities include medications, also are at high risk and must be counseled about
avoiding proximity to flames, chemicals, and hot substances
while they are not on a seizure medication. As example, a
prospective study of burns among people living with epilepsy
in Saudi Arabia reported that 40% of injured patients sustained burns while fasting, in part, because they did not take
their medications [56].
16
B. T. Stewart
Burn injuries among people living with peripheral sensory
neuropathy (e.g., from diabetes, leprosy, spinal cord injury)
are common regardless of national income. Practices like
soaking feet in “warm” water, warming feet in front of fires,
and touching hot objects and substances without the sensation that generates a withdrawal response often cause severe
burns in tissues with poor perfusion, which lead to infection,
need for reconstruction and/or amputations in many cases.
Other physical and cognitive disabilities have been
associated with burn injuries, particularly those resulting
from residential fires and scald and contact injuries. With a
growing aging population, including people without access to
cardiovascular disease management in much of the world,
cognitive disabilities from stroke, vascular dementia,
Alzheimer’s disease, and age-related cognitive dysfunction
are a major cause of burn injuries [57]. Further, elderly
patients with dementia tend to have poorer outcomes despite
smaller injuries, and rehabilitation is typically limited [36, 41].
Interpersonal andCollective Violence
The vast majority of burns in the world are unintentional.
However, self-immolation and assault-by-burning occur
worldwide although are more common in some regions and
among specific populations [43]. In the United States, assault
(including child abuse) is responsible for about 2% of injuries
admitted to burn centers, and less than 1% of admissions are
from self-immolation or attempted suicide [58]. Similar proportions have been reported from Europe and Taiwan [59].
Chemical assault—the use of acid or another caustic or
corrosive substance by one person against another with the
intent to injure or disfigure—has been perpetrated for centuries and is increasing in a number of communities [60, 61].
Recent high-profile attacks and advocacy campaigns have
brought chemical assault to public attention and survivors are
seeking systematic change to the way chemical assault is
viewed and controlled through legislation [61–63]. Although
Chapter 1. Epidemiology
17
such attacks are thought to be more common in the low- and
middle-income countries, their incidence is on the rise in
higher income countries too [61, 64]. However, little is known
about the incidence and distribution of these events globally
or the ways in which health systems and governments are
addressing chemical assault [60].
In many cases, chemical assaults occur as a manifestation
of gender-based (GBV) or intimate partner violence (IPV).
These motives in particular have inspired local, national, and
global campaigns to address chemical assaults and empower
women and girls in communities with pervasive gender inequity [65, 66]. Reports from several countries have described
local efforts to limit access to corrosive substances, facilitate
the prosecution of assailants, and increase support for victims
[60, 61, 63, 67]. A recent systematic review of legislation
around chemical assault collated policies and regulations to
propose a comprehensive legislative framework to prevent
chemical assaults and mitigate their effects on victims, and
included five legislative priorities: (i) apply a public health
approach; (ii) adopt legal definitions specific to chemical
assault; (iii) control chemical supply, sales, and procurement;
(iv) facilitate justice; and (v) support survivors [68].
The United Kingdom has a remarkably high incidence of
chemical assault and acid violence that is predominantly perpetrated by men and boys against men and boys [69]. Unlike
in other regions with high rates of chemical assault, the risk
factors in the United Kingdom tend to be related to organized crime. Acid Survivors Trust International, a United
Kingdom-based, international, non-profit organization, is an
exemplar in their use of epidemiological data to drive targeted interventions in different regions and populations, support advocacy initiatives, and generate evidence-based policy
to prevent and control chemical assault.
Collective violence and the complex humanitarian
emergency that ensues are another form of violence that
generate burn injuries at rates far greater than those in safe
societies. Most wartime burn injuries are related to explosive
devices (e.g., land mines, unexploded ordnances), breakdown
18
B. T. Stewart
of infrastructure (e.g., electricity, formal housing), and poor
fire prevention practices. A representative, clusterrandomized, community-based survey of civilians in postinvasion Baghdad (2003–2014) determined that burn injuries
occurred in 117 per 100,000 persons, which is three times
greater than the rate of burn injuries pre-invasion (39 per
100,000 population) [70]. Further, burn injuries represented
10% of all injuries in Baghdad during the decade postinvasion. In the wake of turmoil, the lack of organized burn
care led to a high mortality rate (16%). Additionally, 40% of
burn-injured people were left with major disabilities and
about half experienced catastrophic health expenditure and/
or food insecurity because of their injury. A report from
Médecins Sans Frontières Operations Center Brussels
described surgical care from projects in 15 countries over
seven years [71]. Eleven percent of all operations were for
burn injuries, including those for general surgical, obstetric,
gynecologic, pediatric, and other conditions. People receiving
surgical care at conflict relief projects had nearly twice the
odds of having a burn operation compared to people requiring
surgery in communities affected by natural disaster.
Data forBurn Injury Prevention andControl
Given the enormous and intolerable burden of burn injuries
globally, prevention and control initiatives should be priorities of community organizations, burn centers, health systems,
professional societies, and governments. Better data can
inform burn injury prevention and control efforts, particularly data from community-based surveys, surveillance systems, and national and multi-national registries.
The approach to injury prevention and control is comprised
of four core functions (i.e., surveillance, analysis, intervention,
evaluation). Injury prevention and control practitioners
undertake a spectrum of activities to understand the problem,
address hazards systematically and holistically, and reduce
the burden of injury:
Chapter 1. Epidemiology
19
• Surveillance and data collection
• Strengthening individual knowledge and skills
• Educating healthcare professionals
• Changing practices of institutions and agencies
• Fostering coalitions and networks
• Mobilizing neighborhoods and communities
• Influencing policy and legislation
A precise understanding of the problem and factors that
contribute to it is the basis for planning effective interventions. In much of the world, data regarding hazard distribution and burn injuries are scarce, inaccurate, or both. A lack
of sufficient and high-quality data limits the development,
implementation, and evaluation of potentially lifesaving and
morbidity reducing interventions. The Haddon Matrix is a
tool to conceptualize host-agent-environment factors that
must be considered when collecting data for planning prevention and control interventions (Table1.2 ). A third dimension
has been added to the matrix that includes common causes of
intervention success and failure (e.g., equity, stigma, preferences, feasibility, cost) (Fig.1.2 ). These issues can facilitate
priority setting and decision-making, but only have value in
light of the epidemiological characteristics associated with
burn injury in specific populations and communities.
There are exemplars of comprehensive national burn
registries (e.g., Australia and New Zealand, Taiwan) and a
nascent, global, hospital-based burn registry supported and
promulgated by the World Health Organization [48, 72].
These registries currently and will continue to inform key
burn injury prevention and control strategies. However,
where these databases do not yet exist or are not utilized,
active surveillance programs and representative
community- based surveys are required to ensure that key risk
factors and vulnerable populations that hide in the shadows
of health systems are understood. Data and patterns from
these surveys from Ghana, Bangladesh, Ethiopia, Iran, Nepal,
Uganda, and Rwanda have taught us that hazards are not
equally distributed within communities, countries of similar
national incomes, or regions [6, 14, 73, 74]. No one set of pre-
20
B. T. Stewart
safe cookstoves
• Support transition to
of structures
• Lower flammability
groups to disseminate
safe cooking best
practices
• Use community
cooking spaces when
able
• Separate living and
smoke detectors
• Pass subsidies for
CO detectors
• Install smoke and
programs
• Fund fire response
• Increase availability
extinguishers
• Distribute fire
• Ensure access to
of burn stabilization
points and care
centers
telephone to call
emergency response
matchboxes
• Childproof
• Safer cookstoves
• Safer fuel storage
about risk of fires
Host Agent Physical environment Social environment
T . Haddon Matrix applied to childhood burn injury from residential res caused by cookstoves
Pre-event • Teach children
creches
• Provide barriers
• Create community
near cookstove
• Keep fire blanket
Event • Teach stop, drop
fabrics and upholstery
• Regulate flammable
fire escape plan
and roll
• Plan and practice
regulators on LPG
stoves
• Install auto- shutoff
education to lay
people
response
• Ensure rapid first
Post-event • Provide first aid
Chapter 1. Epidemiology
F . Haddon Matrix with a third dimension that incorporates
high-value domains for decision-making [75]
21
vention and control interventions will be effective or costeffective without such granular data.
Conclusion
The vast majority of burns can be prevented with targeted,
context-specific interventions that are responsive to the
diversity of people, ways-of-life, home and work environments, and competing interests that exist locally and globally.
There are major inequities in incidence of burn injury
between and within populations and the prevalence of disabilities from un- or under-treated burns globally. Mitigating
exposure to known hazards and changing behaviors are key
to reducing the burden of burn injuries and promoting restorative health justice among disadvantaged populations. The
first step is to generate epidemiological data to describe the
problem, identify opportunities to prevent injuries and
improve service delivery, and benchmark interventions. Every
22
B. T. Stewart
stakeholder in the burn community has a role in supporting
high-quality data collection and utilization, including those
who focus on epidemiology and injury prevention, but also
those in fire services, emergency departments, burn centers,
health systems, and patient advocacy groups. Together, we can
reduce preventable death and disability from burn-related
hazards and eliminate one of the greatest health inequities on
our planet.
References
1. James SL, Lucchesi LR, Bisignano C, et al. Epidemiology of
injuries from fire, heat and hot substances: global, regional and
national morbidity and mortality estimates from the Global
Burden of Disease 2017 study. Inj Prev. 2020;26:i36–45.
2. Diseases GBD, Injuries C. Global burden of 369 diseases and
injuries in 204 countries and territories, 1990-2019: a systematic
analysis for the Global Burden of Disease Study 2019. Lancet.
2020;396:1204–22.
3. Crowe CS, Massenburg BB, Morrison SD, Naghavi M, Pham TN,
Gibran NS. Trends of Burn Injury in the United States: 1990 to
2016. Ann Surg. 2019;270:944–53.
4. Peck MD.Epidemiology of burns throughout the world. Part I:
Distribution and risk factors. Burns. 2011;37:1087–100.
5. DeKoning EP, Hakenewerth A, Platts-Mills TF, Tintinalli
JE.Epidemiology of burn injuries presenting to North Carolina
emergency departments in 2006-2007. Burns. 2009;35:776–82.
6. Mehta K, Gyedu A, Otupiri E, Donkor P, Mock C, Stewart
B.Incidence of childhood burn injuries and modifiable household
risk factors in rural Ghana: A cluster-randomized, populationbased, household survey. Burns. 2021;47:944–51.
7. Correction: a review of the international burn Injury Database
(iBID) for England and Wales: descriptive analysis of burn
injuries 2003-2011. BMJ Open 2019;9:e006184corr1.
8. O'Brien SP, Billmire DA. Prevention and management of
outpatient pediatric burns. J Craniofac Surg. 2008;19:1034–9.
9. Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S.Severe
burn injury in Europe: a systematic review of the incidence,
etiology, morbidity, and mortality. Crit Care. 2010;14:R188.
Chapter 1. Epidemiology
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
23
10. Gabbe BJ, Cleland H, Watterson DM, etal. Long term outcomes
data for the Burns Registry of Australia and New Zealand: Is it
feasible? Burns. 2015;41:1732–40.
11. Song C, Chua A. Epidemiology of burn injuries in Singapore
from 1997 to 2003. Burns. 2005;31(Suppl 1):S18–26.
12. Peck M, Pressman MA.The correlation between burn mortality
rates from fire and flame and economic status of countries.
Burns. 2013;39:1054–9.
13. Reynolds TA, Stewart B, Drewett I, etal. The impact of trauma
care systems in low- and middle-income countries. Annu Rev
Public Health. 2017;
14. Gyedu A, Stewart B, Mock C, etal. Prevalence of preventable
household risk factors for childhood burn injury in semi-urban
Ghana: a population-based survey. Burns. 2016;42:633–8.
15. Sleet DA.The global challenge of child injury prevention. Int J
Environ Res Public Health. 2018;15:1921.
16. Kahn SA, Bernal N, Mosier MJ.Pearls from the national burn
repository. J Burn Care Res. 2018;39:626–7.
1 7. Soleimani T, Evans TA, Sood R, Hartman BC, Hadad I, Tholpady
SS.Pediatric burns: kids' inpatient database vs the national burn
repository. J Surg Res. 2016;201:455–63.
18. Latenser BA, Miller SF, Bessey PQ, et al. National Burn
Repository 2006: a ten-year review. J Burn Care Res.
2007;28:635–58.
19. Friesen B. Haddon's strategy for prevention: application to
native house fires. Circumpolar Health. 2003;84:105–9.
20. Bjerregaard P. Fatal non-intentional injuries in Greenland.
Arctic Med Res. 1992;51(Suppl 7):22–6.
21. Fraser S, Grant J, Mackean T, etal. Burn injury models of care:
a review of quality and cultural safety for care of Indigenous
children. Burns. 2018;44:665–77.
22. Moller H, Falster K, Ivers R, Clapham K, Harvey L, Jorm
L.High rates of hospitalised burn injury in Indigenous children
living in remote areas: a population data linkage study. Aust N Z
J Public Health. 2018;42:108–9.
23. Moller H, Harvey L, Falster K, Ivers R, Clapham KF, Jorm
L. Indigenous and non-Indigenous Australian children hospitalised for burn injuries: a population data linkage study. Med J
Aust. 2017;206:392–7.
24. Kimble RM, Griffin BR.Reducing the incidence of burn injuries
to Indigenous Australian children. Med J Aust. 2017;206:389–90.
Соседние файлы в папке @xirurgi_2025