“Burns Behind Bars”: A 10-year review and cost analysis of burn injuries in prison inmates presenting to a regional burns centre,and the role of the burns outreach service

IntroductionFrom 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.MethodsData was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.Results18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (<1–8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1–8).DiscussionThe disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.ConclusionTargeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital.     

Hospital-admitted injury attributable to alcohol

Background: Primary data collection has established that alcohol causes injuries treated in the emergency department. No comparable data exist for injuries admitted to hospital. Data on the injury risks of heavy drinkers relative to other drinkers also are sparse. Methods: We estimated (i) whether regular heavy drinkers have higher hospitalized injury risks than other people when alcohol‐negative and (ii) how much hospitalized injury risk of regular heavy drinkers and other drinkers rises when alcohol‐positive. We combined national alcohol consumption data with alcohol metabolism rates to estimate hours spent alcohol‐positive versus alcohol‐negative during a year for heavy drinkers versus other people. A literature review provided hospitalized nonfatal injury rates for these groups by alcohol involvement. Results: Relative to other alcohol‐negative people aged 18 and older, heavy drinkers have an estimated relative risk of hospitalized injury of 1.4 when alcohol‐negative and 4.3 when alcohol‐positive. Others have an estimated relative risk of 1.0 when alcohol‐negative and 6.8 when alcohol‐positive. Thus, alcohol greatly raises injury risk. The excess risk patterns persist for a wide range of sensitivity analysis values. Of hospitalized injuries, an estimated 21% are alcohol‐attributable including 36% of assaults. Conclusions: Drinking alcohol is a major cause of hospitalized injury. Heavy drinkers lead risky lifestyles. They tolerate alcohol better than most drinkers, but their injury risks still triple when they drink. Our approach to attribution is a valuable complement to more costly, more precise approaches that rely heavily on primary data collection. It works for any severity of injury. Applying it only requires an existing alcohol consumption survey plus data on alcohol involvement in targeted injuries.     

Chemical injuries from assaults: An increasing trend in a developing country

Objective:

This paper describes chemical injuries, which presented to us and were managed at a burn unit in Nigeria. The purpose of this paper is to highlight the etiologies of these injuries, the extent of the injuries as well as to suggest possible ways to prevent chemical injuries in our environment.

Materials and Methods:

We carried out a retrospective review of chemical burns treated at our center. Our sources of information were the burn unit admission registers, case notes of the patients and operation registers. The results were collated and then analyzed.

Results:

Twenty eight patients presented with chemical burn injuries during the study period between January 2000 and December 2003, constituting 5.7% of all patients with burns treated within that period. Seventeen (60.7%) of the patients were males while 11 (29.3%) were females with a mean age of 20.6 years. The injuries were sustained from assault in 21 (75%), armed robbery attacks in five (17.8%) and suicide attempts in two (7.1%). The agents were usually unknown. Late presentation was observed in all the patients. Raw eggs, palm oil, gentian violet and engine oil were the substances applied immediately after the injuries. Complications observed included septicemia, respiratory distress, blindness, renal failure, mentosternal contractures, ectropion, axillary contractures, hypertrophic scars, keloids and skin depigmentation.

Conclusion:

Chemical burn injuries are mainly due to assaults in Nigeria and are usually extensive and presented late. Education of the people and penalty for any offender will reduce the current spate of such injuries.     

Sexual victimization and hazardous drinking among heterosexual and sexual minority women

Aims

Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because the rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women.

Method

Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking.

Results

Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian.

Conclusions

This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women's heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization.     

Characteristics of Toddlers and Preschoolers Exhibiting Severe Psychiatric Disturbance

The present study reports data collected on 137 toddler and preschool children admitted for acute, psychiatric inpatient hospitalization. Utilizing a comprehensive chart review survey developed by the authors, information was obtained regarding presenting problems, family psychiatric history, family legal problems, child maltreatment in order to examine factors contributing to the need for psychiatric hospitalization. Extremely dangerous behaviors were displayed by these youngsters, placing themselves and others at significant risk of harm. The frequency of occurrence of factors that contributed to these severe adjustment difficulties was alarming. Implications regarding service needs for these young children are discussed.     

Rape Kit Notification: Recommendations and Barriers to Reconnecting with Survivors

ABSTRACT

In the wake of the discovery of untested rape kits across the country, jurisdictions now face questions about how best to reengage with survivors in a sensitive and empowering way. The current study sought to provide guidance on this question through interviews and surveys about effective victim notification procedures. Using a combination of purposive and snowball sampling, the current study interviewed 76 criminal justice, advocacy, and public policy professionals and 19 rape survivors from across the country about their recommendations for rape kit notification. Inductive thematic analysis was used to derive a set of 51 unique recommendations about how and when notification should occur. These recommendations were then transformed into a survey that was sent back to participants for ratings of importance, feasibility, and acceptability. Results suggested that approaches such as involving advocates, responding in a sensitive and empathetic way, engaging in full and ongoing notification, and providing clear information and referrals to survivors were supported by professionals and survivors alike. Results also suggested that feasibility concerns played little role in determining the acceptability of different notification approaches, calling into question the common assertion that feasibility concerns prevent jurisdictions from utilizing survivor-centric and trauma-informed procedures. Implications of these findings for both researchers and practitioners seeking to address the problem of untested rape kits are discussed.     

Epidemiology of burns throughout the World. Part II: intentional burns in adults

A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.     

Forced sexual intercourse,suicidality, and binge drinking among adolescent girls

Although sexual assault victimization has been shown to predict suicidality, little is known about the mechanisms linking these two factors. Using cross-sectional data (N = 6364) from the 2007 Youth Risk Behavior Survey, binge drinking significantly mediated the relationship between forced sexual intercourse and suicide for Hispanic (n = 1915) and Caucasian (n = 2928) adolescent females, but not for African American adolescent females (n = 1521). Results suggest the need for closer monitoring of adolescent victims of sexual assault who also abuse alcohol to intervene in early suicide behaviors. Treatment and intervention programs should also be culturally sensitive to account for differences in reaction to sexual trauma among race/ethnicity. Implications for suicide prevention and alcohol intervention strategies as well as suggestions to clinical providers are discussed.