Assessment of acute burn management in 32 low- and middle-income countries

BACKGROUND: The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs). METHOD: The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries. RESULTS: A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank. CONCLUSION: The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.

Sleep quantity and quality is not compromised during planned burn shifts of less than 12 h

Planned burning is a preventative strategy aimed at decreasing fuel loads to reduce the severity of future wildfire events. During planned burn operations, firefighters can work long shifts. Furthermore, remote burning locations may require firefighters to sleep away from home between shifts. The existing evidence surrounding firefighters' sleep during such operations is exclusively anecdotal. The aims of the study were to describe firefighters' sleep during planned burn operations and evaluate the impact of the key operational factors (shift start time, shift length and sleeping location) that may contribute to inadequate sleep. Thirty-three salaried firefighters were recruited from Australia's fire agencies and sleep was measured objectively using wrist actigraphy for four weeks. All variables were examined in two conditions: (1) burn days, and (2) non-burn days. Time in bed, total sleep time, sleep latency and sleep efficiency were evaluated objectively. Subjective reports of pre- and post-sleep fatigue, sleep location, sleep quality, sleep quantity, number of times woken and sleep timing were also recorded. Analyses revealed no differences in measures of sleep quantity and quality when comparing non-burn and burn days. Total sleep time was less when planned burn shifts were >12 h. However, on burn days, work shift start time as well as sleeping location did not impact firefighters' sleep quantity. Self-reported levels of pre- and post-sleep fatigue were greater on burn days compared to non-burn days. These findings indicate that sleep quantity and quality are not compromised during planned burn operations <12 h in duration.

Soil CO2 emission and its relation to soil properties in sugarcane areas under Slash-and-burn and Green harvest

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Caracterização mecânica e térmica da borracha natural formulada e vulcanizada dos clones: GT 1, IAN 873, PB 235 e RRIM 600

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Forest natural regeneration and biomass production after slash and burn in a seasonally dry forest in the Southern Brazilian Amazon

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nutritional, immunological and microbiological profiles of burn patients

A burn is a lesion on an organic tissue resultant from direct or indirect action of heat on the organism. The present study aimed to evaluate the nutritional, immunological and microbiological status of burn patients at the Bauru State Hospital, São Paulo state, Brazil, in 2007. Eight patients, aged more than 18 years and injured up to 24 hours, were evaluated at the moment of hospitalization and seven days later. All victims were males with a mean age of 38 years. on average, 17.5% of their body surfaces were burned and 50% of the patients were eutrophic. There were significant alterations in levels of erythrocytes, hemoglobin, hematocrit, total protein and albumin due to increased endothelial permeability, direct destruction of proteins in the heat-affected area and blood loss from lesions or debridement. At a second moment, cytokines IL-6 and TNF-alpha had augmented significantly, with IL-6 presenting elevated levels in relation to controls at the first moment. Microbiological analysis showed that 100% of the samples collected at hospital admission were negative and after one week Staphylococcus aureus was found in all cultures. Therefore, a burn patient may be considered immunosuppressed and these results indicate significant nutritional, immunological and microbiological alterations that can interfere in his recovery.