Babywalkers: prevalence of use and relationship with other safety practices

OBJECTIVE

To examine the prevalence of walker use, and to compare sociodemographic factors, perceptions of the risk of injury and of household hazards, and safety practices in families by walker use.

SETTING

36 Primary care practices across Nottingham, UK.

METHODS

Postal questionnaire to all parents of children aged 3-12 months registered at each practice (n = 2152) to assess safety practices, perceptions of risk of injury, and of the risk associated with household hazards and sociodemographic factors. Data were analysed using chi 2 tests for categorical data, Mann-Whitney U tests for ordinal data, and logistic regression analysis.

RESULTS

The response rate was 74%. Fifty per cent of parents used babywalkers. Receipt of means tested benefits (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.02 to 1.99), non-owner occupation (OR 1.46, 95% CI 1.04 to 2.04), residence in a deprived area (OR 1.42, 95% CI 1.06 to 1.91), and unemployment (OR 0.64, 95% CI 0.41 to 0.99) were independently associated with use of walkers. Families using babywalkers were less likely to use stair gates (chi 2 = 4.36, 1 df, p = 0.037), fireguards (chi 2 = 6.80, 1 df, p = 0.009), and had a higher total number of unsafe practices (Mann-Whitney U test, Z = -2.90, p = 0.004). Perceptions of risk of injury and of the risk associated with household hazards however, did not differ by walker use.

CONCLUSIONS

Babywalker use is common across all social groups and is associated with other unsafe practices such as not using stair gates or fireguards. Health professionals should support campaigns to limit the sale of babywalkers, but, in addition, they should ascertain each family's reasons for walker use and try to find acceptable alternatives. They should also make the family aware of the importance of properly fitted stair gates and fireguards and help the family to obtain and use such items of safety equipment.

Injury prevention training: is it effective

The aim of this controlled follow-up study was to assess the effectiveness of a multi-disciplinary training programme in increasing knowledge, changing attitudes and practice in injury prevention amongst primary health care professionals. All primary health care team members in Nottinghamshire were invited to participate in the training programme. Thirty-one health visitors, 11 general practitioners and 16 practice nurses attended the training programme, and completed the study questionnaire 3-4 months before and after the training. A comparison was made with a professional of the same status, who had not attended the training session who had also completed both questionnaires, and who was matched with a trained participant on the basis of pre-training attitude and knowledge scores (to within 1 point of each score). A significant increase in the number of individuals answering correctly to questions on accidental injury epidemiology was demonstrated in the trained group (Wilcoxon matched-pairs signed rank, health visitors P = 0.002, practice nurses P = 0.0004, general practitioners P = 0.02), but no significant change was demonstrated in the control group. Changes in attitude scores were only significant for the practice nurses (Wilcoxon matched-pairs signed rank, P = 0.01). Increases were also demonstrated in the frequency of health visitors identifying hazards on home visits and discussing them with parents (chi 2 = 6.19, d.f. = 2, P = 0.04) and in the number of health visitors who, on receiving notification of a child attending the A&E department following an injury, carried out a home visit to discuss injury prevention (chi 2 = 9.19, d.f. = 2, P = 0.01). The number of general practitioners displaying posters in the surgery waiting rooms also increased significantly (chi 2 = 9.21, d.f. = 2, P = 0.002). The number of contacts with representatives of other agencies and individuals concerning child safety significantly increased in the trained group (Wilcoxon matched-pairs, P = 0.02). We conclude that education and training with regard to injury prevention was effective in increasing knowledge and some injury prevention practices. Although training did not appear to change the attitudes of health visitors and general practitioners to a significant extent, a marked change was unlikely due to high baseline attitude scores.

Injury prevention programmes in primary care: a high risk group or a whole population approach?

OBJECTIVE

To examine the relationship between risk factors for childhood unintentional injury and injury outcome and to assess the feasibility of using risk factors to identify children at high risk of injury.

SETTING

One general practice in Nottingham, UK.

METHOD

A postal questionnaire survey to all parents of children registered with the practice (n = 771) to obtain data on risk and sociodemographic factors. All children still registered with the practice one year later were followed up for occurrence of a medically attended injury.

RESULTS

The response rate was 78%. The injury rate over the follow up year was 246 injuries per 1000 children. Previous medically attended injury was associated with each of the injury outcomes (odds ratio (confidence interval) for all attendances, 2.33 (1.37 to 4.05); for accident and emergency attendances, 2.27 (1.15 to 4.4); and for primary health care team attendances, 2.58 (1.33 to 5.0)). Male sex was associated only with accident and emergency department attendance (odds ratio 2.13 (1.06 to 4.2)). Maternal age and previous injury were associated with a higher number of injuries in the subsequent year on univariate and multivariate analyses. The sensitivity and positive predictive value of the risk factors were low, except for previous injury and male sex. The number of children needing an injury prevention intervention to prevent one injury as identified by the risk factors was not significantly different from that required if a whole population approach were to be used.

CONCLUSION

Primary care based injury prevention programmes, at present, should not be targeted at children identified as being at 'high risk' of injury. Nevertheless, a larger study using a wider cross section of the population is needed to address this issue further.

Accidental injury: risk and preventative interventions

OBJECTIVE

To evaluate the relation between risk factors for childhood unintentional injury and requests for injury prevention interventions as part of the Nottingham Safe at Home project, a primary care based controlled intervention study assessing the effectiveness of a package of injury prevention interventions.

SETTING

17 practices in Nottingham randomly selected from 55 practices volunteering to take part in the study.

METHODS

Postal questionnaire to all parents of children aged 3 to 12 months registered with the intervention practices (n = 1124) to assess risk factors for injury and to elicit requests for three injury prevention interventions: free home safety checks, low cost safety equipment, and free first aid training.

RESULTS

73% of parents responded to the questionnaire. The distribution of sociodemographic variables among responders was similar to that for the population of Nottingham. One third of parents (34%) requested one intervention, 21% requested two interventions, and 10% requested three. Receipt of means tested benefits, ethnicity, and residence in a deprived area were independently associated with requesting home safety checks. Non-owner occupation, lack of access to a car, receipt of means tested benefits, ethnicity, and unemployment were independently associated with requesting low cost safety equipment. Non-owner occupants were less likely to request first aid training.

CONCLUSIONS

Families with risk factors for childhood unintentional injury do request home safety checks and low cost safety equipment, but they are less likely to request first aid training. Other methods for providing first aid advice may be needed to reach such families.

Melanosis coli is associated with an increase in colonic epithelial apoptosis and not with laxative use

We have investigated the clinical presentation, laxative use and histopathology of 38 patients with a histological diagnosis of melanosis coli and measured the colonic epithelial apoptosis in these cases. The presence of lipofuscin was confirmed in all cases. Fifteen of the cases had constipation, whilst eight had diarrhoea. Neither constipation nor diarrhoea was present in 13 cases and both were present, at different times, in two. Laxatives had been used in all those with constipation, in only one with diarrhoea and in none of the others. The mean apoptotic count was significantly increased in those with melanosis coli compared with the controls. In the majority of cases with constipation there was no other abnormality, whilst an additional diagnosis was present in the majority of the remainder. Colonic epithelial apoptosis was increased in melanosis coli and the majority of cases were not associated with laxative use. These results support the proposed role of apoptosis in melanosis coli, but indicate that melanosis coli is a non-specific marker of increased apoptosis with many possible causes, of which the use of laxatives is only one.

An exploratory study of male recovering substance abusers living in a self-help, self-governed setting

Adult men (n = 132; 92% of the population) with histories of alcohol/drug use disorders were interviewed upon their entry to 11 Oxford Houses located in the state of Illinois. Individuals still in residence at a six-month follow-up (n = 48) were reinterviewed; prior to the follow-up interview, 42 men had left voluntarily and 42 men had been evicted for abuse or disruptive behavior. The men remaining in residence tended to be older (M age = 37 years), were disproportionately African American (56%), and were less pessimistic about their future. At the intake interview, individuals who would be evicted reported a lower expectation for abstinence social support from the other residents in Oxford House. The Oxford House model of social support for recovery from alcohol and drug dependence appears to help some residents maintain sobriety.

Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes

OBJECTIVE

A prospective study of the interaction between airbag (AB) and seat-belt (Bt) protection versus vehicular compartment (VC) intrusion effects on injury patterns in motor vehicle crash (MVC) trauma patients.

METHODS

Two hundred MVC patients, nonejected drivers or front seat passengers with multiple trauma or severe lower extremity (LE) trauma admitted to two Level I trauma centers.

RESULTS

In frontal crashes, airbags (AB) more than Bt reduced Glasgow Coma Scale severity in brain injury, face fracture, shock, and the need for MVC extrication (all p < 0.05). Frontal AB also had a protective effect on LE fractures (41% vs. 66%, p < 0.01), but had no significant protective effect on pelvic fractures. When AB protection was present, it prevented brain and face fracture injuries caused by impact contacts and reduced the incidence of these injuries resulting from VC intrusions (p < 0.05). Thoracoabdominal injuries resulting from steering wheel intrusion showed AB protection against intrusions of twice the magnitude of those seen in non-AB vehicles (p < 0.05). In frontal MVCs, AB reduced LE fracture contact injuries but did not prevent LE fractures resulting from intrusions of instrument panel, toepan, or floor pedal structures. In lateral MVCs, Bt did not protect against brain, face, thorax, or pelvic injuries.

CONCLUSIONS

Safety measures beyond frontal airbags must address frontal crash LE injuries induced by steering wheel, instrument panel, and toepan passenger compartment structure intrusions. Lateral crash injuries may profit from side AB supplemental restraint protection.

How do practice nurses see their role in childhood injury prevention?

OBJECTIVES

To assess the knowledge of unintentional injury epidemiology, the attitudes towards, and current practices in injury prevention among practice nurses.

SETTING

Practice nurses employed by general practitioners in Nottinghamshire, United Kingdom.

METHOD

A postal questionnaire was sent to all practice nurses on the Family Health Services Authority list (n = 322) with questions covering sociodemographic details, occupational details, unintentional injury epidemiology, attitudes towards the injury prevention activities suggested by a government report as part of the role of the primary health care team, and current practices in injury prevention.

RESULTS

A response rate of 71.1% was achieved. More than 50% knew that unintentional injuries were the most common cause of death in childhood. A similar per cent knew the site of most fatal injuries in the under 1 and 5-16 year age groups. More than two thirds correctly identified a range of risk factors for unintentional injury. However, only two fifths of nurses believed they could be effective in preventing injuries. There were considerable gaps between attitudes and practice for most activities. The activities most commonly undertaken include displaying posters and leaflets (69.4%), giving advice on prevention (51.1%), and advice on first aid (45.0%) during injury consultations.

CONCLUSIONS

Most practice nurses hold positive attitudes towards injury prevention activities, but fewer undertake these activities regularly. The activities most commonly undertaken employ an educational model. Further research is needed on the barriers to practice nurses undertaking more injury prevention work, the effectiveness of systems to overcome such barriers, and the effectiveness of these injury prevention activities.

Health visitors' knowledge, attitudes and practices in childhood accident prevention

BACKGROUND

The importance of the health visitor's role in childhood accident prevention has long been recognized, although previous work suggests that many health visitors are unsure of that role, feel inadequately prepared for it and recognize significant constraints on their accident prevention activity. The Health of the nation suggested that specific accident prevention activities should be undertaken by health visitors. This study aims to assess whether those activities are currently part of routine health visiting practice, as well as the attitudes towards accident prevention and knowledge of childhood accidental injury epidemiology.

METHOD

A postal questionnaire survey covering knowledge, attitudes and practices in accident prevention as well as personal characteristics was sent to all health visitors in Nottinghamshire, using the community unit trusts' list of employees as the sampling frame.

RESULTS

A response rate of 88.5 per cent was obtained. The majority of health visitors were aware that accidental injuries are the most common cause of death in childhood above the age of one year. The majority of health visitors were also aware of the types of accident most likely to be fatal, and aware of the risk factors for childhood accidental injuries. Many health visitors held positive attitudes towards all accident prevention activities covered in the questionnaire. There was a positive correlation between attitude and knowledge scores (p < 0.01). There were some discrepancies between attitudes and current practices, particularly in the areas of teaching first aid to parents' groups and lobbying or campaigning on local safety issues.

CONCLUSIONS

Although many health visitors hold positive attitudes towards, and currently undertake many of the accident prevention activities suggested in the Health of the nation, there are areas where practice could be improved, such as giving advice about stockists of safety equipment including local loan schemes, undertaking first aid sessions in parents' groups and lobbying or campaigning on local safety issues.

Restricted expression of a zinc finger protein in male germ cells

Zfp-37 is a zinc finger protein gene expressed in male germ cells. The cDNA detected two transcripts on Northern blots of testis RNA, with expression first detected at around day 19. To establish the pattern of expression of the protein we have raised antibodies to ZFP-37 and used them on thin sections of testis and on Western blots. On Western blots the antibody detected two proteins exclusively in testis extracts, confirming the previous mRNA expression data. A time-course study revealed that the larger of the two proteins appears at about day 22 but the smaller one is not detected until day 34. Analysis of the expression of these two proteins in purified germ cell preparations revealed that the smaller protein is only detectable in the elongating spermatids or residual bodies. Data from thin sections showed that most, but not all, of the protein recognized by the antibody is in the nucleus, a result further confirmed by Western blotting. These results are discussed in the light of the possible role of this protein in regulating spermatogenesis.

The mouse t-complex gene, Tcp-11, is under translational control

The mouse t-complex is known to harbour genes which affect male fertility. Tcp-11 is a t-complex gene which is only expressed in male germ cells and from its position is a candidate for a distorter, one of the two types of genetic element involved in transmission ratio distortion. Antibodies raised to TCP-11 protein made in E. Coli were used on thin sections of testis and shown to recognise late spermatids. On Western blots the antibodies bound to a 68-kD protein present in protein extracts from testis. No specific signal could be detected using the antibody on protein extracts from other mouse tissues. Following gentle lysis of the germ cells and fractionation on sucrose gradients, all the material recognised by the anti-Tcp-11 antibody was found to be soluble and unassociated with any membrane fraction or organelle. A comparison of the time course of expression of the Tcp-11 mRNA and the TCP-11 protein revealed that expression of this gene is under translational control.

Follicle-stimulating hormone receptor mRNA in the mouse ovary during post-natal development in the normal mouse and in the adult hypogonadal (hpg) mouse: structure of alternate transcripts

The structure of RNA encoding the mouse ovarian follicle-stimulating hormone (FSH) receptor was studied during post-natal development and in the adult hypogonadal (hpg) mouse which lacks circulating gonadotrophins. Using reverse transcription and the polymerase chain reaction (PCR) four major transcripts of the FSH receptor were found in the normal adult ovary. The largest transcript was the expected size from the position of the PCR primers (on exons 1 and 10) and sequencing confirmed that it was derived from FSH receptor mRNA. The three other transcripts were also derived from FSH receptor mRNA but they contained deletions corresponding to one or more complete exons. Each transcript lacked exon 2 while exons 5 and/or 6 were lacking in the smaller species. All four transcripts were present in ovaries of hpg mice showing that expression of receptor mRNA and development of alternate splicing are not gonadotrophin-dependent. During development in the mouse full-length FSH receptor transcripts were not detected in the ovary until day 5 although shorter transcripts were present at days 1 and 3. Results confirm that the FSH receptor primary transcript undergoes alternate splicing in the ovary and that the pattern of splicing changes as the ovary develops, probably as a result of follicular development.

Atopy as a risk factor for cryptogenic fibrosing alveolitis

In a case-control study of occupational and environmental causes of cryptogenic fibrosing alveolitis we recently observed a higher prevalence of self-reported symptoms of wheeze, rhinitis or conjunctivitis in cases than in controls. To determine objectively whether this was due to a higher prevalence of atopy amongst cases of CFA, we have measured skin sensitivity to common allergens (D. Pteronyssinus, grass pollen, and cat fur), eosinophil counts and total Immunoglobulin E (IgE) in venous blood in the 22 surviving CFA cases from that study who were willing to provide a blood sample, and in one matched control per case. At least one positive skin test was recorded in 13 cases and six controls, the matched odds of one or more positive test being significantly increased in cases by a ratio of 8.0 (95% confidence interval 1.01-64, P = 0.05). Geometric mean eosinophil counts and IgE levels were also increased amongst cases by factors of 1.6 (95% CI 0.96-2.6) and 1.9 (0.9-3.8) respectively, although these differences were not significant. Differences in skin sensitivity, eosinophil counts, and IgE levels all tended to be more obvious in the 13 case control pairs in which the case was not taking steroids or other immunosuppressive treatment. We conclude that cases of CFA showed increased skin sensitivity to common allergens, and had evidence of increased IgE and eosinophilia in peripheral blood. These findings suggest that atopy may be an important determinant of susceptibility to CFA.

Arg-188 and Trp-144 are implicated in the binding of urea and acetamide to the active site of the amidase from Pseudomonas aeruginosa

Urea is a time-dependent active-site-directed inhibitor of Pseudomonas aeruginosa amidase. We found that 20 mM hydroxylamine caused bound urea to be released from the inactive urea:amidase complex with the restoration of enzyme activity. Bound urea restricts the titrability of the enzyme's -SH groups to 6 per hexameric molecule and protects it against thermal denaturation suggesting that urea binding provokes a conformational change in the enzyme. Mutations in the P. aeruginosa amidase gene that reduce the binding affinity of the enzyme for both urea and the substrate acetamide have been identified by direct sequencing of PCR-amplified mutant genes and confirmed by sequencing cloned PCR-amplified genes. The mutations were in two regions of the enzyme substituting either Arg-188 (or Gln-190, in one case) or Trp-144; one amidase that bound neither urea nor acetamide was doubly mutant with an amino-acid change at both sites.

A clinicopathologic correlative study of noncontact transscleral Nd:YAG cyclophotocoagulation

We studied the histopathologic changes of three eyes enucleated two weeks, eight weeks, and 17 months, respectively, after noncontact Nd:YAG cyclophotocoagulation. The histologic findings at two weeks were destruction of the nonpigmented and pigmented ciliary body epithelium, occlusion of the capillaries of the ciliary processes, and ciliary body stromal necrosis in the region of the processes. Hyperplasia of the pigmented and nonpigmented epithelium, fibrosis and near total atrophy of the ciliary processes, and partial atrophy of the ciliary muscles were present at eight weeks and 17 months. We concluded that application of treatment 1.0 to 1.5 mm posterior to the corneoscleral limbus selectively destroys the pars plicata, and that, histologically, the mechanism for reducing intraocular pressure appears to be destruction of ciliary processes with reduction of aqueous formation.