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Tian J, Cheng P, Wang X, Xiang H, Gao Q, Zhu H. Exploring home fall events among infants and toddlers using social media information: an infodemiology study in China. Inj Prev 2024:ip-2023-045014. [PMID: 38768979 DOI: 10.1136/ip-2023-045014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Practical interventions of fall prevention are challenging for infants and toddlers. This study aimed to explore specific details of falls that occurred at home for kids 0-3 years old using key information from social media platforms, which provided abundant data sources for fall events. METHODS We used internet-based search techniques to collect fall events information from 2013 to 2023. The search was restricted and implemented between 1 and 12 April 2023. Online platforms included Baidu, Weibo, WeChat, TikTok, Toutiao and Little Red Book. A qualitative descriptive approach was used to analyse the fall events and major factors, including the fall event time, child age, environmental factors and behavioural characteristics of children and caregivers. RESULTS We identified 1005 fall injury cases among infants and toddlers. Fall mechanisms included falls from household furniture (71.2%), falls from height (21.4%) and falls on the same level (7.4%). Environmental risk factors mainly consisted of not using or installing bed rails incorrectly, a gap between beds, unstable furniture, slippery ground and windows without guardrails. Behavioural factors included caregivers leaving a child alone, lapsed attention, turning around to retrieve something, misusing baby products, inadequately holding the child and falling asleep with children. Child behavioural factors included walking or running while holding an object in hand or mouth and underdeveloped walking skills. CONCLUSION Interventions for preventing falls should be designed specifically for Chinese families, especially considering family function in the context of Chinese culture. Social media reports could provide rich information for researchers.
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Affiliation(s)
- Jiang Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Peixia Cheng
- Department of Maternal and Child Health, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Henry Xiang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Huiping Zhu
- Department of Maternal and Child Health, School of Public Health, Capital Medical University, Beijing, China
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Johnson MD, Berman S, Azen R, Otieno W, Campbell-Kyureghyan N. Robotization of Industrial Processes: Motivational Differences between Companies with and without Existing Robotic Processes. IISE Trans Occup Ergon Hum Factors 2024; 12:41-54. [PMID: 37938034 DOI: 10.1080/24725838.2023.2278794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
OCCUPATIONAL APPLICATIONSOur survey of 100 manufacturing facilities revealed statistically significant differences among company types in their perceptions of cost savings, productivity gains, and safety improvements as benefits of robotic implementation. Regardless of company type or size, indications of presence of cumulative, incidental, and static postural hazards were identified as primary perceived factors for injury potential. More than half of the surveyed companies reported being unaware of general safety standards utilized within their facilities, and most (70%) robotic companies were unaware of any robotic-specific standards utilized at their company. Our results indicate the importance of accounting for varying perspectives between company types regarding motivation for and safety impacts of robotics. With the advancement of technology and robotization of the manufacturing industry, there are also pressing needs for advancing robotic safety standards, implementing training programs, and continuous promotion of the general safety awareness.
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Affiliation(s)
- Meredith Dentice Johnson
- College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Sigal Berman
- Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Razia Azen
- College of Community Engagement and Professions, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Wilkistar Otieno
- College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Naeem R, Ali A, Buksh AR, Quddusi A, Khan UR. Tip-over injuries among children: Data from an urban emergency department of Karachi, Pakistan. Injury 2023; 54 Suppl 4:110526. [PMID: 36481052 DOI: 10.1016/j.injury.2022.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department. METHODS We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information about the injury scene. File review and telephonic interviews were conducted in the year 2015 and 2016. RESULTS A total of 75 children visited the emergency department with tip-over injuries, out of which 55 (73%) were boys. The majority of incidents (75.5%) happened inside the home, and the most common places were the living room and bedroom (32% and 21% respectively). More than half (53%) of the children were not under adult supervision at the time of the incident and less than half (47%) of the household took safety measures after the incident. Tip-over injuries were common among 3-year-old children with decreasing frequency as children grew older. The most common causes of tip-overs were TV/TV trolley (32%), followed by furniture (28%), and wall and roof (23%). The most common sites of injuries were head (n = 33, 44%) and extremities (n = 33, 44%). A majority of the cases (n = 66, 88%) were admitted to the hospital from the emergency department, under care of both general (n = 51, 68%) and critical care units (n = 15, 20%). More than a quarter (n = 27, 36%) required at least one surgical procedure during their hospital stay. The median length of hospital stay was one days (interquartile range, IQR 1-5 days). There were two cases of mortality (3%). CONCLUSION Most tip-over injuries among children were caused by TV, furniture, and TV trolleys. These injuries can be prevented with public education around home safety measures, such as mounting them on the wall.
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Affiliation(s)
- Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem Buksh
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Injuries of Primary School Children during Sports Activities. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
The purpose of the research was to analyse the injuries of primary school children in the framework of organised sports activities at school and in clubs or associations, and in leisure time without professional guidance.
Methods
We surveyed 631 participants, of which there were 282 boys and 349 girls from eight Slovenian primary schools. Frequencies were calculated and a Chi-square test was performed.
Results
In physical education (PE) at school, 32% of the participants were injured in one school year, and there were no statistically significant differences in the number of injuries according to sex (p=0.18) and age (p=0.12). Most injuries were recorded in the lower extremities (50%), in the form of wounds. The participants were injured less often in PE at school than in a club or association, and more often than in their leisure time. The participants were absent from PE classes for longer after an injury in a club or association than in PE, while no significant differences in absences after injury were found. At school, the participants were most often injured in ball games, boys in football (43%) and girls in volleyball (19%). In activities in a club or association, we recorded the most injuries in boys in martial arts (18%) and dance for girls (19%). In their leisure time, boys suffered the most injuries from football (26%) and cycling, while girls suffered the most from running and rollerblading.
Conclusion
In the last ten years, the number of injuries in PE has increased in Slovenia. Based on the obtained results, we propose measures to reduce injuries and thus encourage more sports activities among children and adolescents, while ensuring their safety.
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Jones M, Hill T, Coupland C, Kendrick D, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Martin A, Orton E. Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5. Inj Prev 2023; 29:158-165. [PMID: 36600567 DOI: 10.1136/ip-2022-044698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness. MATERIALS AND METHODS Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1. RESULTS Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH. CONCLUSION SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.
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Affiliation(s)
- Matthew Jones
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Trevor Hill
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Carol Coupland
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Denise Kendrick
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ashley Akbari
- Faculty of Medicine, Health, & Life Science, University of Wales Swansea, Swansea, UK
| | - Sarah Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Ashley Martin
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Availability of death review of children using death certificates and forensic autopsy results. Leg Med (Tokyo) 2023; 60:102156. [PMID: 36270202 DOI: 10.1016/j.legalmed.2022.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/28/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
The Model Project for Child Death Review (CDR) was initiated in Japan, but parental consent is required for detailed investigations. We proposed an alternative method to review child deaths using death certificates and forensic autopsy results when parental consent is not provided. We extracted and reviewed death certificates for the deceased younger than 18 years from among all certificates submitted in Shiga Prefecture between 2015 and 2017. In addition, we analyzed autopsy records in cases that underwent forensic autopsy. The prevalence of each cause of death was compared among age groups. The situation and circumstances of unnatural deaths were analyzed in detail. Of 131 certificates, unnatural deaths accounted for 29.7 %. The prevalence of each cause of death significantly differed among age groups. Malignant disease and suicide were most common in school-aged children and congenital disease was most common in infants. Suicide was the leading cause of unnatural death, followed by suffocation, which was most common in infants. Situations where suffocation was reported included co-sleeping with the mother and breastfeeding. Despite parental consent not being obtained, the trends of regional child deaths and the circumstances of accidental deaths were clarified by the present method. However, the results of detailed investigation were lacking. This study provided basic information for implementing detailed methods and procedures for CDR at the governmental level. To perform optimal CDR, legislation for collecting detailed information without parental consent is required.
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Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, Hayes M, Jones M, Coupland C, Kendrick D. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-233. [PMID: 36720631 DOI: 10.1136/ip-2022-044745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the effectiveness of systematically delivered evidence-based home safety promotion for improving child home safety practices. DESIGN Controlled before-and-after study. SETTING Nine electoral wards in Nottingham, UK. PARTICIPANTS 361 families with children aged 2-7 months at recruitment living in four intervention wards with high health, education and social need; and 401 in five matched control wards. INTERVENTION Evidence-based home safety promotion delivered by health visiting teams, family mentors and children's centres including 24 monthly safety messages; home safety activity sessions; quarterly 'safety weeks'; home safety checklists. OUTCOMES Primary: composite measure comprising having a working smoke alarm, storing poisons out of reach and having a stairgate. Secondary: other home safety practices; medically attended injuries. Parents completed questionnaires at 12 and 24 months after recruitment plus optional three monthly injury questionnaires. RESULTS At 24 months there was no significant difference between groups in the primary outcome (55.8% vs 48.8%; OR 1.58, 95% CI 0.98 to 2.55) or medically attended injury rates (incidence rate ratio 0.89, 95% CI 0.51 to 1.56), but intervention families were more likely to store poisons safely (OR 1.81, 95% CI 1.06 to 3.07), have a fire escape plan (OR 1.81, 95% CI 1.06 to 3.08), use a fireguard or have no fire (OR 3.17, 95% CI 1.63 to 6.16) and perform more safety practices (β 0.46, 95% CI 0.13 to 0.79). CONCLUSIONS Systematic evidence-based home safety promotion in areas with substantial need increases adoption of some safety practices. Funders should consider commissioning evidence-based multicomponent child home safety interventions. TRIAL REGISTRATION NUMBER ISRCTN31210493.
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Affiliation(s)
- Michael James Taylor
- Healthcare Public Health Team, NHS England and NHS Improvement Midlands, Nottingham, UK .,Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elizabeth Orton
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tina Patel
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Timblin
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Clarke
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Matthew Jones
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Markiewitz ND, Garcia-Munoz J, Lilley BM, Oduwole S, Shah AS, Williams BA. Epidemiologic Changes in Pediatric Fractures Presenting to Emergency Departments During the COVID-19 Pandemic. J Pediatr Orthop 2022; 42:e815-e820. [PMID: 35818171 PMCID: PMC9351512 DOI: 10.1097/bpo.0000000000002194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fractures are a common pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life that could impact the incidence of pediatric fractures. The purpose of this study was to compare the incidence of pediatric fractures in the United States during the COVID-19 pandemic to previous seasonally adjusted fracture incidence rates using the National Electronic Injury Surveillance System (NEISS) database and the American Community Survey (ACS). METHODS The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0 to 17 y) patients. ACS population data allowed for the estimation of fracture incidence per 1000 person-years. Using a quasiexperimental interrupted time series design, Poisson regression models were constructed to test the overall and differential impact of COVID-19 on monthly fracture rate by age, sex, fracture site, injury location, and disposition. RESULTS Our sample consisted of 121,803 cases (mean age 9.6±4.6 y, 36.1% female) representing 2,959,421±372,337 fractures nationally. We identified a stable 27% decrease in fractures per month after February 2020 [risk difference (RD) per 1000 youth years=-2.3; 95% confidence interval: -2.98, -1.57]). We found significant effect modification by age, fracture site and injury location ( P <0.05). The fracture incidence among children 5 years or older significantly decreased, as well as the incidence of fractures at school [RD=-0.96 (-1.09, -0.84)] and during sports [risk difference=-1.55 (-1.77, -1.32)]. There was also a trend toward a reduction in upper extremity fractures and fractures requiring admission. CONCLUSION A nationally representative injury database demonstrated a 27% decline in monthly pediatric fractures during the COVID-19 pandemic that persisted into the latter half of 2020. These trends appeared most attributable to a reduction in fractures discharged home and upper extremity fractures among older children sustained at school and in sports. Our findings provide unique insight into the epidemiology of pediatric fractures and demonstrate a baseline need for musculoskeletal care among young children even in the setting of a national shutdown. LEVEL OF EVIDENCE Level II-retrospective prognostic study.
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Affiliation(s)
| | | | | | | | - Apurva S. Shah
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brendan A. Williams
- Department of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Shalev L, Luder A, Spitzer S, Krupik D, Essa-Hadad J, Rudolf MCJ. Keeping our children safe: piloting a hospital-based home-visitation program in Israel. Isr J Health Policy Res 2022; 11:21. [PMID: 35410306 PMCID: PMC8995883 DOI: 10.1186/s13584-022-00525-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety. Methods The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of each visit. Results 352 of 773 eligible families agreed to be contacted. 135 participated, 98 completed both home visits. Significant improvement in home-safety items was observed 4 months after the first visit (14 [IQR12-16]) vs. (17 [IQR15-19]; p < 0.001), accompanied by an overall increase in home safety (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; p < 0.001). 64% reported greater awareness of dangers, 60% affirmed home was safer, and 70% valued the equipment. No difference was found in the prevalence of injuries (14 of 98 families prior and 8 after the visit; p = 0.17). Home visitors reported benefiting from the experience of working with disadvantaged families. Conclusion The program, which included recruitment in a hospital emergency setting and use of healthcare students as home visitors, was successfully implemented and accompanied by significant improvement in home safety with a non-significant trend of child injury decrease.
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Sears CG, Lanphear BP, Xu Y, Chen A, Yolton K, Braun JM. Identifying periods of heightened susceptibility to lead exposure in relation to behavioral problems. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:1-9. [PMID: 34728761 PMCID: PMC8776587 DOI: 10.1038/s41370-021-00389-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Lead exposure is associated with behavioral problems in children, but the age(s) of greatest susceptibility to low-level lead exposure is unknown. OBJECTIVE We evaluated the association of repeated blood lead concentrations with parent-reported behaviors to identify periods of heightened susceptibility during infancy and childhood (HOME Study; Cincinnati, OH; 2003-2006; n = 244). METHODS We quantified lead in whole blood samples (ages 1, 2, 3, 4, 5, and 8 years) and assessed behavior using the Behavioral Assessment System for Children-2 (BASC-2; ages 2, 3, 4, 5, and 8 years). We used multiple informant models and modified Poisson regression to estimate covariate-adjusted associations of ln-transformed blood lead concentrations with continuous BASC-2 T-scores and the relative risk of behavior scores classified as at-risk or clinically significant, respectively. RESULTS We observed trends indicating that higher blood lead concentrations at all ages were adversely associated with scores on behavioral scales. On the Externalizing Problems and Adaptive Skills scales, these associations were strongest for blood lead concentrations at age 8 years (β = 3.1-point; 95% CI = 0.7, 5.4 and β = -2.2-point; 95% CI = -4.9, 0.5, respectively) compared with other ages. Overall, higher blood lead concentrations were associated with elevated risk of behavior scores classified as at-risk or clinically significant on the Adaptive Skills, Behavioral Symptom Index, and Externalizing Problems scales. SIGNIFICANCE Contemporary levels of lead exposure during the first 8 years of life were associated with ADHD-related behaviors, specifically aggression, hyperactivity, and conduct problems. IMPACT STATEMENT Our results highlight the importance of primary lead prevention across childhood.
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Affiliation(s)
- Clara G Sears
- Department of Epidemiology, Brown University, Providence, RI, USA.
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA.
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Hill T, Coupland C, Kendrick D, Jones M, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Orton E. Impact of the national home safety equipment scheme 'Safe At Home' on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022; 76:53-59. [PMID: 34158405 PMCID: PMC8666806 DOI: 10.1136/jech-2021-216613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a 'natural experiment' for evaluating the scheme's impact on hospital admissions for unintentional injuries. METHODS Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision. RESULTS 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11%-0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended. CONCLUSIONS A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.
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Affiliation(s)
- Trevor Hill
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sarah Rodgers
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Braun JM, Yolton K, Newman N, Jacobs DE, Taylor M, Lanphear BP. Residential dust lead levels and the risk of childhood lead poisoning in United States children. Pediatr Res 2021; 90:896-902. [PMID: 32722664 DOI: 10.1038/s41390-020-1091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The United States Environmental Protection Agency (EPA) recently lowered residential floor and windowsill dust lead hazard standards, but maintained previous post-abatement clearance standards. We examined whether the discrepancy in these regulations places children at higher risk of lead poisoning. METHODS In 250 children from Cincinnati, Ohio (2004-2008) living in homes built before 1978, we measured residential floor and windowsill dust lead loadings and blood lead concentrations at ages 1 and 2 years. Using linear regression with generalized estimating equations, we estimated covariate-adjusted associations of dust lead levels with blood lead concentrations and risk of lead poisoning. RESULTS An increase in floor dust lead from 10 (revised dust lead hazard standard) to 40 μg/ft2 (post-abatement clearance standard) was associated with 26% higher (95% confidence interval (CI):15, 38) blood lead concentrations and 2.1 times the risk of blood lead concentrations ≥5 μg/dL (95% CI: 1.44, 3.06). Extrapolating our findings to US children age 1-5 years, we estimated that 6.9% (95% CI: 1.5, 17.2) of cases of blood lead concentrations ≥5 μg/dL are attributable to floor dust lead loadings between 10 and ≤40 μg/ft2. CONCLUSIONS The EPA's residential dust lead regulations place children at increased risk of lead poisoning. We recommend adopting more protective dust lead standards. IMPACT We determined whether children are at increased risk of lead poisoning with the 2019 EPA residential post-abatement lead clearance standards being higher than dust lead hazard standards. In this observational study, 2019 EPA dust lead clearance standards were associated with increased risk of lead poisoning compared to the revised dust lead hazard standard. Both EPA standards were associated with increased risk of lead poisoning compared to more stringent standards employed in our study. Extrapolating our findings to US children, the 2019 EPA dust lead clearance standards could place up to 36,700 children at risk of lead poisoning.
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Affiliation(s)
- Joseph M Braun
- Department of Epidemiology, Brown University, Providence, 02912, RI, USA.
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, 45229, OH, USA
| | - Nicholas Newman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, 45229, OH, USA.,Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, 45226, OH, USA
| | - David E Jacobs
- National Center for Healthy Housing and University of Illinois at Chicago, Chicago, 60612, IL, USA
| | - Mark Taylor
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, Sydney, NSW, 2109, Australia
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BCV5A 1S6, Canada
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Loo BKG, Lim MCM, Gao JSM, Zainuddin MA. Impact of Singapore’s COVID-19 control measures on home-based physical activity in children. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.202138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Parsons AA, Ollberding NJ, Copeland KA, Phelan KJ. Factors Associated With Residential Relocation and Effects on Early Childhood Development in a Low-Income Home Visitation Population. J Prim Prev 2021; 42:125-141. [PMID: 33651259 DOI: 10.1007/s10935-021-00625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
Residential relocation (RR) is associated with behavior problems and cognitive delays in school-age children. Little is known regarding effects of RR on early childhood development. The data from this study were collected from 2011 to 2016 through the Cincinnati Home Injury Prevention and Literacy Promotion Trial. The purpose of the current study was to identify factors associated with RR and determine effects of RR on early childhood development in a cohort of mother/child dyads (n = 424). High RR was relocating ≥ 3 times over the 24-month study period. Differences in baseline characteristics and early childhood development, measured by the Ages and Stages Questionnaire (ASQ) and MacArthur Bates Communicative Development Inventory, according to relocations, were estimated by negative binomial regression and logistic regression, respectively. Participants moved on average 1.46 times over 24 months. Relocations decreased by 0.05 for each year of increasing maternal age. Mothers with college degrees moved 0.72 fewer times than those with a high school diploma or less. Mothers living alone moved 0.47 fewer times than their counterparts. Mothers who could not count on someone to loan them $1000 and those with food insecurity more (0.41) than their counterparts (0.50). Odds of scoring in the bottom-tertile for the communication domain of the ASQ was significantly higher in those relocating ≥ 3 times. High RR was associated with concern for delayed language development at 24-month follow-up in some, but not all models. Early intervention may be more successful if primary care physicians and community health professionals collaborate to link families at risk of high RR to relevant community based resources.
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Affiliation(s)
- Allison A Parsons
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, CCHMC, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Kieran J Phelan
- Division of Pediatric Emergency Medicine, CCHMC, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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15
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Varying Effect of a Randomized Toddler Home Safety Promotion Intervention Trial by Initial Home Safety Problems. Matern Child Health J 2020; 24:432-438. [PMID: 31832912 DOI: 10.1007/s10995-019-02845-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Toddlers are vulnerable to unintentional injuries. A safety intervention targeting low-income families of toddlers, was effective at improving home safety. The current study examined whether the effect varies by initial home safety problems. METHODS 277 mother-toddler dyads recruited in the Mid-Atlantic region of the United States during 2007-2010 were randomized into safety promotion (n = 91) or attention-control groups (n = 186). Observers rated participants' homes with a 9-item safety problem checklist at baseline, and at 6- and 12-months follow-up. Initial home safety problems were categorized as multiple (≥ 4 problems) and none/few (< 4). Linear mixed models assessed the moderating effect with a three-way interaction (time, intervention, and initial safety problems). RESULTS At 12 months, the intervention effect was stronger among families with multiple initial problems than no/few initial problems, with a reduction of 1.55 more problems among the families with multiple problems, compared to the families with no/few problems (b = - 1.55, SE = 0.62, p = 0.013). CONCLUSIONS Interventions targeting families with multiple safety problems may be more effective than universal programming.
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16
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Mirahmadizadeh A, Hemmati A, Zahmatkesh S, Saffari M, Bagheri P. Incidence of accidents and injuries in children under 6 years old in southern Iran: a population-based study. J Inj Violence Res 2020. [PMCID: PMC7487133 DOI: 10.5249/jivr.vo112i2.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Background: Accidents and injuries are the leading cause of childhood morbidity and mortality. This study aimed to investigate the incidences of different causes of accidents in children under 6 years old. Methods: This population-based cross-sectional study was carried out in one year (2016-2017) on a sample of 6000 children in Southern Iran with a multistage sampling method using a standard checklist for comprehensive child health monitoring. Results: The annual incidence rate of accidents was 16% and the mean age of accident victims was 2.5±1.5 years. Of these, 17.3% and 14.8% were male and female, respectively. 25% of the children suffered from more than one accident. The most common causes of accidents were burns (16%), falls (14%), and accidents involving objects (10%). In multivariate analysis, a higher number of male children in the family and lower child age significantly increased the likelihood of accidents (p less than 0.05). Conclusions: This study was a direct survey of the population, and showed that the incidence rate of accidents in children in southern Iran was in line with that of other regions of Iran, but less than the world average. There was no significant difference in accident etiology and only trends in etiology were found compared to studies using existing data.
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Affiliation(s)
- Alireza Mirahmadizadeh
- a Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abdolrasool Hemmati
- b Vice-Chancellor of Health Affairs, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soraya Zahmatkesh
- c Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masoomeh Saffari
- c Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pezhman Bagheri
- d Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
,
Corresponding Author at:
Pezhman Bagheri: Department of Epidemiology, School of Public Health, Shiraz University of Medical Sciences. Tel: +987137251001, Postal code: 71348- 14336; (Bagheri P.). https://orcid.org/0000-0003-0920-5734
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17
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Abstract
BACKGROUND Safe medication storage is a proven barrier to ingestions in the pediatric population, but caregivers are often unaware of the importance of safe storage practices or do not have a safe place to store medications. Caregivers may also not be fully aware that the patterns of opioid use and misuse have recently reached crisis levels. The objectives of this study were to define medication storage practices and knowledge of the opioid crisis of participants and to assess the effectiveness of an emergency department intervention on safe medication storage. METHODS This was a prospective interventional study of caregivers in an urban pediatric emergency department (ED) on safe medication storage and the opioid crisis. Questions assessed the caregivers' current perceptions and practices related to medication storage and disposal, and opioid crisis awareness. The intervention included verbal instruction about recommended safe storage methods and the opioid crisis, provision of a medication safety handout, and distribution of a medication lock box. A follow-up phone survey conducted 2 weeks later asked participants about use of and satisfaction with the lock box. Frequencies of safe storage behaviors were calculated, and the chi-square statistic was used to compare storage behavior after the intervention. RESULTS Fifty caregivers of 112 children were enrolled. Only 4% reported they currently stored medications in a locked or latched place. Thirty-eight percent reported their main barrier to storing medications safely was that they did not have a locked or latched storage location. Fifty percent were unaware of the opioid crisis. Ninety-two percent reported they would use a lock box if given one. Twenty-eight participants (56%) responded to the follow-up phone call survey 2 weeks later. At follow up 90% (25/28) reported they placed their medications within the provided lock box (p < 0.00001). Ninety-two percent reported being "very satisfied" with the lock box and how it works. CONCLUSIONS Despite widespread reporting on this issue, many caregivers remain unaware of safe medication storage practices and the opioid crisis. Providing medication lock boxes removes a commonly reported barrier to safely storing medications and improved reported practices.
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Affiliation(s)
- Alicia C. Webb
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham, Birmingham, AL 35233 USA
| | - Michele H. Nichols
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham, Birmingham, AL 35233 USA
| | - Nipam Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham, Birmingham, AL 35233 USA
- Children’s of Alabama Hospital, Birmingham, USA
| | - Kathy W. Monroe
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama-Birmingham, Birmingham, AL 35233 USA
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18
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Furman L, Strotmeyer S, Vitale C, Gaines BA. Evaluation of a mobile safety center's impact on pediatric home safety knowledge and device use. Inj Epidemiol 2020; 7:27. [PMID: 32532361 PMCID: PMC7291631 DOI: 10.1186/s40621-020-00254-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background A Mobile Safety Center (MSC) is designed to remove financial accessibility barriers to home safety by providing education and safety devices within local communities. The objective of this study was to evaluate the impact of an MSC on pediatric home safety knowledge and device use. Methods We conducted a prospective home safety interventional study. Parents and grandparents with children at home were recruited at community events attended by the MSC. Participants completed a pre-test survey assessing demographics and current home safety knowledge, practices, and device use. Participants then attended the MSC’s short home safety educational program. Afterwards, participants completed a knowledge reassessment post-test and were offered free safety devices: a smoke detector, a gun lock, and a childproofing kit comprising outlet covers, doorknob covers, and cabinet latches. We administered two follow-up surveys four weeks and six months after visiting the MSC. Descriptive statistics, Friedman tests, Wilcoxon Sum-Rank tests, and Pearson Chi-Square were used to assess respondent demographic characteristics and changes in home safety knowledge, practices, and device use. Results We recruited 50 participants, of whom 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants who completed both follow-ups increased total correct answers to safety knowledge questions between the pre-test and post-test (p = 0.005), pre-test and follow-up 1 (p = 0.003), and pre-test and follow-up 2 (p = 0.012) with no significant changes between the post-test, follow-up 1, and follow-up 2. Of the respondents who reported accepting safety products, outlet covers were used most frequently, followed by the smoke detector, doorknob covers, cabinet latches, and the gun lock. Conclusions The MSC may be an effective means of increasing home safety among families with children, as participation in the MSC’s home safety educational program significantly increased home safety knowledge and spurred home safety device use. Implementation of MSCs could potentially reduce childhood injury rates within communities through promotion of home safety.
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Affiliation(s)
- Leah Furman
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christine Vitale
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara A Gaines
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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19
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Braun JM, Buckley JP, Cecil KM, Chen A, Kalkwarf HJ, Lanphear BP, Xu Y, Woeste A, Yolton K. Adolescent follow-up in the Health Outcomes and Measures of the Environment (HOME) Study: cohort profile. BMJ Open 2020; 10:e034838. [PMID: 32385062 PMCID: PMC7228515 DOI: 10.1136/bmjopen-2019-034838] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/11/2020] [Accepted: 04/20/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Environmental chemical exposures may adversely affect an array of adolescent health outcomes. Thus, we used the Health Outcomes and Measures of the Environment (HOME) study, a prospective cohort that recruited pregnant women and conducted longitudinal follow-up on children over the first 12 years of life, to determine if and when chemical exposures affect adolescent health. PARTICIPANTS We recruited 468 pregnant women (age range: 18-45 years) from the Cincinnati, Ohio region to participate in a cohort study between March 2003 and January 2006. Follow-up included two clinic and one home visits during pregnancy, a delivery hospital visit, and four home and six clinic visits when children were aged 4 weeks and 1, 2, 3, 4, 5 and 8 years. Of 441 children available for follow-up, 396 (90%) completed at least one follow-up and 256 (58%) completed the most recent follow-up at 12 years of age (range: 11-14). FINDINGS TO DATE Our new measures include maternal/child report of internalising symptoms, neuroimaging, dual-energy X-ray absorptiometry-derived estimates of lean/adipose tissue and bone mineral density, and cardiometabolic risk biomarkers. We assessed adolescent exposure to perfluoroalkyl substances, phenols, phthalates and flame retardants. Participants completing follow-up at 12 years of age were similar to the original cohort in terms of baseline factors. Most children had typical and expected values for this age on measures of internalising symptoms, body composition, bone density and cardiometabolic risk markers. Notably, 36% and 11% of children had scores indicative of potential anxiety and depressive disorders, respectively. Approximately 35% of children were overweight or obese, with higher prevalence among girls. Thirty-three per cent of children had borderline or high triglyceride concentrations (>90 mg/dL). FUTURE PLANS We will examine associations of early life environmental chemical exposures with adolescent health measures while considering potential periods of heightened susceptibility and mixture effects. TRIAL REGISTRATION NUMBER NCT00129324.
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Affiliation(s)
- Joseph M Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anastasia Woeste
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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20
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Mohammed Z, Aledhaim A, AbdelSalam EM, El-Setouhy M, El-Shinawi M, Hirshon JM. Factors associated with injuries among preschool children in Egypt: demographic and health survey results, 2014. BMC Public Health 2020; 20:595. [PMID: 32357864 PMCID: PMC7193349 DOI: 10.1186/s12889-020-08658-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Childhood injuries are a significant and growing global public health problem, often with high morbidity and, at times, mortality. A large proportion of injuries in preschool children occur in or around the home. We aimed to identify socioeconomic and demographic factors associated with preschool children injuries in Egypt. Methods Secondary data analysis were done for the Egyptian Demographic and Health Surveys (EDHS), 2014. Potential associated factors were measured from data on child welfare and questions on the prevalence of accidents and injuries of preschool children. These data were linked to the children demographic data, maternal age at marriage, working status of the mother, and questions on childcare arrangements. Results Out of the 634 injured children, 520 (83.4%) children required medical care for their injuries. The most common reported injury was an open wound 288 (45.5%), followed by fractures 237 (35.7%), burns 124 (19.7%), electrical shock 12 (1.9%) and other unknown types of injury 15 (2.4%). There was a positive correlation between injury and child’s age, household wealth, mother’s age at marriage, and unsupervised children or children left in the care of a minor. Conclusion Leaving children unsupervised or in the presence of other young children is significantly associated with the occurrence of child injuries.
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Affiliation(s)
- Zeinab Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt. .,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Ali Aledhaim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.,Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed El-Shinawi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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21
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Sears CG, Lanphear BP, Calafat AM, Chen A, Skarha J, Xu Y, Yolton K, Braun JM. Lowering Urinary Phthalate Metabolite Concentrations among Children by Reducing Contaminated Dust in Housing Units: A Randomized Controlled Trial and Observational Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:4327-4335. [PMID: 32101426 PMCID: PMC7494216 DOI: 10.1021/acs.est.9b04898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Dust in homes can contain phthalates that may adversely affect child development, but whether residential interventions and dust removal can prevent children's exposure to phthalates is unknown. We quantified the influence of a residential lead hazard intervention and dust control on children's urinary phthalate metabolite concentrations. Between 2003 and 2006, The Health Outcomes and Measures of the Environment (HOME) Study randomized 355 pregnant women to receive an intervention to reduce either residential lead or injury hazards before delivery. We quantified eight urinary phthalate metabolites from 288 children at ages 1, 2, or 3 years (680 observations). During yearly home visits, we assessed dust accumulation in housing units. Children in the lead intervention group had 11-12% lower concentrations of the sum of di(2-ethylhexyl) phthalate metabolites, monocarboxyoctyl phthalate, and monocarboxynonyl phthalate compared to the injury intervention group. Monoethyl phthalate concentrations did not differ by group. In observational analyses, children living in housing units that appeared clean had 12-17% lower concentrations of these phthalate metabolites and monobenzyl phthalate, compared to children living in housing units with more dust accumulation. Features of this lead hazard intervention and measures to control dust may reduce children's exposure to phthalates found in building materials and household furnishings.
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Affiliation(s)
- Clara G. Sears
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Aimin Chen
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julianne Skarha
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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22
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Bhatta S, Mytton JA, Deave T. Assessment of home hazards for non-fatal childhood injuries in rural Nepal: a community survey. Inj Prev 2020; 27:104-110. [PMID: 32060131 DOI: 10.1136/injuryprev-2019-043482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unintentional injuries in and around the home are important causes of preventable death and disability among young children globally. In Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries. This study aimed to determine the burden of unintentional home injuries in children <5 years in rural Nepal and quantify the injury hazards in their homes. METHODS A survey was conducted in 740 households in rural areas of the Makwanpur district during February and March 2015. The primary carer reported home injuries which occurred in the previous 3 months and data collector observation identified the injury hazards. Injury incidence, mechanism and the proportion of households with different hazards were described. Multivariable logistic regression explored associations between the number and type of home hazards and injuries. RESULTS Injuries severe enough to need treatment, or resulting in non-participation in usual activities for at least a day, were reported in 242/1042 (23.2%) children <5 years. The mean number of injury hazards per household was 14.98 (SD=4.48), range of 3-31. Regression analysis found an estimated increase of 31% in the odds of injury occurrence associated with each additional injury hazard found in the home (adjusted OR 1.31; 95% CI 1.20 to 1.42). CONCLUSIONS A high proportion of young children in rural Nepal sustained injuries severe enough to miss a day of usual activities. Increased frequency of hazards was associated with an increased injury risk.
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Affiliation(s)
- Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie A Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, University of the West of England, Bristol, UK
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Dorney K, Dodington JM, Rees CA, Farrell CA, Hanson HR, Lyons TW, Lee LK. Preventing injuries must be a priority to prevent disease in the twenty-first century. Pediatr Res 2020; 87:282-292. [PMID: 31466080 DOI: 10.1038/s41390-019-0549-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/03/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023]
Abstract
Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.
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Affiliation(s)
- Kate Dorney
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - James M Dodington
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chris A Rees
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Caitlin A Farrell
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Holly R Hanson
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
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Rostami-Moez M, Kangavari M, Teimori G, Afshari M, Ebrahimi Khah M. Cultural adaptation for country diversity: A systematic review of injury prevention interventions caused by domestic accidents in children under five years old. Med J Islam Repub Iran 2019; 33:124. [PMID: 32280630 PMCID: PMC7137865 DOI: 10.34171/mjiri.33.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Children under five years old are the most vulnerable in home-injuries. More than half of the accident happens at home. Intervention programs are effective ways to reduce the risk of injuries. The use of cultural strategies has been recommended for effective interventions. The aim of this study was to evaluate cultural adaptability in interventional studies which were performed to prevent injuries caused by domestic accidents in children under five years old in all countries.
Methods: This systematic review has been conducted from June to July 2016. Iran Medex, Magiran, SID from Persian databases and Scopus, Web of Science, Science direct, Pub Med, Biomed central from English databases were employed. Available cultural adaptation guidelines were used to compare the cultural adaptation strategies. A search of studies had been conducted from the creation of databases until July 2016.
Results: Overall, 15 studies were entered into the analyses. The interventional approach in 11 studies was an educational approach. Consequently, 8 studies from 11 reported that they had significantly achieved all expected outcomes. Three studies had used behavioral change models or theories to achieve the desired changes. Seven studies had considered socio-cultural strategy in their interventions, and six studies had reported achieving outcomes. Only seven studies acquired a minimum score of cultural adaptation.
Conclusion: In this systematic review, an educational intervention was effective in preventing child injuries. If cultural strategies are taken into consideration in interventions, they will have a change in behavior in this regard. Also, theoretical frameworks and models can be effective.
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Affiliation(s)
- Masomeh Rostami-Moez
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Kangavari
- Department of Occupational Health and Safety, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamheidar Teimori
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Maryam Afshari
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marya Ebrahimi Khah
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Braun JM, Hornung R, Chen A, Dietrich KN, Jacobs DE, Jones R, Khoury JC, Liddy-Hicks S, Morgan S, Vanderbeek SB, Xu Y, Yolton K, Lanphear BP. Effect of Residential Lead-Hazard Interventions on Childhood Blood Lead Concentrations and Neurobehavioral Outcomes: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:934-942. [PMID: 30178064 PMCID: PMC6233767 DOI: 10.1001/jamapediatrics.2018.2382] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Childhood lead exposure is associated with neurobehavioral deficits. The effect of a residential lead hazard intervention on blood lead concentrations and neurobehavioral development remains unknown. OBJECTIVE To determine whether a comprehensive residential lead-exposure reduction intervention completed during pregnancy could decrease residential dust lead loadings, prevent elevated blood lead concentrations, and improve childhood neurobehavioral outcomes. DESIGN, SETTING, AND PARTICIPANTS This longitudinal, community-based randomized clinical trial of pregnant women and their children, the Health Outcomes and Measures of the Environment (HOME) Study, was conducted between March 1, 2003, and January 31, 2006. Pregnant women attending 1 of 9 prenatal care clinics affiliated with 3 hospitals in the Cincinnati, Ohio, metropolitan area were recruited. Of the 1263 eligible women, 468 (37.0%) agreed to participate and 355 women (75.8%) were randomized in this intention-to-treat analysis. Participants were randomly assigned to receive 1 of 2 interventions designed to reduce residential lead or injury hazards. Follow-up on children took place at 1, 2, 3, 4, 5, and 8 years of age. Data analysis was performed from September 2, 2017, to May 6, 2018. MAIN OUTCOMES AND MEASURES Residential dust lead loadings were measured at baseline and when children were 1 and 2 years of age. At 1, 2, 3, 4, 5, and 8 years of age, the children's blood lead concentrations as well as behavior, cognition, and executive functions were assessed. RESULTS Of the 355 women randomized, 174 (49.0%) were assigned to the intervention group (mean [SD] age at delivery, 30.1 (5.5) years; 119 [68.3%] self-identified as non-Hispanic white) and 181 (50.9%) to the control group (mean [SD] age at delivery, 29.2 [5.7] years; 123 [67.9%] self-identified as non-Hispanic white). The intervention reduced the dust lead loadings for the floor (24%; 95% CI, -43% to 1%), windowsill (40%; 95% CI, -60% to -11%), and window trough (47%; 95% CI, -68% to -10%) surfaces. The intervention did not statistically significantly reduce childhood blood lead concentrations (-6%; 95% CI, -17% to 6%; P = .29). Neurobehavioral test scores were not statistically different between children in the intervention group than those in the control group except for a reduction in anxiety scores in the intervention group (β = -1.6; 95% CI, -3.2 to -0.1; P = .04). CONCLUSIONS AND RELEVANCE Residential lead exposures, as well as blood lead concentrations in non-Hispanic black children, were reduced through a comprehensive lead-hazard intervention without elevating the lead body burden. However, this decrease did not result in substantive neurobehavioral improvements in children. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00129324.
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Affiliation(s)
- Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Richard Hornung
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kim N. Dietrich
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David E. Jacobs
- National Center for Healthy Housing, Chicago, Illinois,Department of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago
| | - Robert Jones
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacey Liddy-Hicks
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Samantha Morgan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Braun JM, Kalloo G, Chen A, Dietrich KN, Liddy-Hicks S, Morgan S, Xu Y, Yolton K, Lanphear BP. Cohort Profile: The Health Outcomes and Measures of the Environment (HOME) study. Int J Epidemiol 2018; 46:24. [PMID: 27006352 DOI: 10.1093/ije/dyw006] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Geetika Kalloo
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Kim N Dietrich
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Stacey Liddy-Hicks
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha Morgan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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27
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Barcelos RS, Del-Ponte B, Santos IS. Interventions to reduce accidents in childhood: a systematic review. J Pediatr (Rio J) 2018; 94:351-367. [PMID: 29291398 DOI: 10.1016/j.jped.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To review the literature on interventions planned to prevent the incidence of injuries in childhood. SOURCE OF DATA The PubMed, Web of Science, and Bireme databases were searched by two independent reviewers, employing the single terms accidents, accident, injuries, injury, clinical trial, intervention, educational intervention, and multiple interventions, and their combinations, present in the article title or abstract, with no limits except period of publication (2006-2016) and studies in human subjects. SYNTHESIS OF DATA Initially, 11,097 titles were located. Fifteen articles were selected for the review. Eleven were randomized trials (four carried out at the children's households, five in pediatric healthcare services, and two at schools), and four were non-randomized trials carried out at the children's households. Four of the randomized trials were analyzed by intention-to-treat and a protective effect of the intervention was observed: decrease in the number of risk factors, decrease in the number of medical consultations due to injuries, decrease in the prevalence of risk behaviors, and increase of the parents' knowledge regarding injury prevention in childhood. CONCLUSION Traumatic injuries in childhood are amenable to primary prevention through strategies that consider the child's age and level of development, as well as structural aspects of the environment.
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Affiliation(s)
- Raquel S Barcelos
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil.
| | - Bianca Del-Ponte
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPel), Departamento de Medicina Social, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
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Interventions to reduce accidents in childhood: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Telfar-Barnard L, Bennett J, Howden-Chapman P, Jacobs DE, Ormandy D, Cutler-Welsh M, Preval N, Baker MG, Keall M. Measuring the Effect of Housing Quality Interventions: The Case of the New Zealand "Rental Warrant of Fitness". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111352. [PMID: 29112147 PMCID: PMC5707991 DOI: 10.3390/ijerph14111352] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/16/2022]
Abstract
In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.
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Affiliation(s)
- Lucy Telfar-Barnard
- Department of Public Health, University of Otago, Wellington 6021, New Zealand.
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington 6021, New Zealand.
| | | | - David E Jacobs
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
- National Center for Healthy Housing, Columbia, MD 21044, USA.
| | - David Ormandy
- Warwick Medical School-Health Sciences, University of Warwick, Coventry CV5 6EG, UK.
| | | | - Nicholas Preval
- Department of Public Health, University of Otago, Wellington 6021, New Zealand.
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington 6021, New Zealand.
| | - Michael Keall
- Department of Public Health, University of Otago, Wellington 6021, New Zealand.
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30
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 2017; 24:41-47. [PMID: 28385953 DOI: 10.1136/injuryprev-2016-042178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Toddler-aged children are vulnerable to unintentional injuries, especially those in low-income families. OBJECTIVE To examine the effectiveness of an intervention grounded in social cognitive theory (SCT) on the reduction of home safety problems among low-income families with toddlers. METHODS 277 low-income mother-toddler dyads were randomised into a safety promotion intervention (n=91) or an attention-control group (n=186). Mothers in the safety promotion intervention group received an eight-session, group-delivered safety intervention targeting fire prevention, fall prevention, poison control and car seat use, through health education, goal-setting and social support. Data collectors observed participants' homes and completed a nine-item checklist of home safety problems at study enrolment (baseline), 6 and 12 months after baseline. A total score was summed, with high scores indicating more problems. Linear mixed models compared the changes over time in home safety problems between intervention and control groups. RESULTS The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up (between-group difference in change over time β=-0.54, 95% CI -0.05 to -1.03, p=0.035), with no significant differences at the 6-month follow-up. CONCLUSIONS A safety promotion intervention built on principles of SCT has the potential to promote toddlers' home safety environment. Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinically important improvement in home safety practices. TRIAL REGISTRATION NUMBER NCT02615158; post-results.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea C Gielen
- The Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,RTI International, Research Triangle Park, North Carolina, USA
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Evaluation of Early Childhood Home Visiting to Prevent Medically Attended Unintentional Injury. Ann Emerg Med 2017; 70:302-310.e1. [PMID: 28238500 DOI: 10.1016/j.annemergmed.2017.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/16/2016] [Accepted: 01/19/2017] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE We evaluated the influence of home visiting on the risk for medically attended unintentional injury during home visiting (0 to 3 years) and subsequent to home visiting (3 to 5 years). METHODS A retrospective, quasi-experimental study was conducted in a cohort of mother-child pairs in Hamilton County, OH. The birth cohort (2006 to 2012) was linked to administrative home visiting records and data from a population-based injury surveillance system containing records of emergency department (ED) visits and hospitalizations. Cox proportional-hazard regression was used to compare medically attended unintentional injury risk (0 to 2, 0 to 3, and 3 to 5 years) in a home-visited group versus a propensity score-matched comparison group. The study population was composed of 2,729 mother-child pairs who received home visiting and 2,729 matched mother-child pairs in a comparison group. RESULTS From birth to 2 years, 17.2% of the study population had at least one medically attended unintentional injury. The risk for medically attended unintentional injury from aged 0 to 2 and 0 to 3 years was significantly higher in the home-visited group relative to the comparison group (hazard ratio 1.17, 95% confidence interval 1.01 to 1.35; hazard ratio 1.15, 95% confidence interval 1.00 to 1.31, respectively). Additional injuries in the home-visited group were superficial, and the increased risk for medically attended unintentional injury was observed for ED visits and not hospitalizations. CONCLUSION Home-visited children were more likely to have a medically attended unintentional injury from birth to aged 3 years. This finding may be partially attributed to home visitor surveillance of injuries or greater health care-seeking behavior. Implications and alternative explanations are discussed.
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An effective way to utilize daycare organizations to distribute home safety equipment. J Trauma Acute Care Surg 2016; 81:S3-7. [PMID: 27488482 DOI: 10.1097/ta.0000000000001180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Safety equipment installed in the home can reduce pediatric injuries. The purpose of this study was to compare the proper use of home safety equipment installed by an injury prevention specialist to equipment installed by a family after distribution at a daycare. METHODS A prospective study involving two daycare organizations from a high-risk community was performed. Both groups consisted of families with children 4 to 24 months old who received a packet containing: cabinet and drawer latches, carbon monoxide (CO) detector, magnetic phone list, and five other items. After consent was obtained, both groups completed a prescreen survey to determine current equipment use. The self-installation group (SI) from one daycare received home safety equipment and education for self-installation of the equipment. The professional installation group (PI) from a comparable daycare received the same equipment and education; however, equipment was installed for them. Assessments of equipment usage and maintenance were performed at follow-up home visits 6 to 9 months after equipment disbursement. Frequencies and χ analysis were used for comparisons. RESULTS Seventy-nine SI families and 81 PI families were enrolled. There was no difference in home equipment use between the groups prior to interventions with CO detectors (11.4% vs. 12.3%), cabinet locks (2.5% vs. 11.1%), drawer locks (0% vs. 2.5%), or posted emergency numbers (24.1% vs. 19.8%). Follow-up home visits occurred in 71 SI families (87.7%) and 75 PI families (92.6%). In both groups, there was a significantly increased use of CO detectors (73.2% vs. 89.3%, p = 0.02), cabinet locks (38.0% vs. 78.7%, p < 0.001), and drawer locks (22.5% vs. 62.7%, p < 0.001); posted emergency number increased in both groups, but the difference was not significant (78.9% vs. 89.3%, p = 0.11). CONCLUSION When provided with home safety equipment, it is used much of the time; however, equipment installed by a professional resulted in higher use than if self-installed. For some equipment, distribution of products in daycare settings may be just as effective as if professionally installed.
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Ehrhardt J, Xu Y, Khoury J, Yolton K, Lanphear B, Phelan K. Cognitive and motor abilities of young children and risk of injuries in the home. Inj Prev 2016; 23:16-21. [PMID: 27435102 DOI: 10.1136/injuryprev-2016-042031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Residential injury is a leading cause of morbidity and mortality in US children. Rates and types of injury vary by child age but little is known about injury risk based on child cognitive and motor abilities. The objective of this study was to determine whether cognitive or motor development in young children is associated with residential injury. METHODS We employed data from Health Outcomes and Measures of the Environment (HOME) Study. Parent report of medically attended injury was obtained at regular intervals from 0 to 42 months. Child development was assessed at 12, 24 and 36 months using Bayley Scales of Infant and Toddler Development, 2nd edition, which generates both mental developmental index (MDI) and a psychomotor developmental index (PDI). Injury risk was modelled using multivariable logistic regression as function of child's MDI or PDI. Effects of MDI and PDI on injury risk were examined separately and jointly, adjusting for important covariates. RESULTS Children with cognitive delay (MDI <77) were at significantly higher risk of injury than children without cognitive delay (OR=3.7, 95% CI 1.4 to 10.5, p=0.012). There was no significant association of PDI with injury. There was, however, significant interaction of MDI and PDI (p=0.02); children with cognitive delay but normal motor development were at significantly higher risk of injury than children with normal cognitive and motor development (OR=9.6, 95% CI 2.6 to 35.8, p=0.001). CONCLUSIONS Children with cognitive delays, especially those with normal motor development, are at elevated risk for residential injuries. Injury prevention efforts should target children with developmental delays. CLINICAL TRIALS NUMBER NCT00129324; post-results.
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Affiliation(s)
- Jennifer Ehrhardt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kimberly Yolton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bruce Lanphear
- Child and Family Research Institute, BC Children's and Women's Hospital and Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Kieran Phelan
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Falcone RA, Edmunds P, Lee E, Gardner D, Price K, Gittelman M, Pomerantz W, Besl J, Madhavan G, Phelan KJ. Volunteer driven home safety intervention results in significant reduction in pediatric injuries: A model for community based injury reduction. J Pediatr Surg 2016; 51:1162-9. [PMID: 26792663 DOI: 10.1016/j.jpedsurg.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Home based injuries account for a significant number of injuries to children between 1 and 5years old. Evidence-based safety interventions delivered in the home with installation of safety equipment have been demonstrated to reduce injury rates. The aim of this study was to evaluate the impact of a community based volunteer implemented home safety intervention. METHODS In partnership with a community with high injury rates for children between 1 and 5years old, a home safety bundle was developed and implemented by volunteers. The safety bundle included installing evidence based safety equipment. Monthly community emergency room attended injury rates as well as emergency room attended injuries occurring in intervention and nonintervention homes was tracked throughout the study. RESULTS Between May 2012 and May 2014 a total of 207 homes with children 1-5years old received the home safety bundle. The baseline monthly emergency room attended injury rate for children aged 1-5years within our target community was 11.3/1000 and that within our county was 8.7/1000. Following the intervention current rates are now 10.3/1000 and 9.2/1000 respectively. Within intervention homes the injury rate decreased to 4.2/1000 while the rate in the homes not receiving the intervention experienced an increase in injury rate to 12/1000 (p<0.05). When observed vs. expected injuries were examined the intervention group demonstrated 59% fewer injuries while the nonintervention group demonstrated a 6% increase (p<0.05). CONCLUSION Children in homes that received a volunteer-provided, free home safety bundle experienced 59% fewer injuries than would have been expected. By partnering with community leaders and organizing volunteers, proven home safety interventions were successfully provided to 207 homes during a two-year period, and a decline in community injury rates for children younger than 5years was observed compared to county wide injury rates.
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Affiliation(s)
- Richard A Falcone
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Patrick Edmunds
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Emily Lee
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Dawne Gardner
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kimberly Price
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Michael Gittelman
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Wendy Pomerantz
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - John Besl
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Gowri Madhavan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kieran J Phelan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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Bennett J, Howden-Chapman P, Chisholm E, Keall M, Baker MG. Towards an agreed quality standard for rental housing: field testing of a New Zealand housing WOF tool. Aust N Z J Public Health 2016; 40:405-411. [DOI: 10.1111/1753-6405.12519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/01/2015] [Accepted: 12/01/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Julie Bennett
- Housing and Health Group/He Kainga Oranga; Department of Public Health, Wellington School of Medicine; University of Otago; New Zealand
| | - Philippa Howden-Chapman
- Housing and Health Group/He Kainga Oranga; Department of Public Health, Wellington School of Medicine; University of Otago; New Zealand
| | - Elinor Chisholm
- Housing and Health Group/He Kainga Oranga; Department of Public Health, Wellington School of Medicine; University of Otago; New Zealand
| | - Michael Keall
- Housing and Health Group/He Kainga Oranga; Department of Public Health, Wellington School of Medicine; University of Otago; New Zealand
| | - Michael G. Baker
- Housing and Health Group/He Kainga Oranga; Department of Public Health, Wellington School of Medicine; University of Otago; New Zealand
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Younesian S, Mahfoozpour S, Ghaffari Shad E, Kariman H, Hatamabadi HR. Unintentional Home Injury Prevention in Preschool Children; a Study of Contributing Factors. EMERGENCY (TEHRAN, IRAN) 2016; 4:72-7. [PMID: 27274516 PMCID: PMC4893754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Different factors such as parents' knowledge and attitudes regarding preventive measures (PM) have a great role in reducing children unintentional home injuries. The present study aims to evaluate the contributing factors of unintentional home injury prevention in preschool victims presented to the emergency department. METHODS The subjects consisted of all the mothers of preschool children who were presented to the emergency department of Imam Hossein and Shohadaie-Hafte-Tir Hospitals, with unintentional home injuries, from March 2011 to February 2012. The participants were divided into two groups according to implementation of preventive measures status. The significant confounding factors of PM application was determined by chi-squared test and entered into the backward multivariate logistic regression model. RESULTS 230 mothers with the mean age of 29.4 ± 5.2 years were evaluated. 225 (97.83%) of them were still married, 74 (32.17%) had high school education or higher, 122 (53.04%) were homemakers, and 31 (13.49%) worked outside the home for at least 8 hours daily. High level of knowledge (OR = 0.05; 95% CI: 0.002‒0.32; P = 0.002), appropriate attitude (OR = 0.12; 95% CI: 0.03‒0.51; P = 0.01), having at least three children (OR = 7.2; 95% CI: 1.1‒32.9; P = 0.04), daily absence of mother for at least 8 hours (OR = 9.2; 95% CI: 2.2‒35.46; P = 0.002), and a history of home injury during the previous 3 weeks (OR = 8.3; 95% CI: 2.1‒41.3; P = 0.001) were independent factors which influenced application of preventive measures. CONCLUSION Increasing mothers' knowledge level and improving their attitudes were facilitating factors and mothers' absence from the house for more than 8 hours a day and having at least 3 children were obstacles to application of preventive measures. In addition, a history of same injury during the previous 3 weeks increased the risk of repeated event.
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Affiliation(s)
- Somaye Younesian
- Department of Emergency Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Soad Mahfoozpour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ensieh Ghaffari Shad
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hamid Kariman
- Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Hatamabadi
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Hamid Reza Hatamabadi; Emergency Department, Imam Hossein Hospital, Shahid Madani Avenue, Tehran, Iran. Tel/Fax: +982177557069,
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Wynn PM, Zou K, Young B, Majsak-Newman G, Hawkins A, Kay B, Mhizha-Murira J, Kendrick D. Prevention of childhood poisoning in the home: overview of systematic reviews and a systematic review of primary studies. Int J Inj Contr Saf Promot 2015; 23:3-28. [DOI: 10.1080/17457300.2015.1032978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Gosia Majsak-Newman
- NHS Clinical Research and Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adrian Hawkins
- Great North Children's Hospital, New Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Bryony Kay
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | | | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Zou K, Wynn PM, Miller P, Hindmarch P, Majsak-Newman G, Young B, Hayes M, Kendrick D. Preventing childhood scalds within the home: Overview of systematic reviews and a systematic review of primary studies. Burns 2015; 41:907-24. [PMID: 25841997 PMCID: PMC4504085 DOI: 10.1016/j.burns.2014.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To synthesise and evaluate the evidence of the effectiveness of interventions to prevent scalds in children. METHODS An overview of systematic reviews (SR) and a SR of primary studies were performed evaluating interventions to prevent scalds in children. A comprehensive literature search was conducted covering various resources up to October 2012. Experimental and controlled observational studies reporting scald injuries, safety practices and safety equipment use were included. RESULTS Fourteen systematic reviews and 39 primary studies were included. There is little evidence that interventions are effective in reducing the incidence of scalds in children. More evidence was found that inventions are effective in promoting safe hot tap water temperature, especially when home safety education, home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided. No consistent evidence was found for the effectiveness of interventions on the safe handling of hot food or drinks nor improving kitchen safety practices. CONCLUSION Education, home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds. Further research is needed to evaluate the effectiveness of interventions on scald injuries and to disentangle the effects of multifaceted interventions on scald injuries and safety practices.
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Affiliation(s)
- Kun Zou
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Persephone M Wynn
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Philip Miller
- Acute Medicine, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Paul Hindmarch
- Great North Children's Hospital, Research Unit Level 2, New Victoria Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
| | - Gosia Majsak-Newman
- NHS Clinical Research & Trials Unit, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Ben Young
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1-3 Brixton Road, London SW9 6DE, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
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Achana FA, Sutton AJ, Kendrick D, Wynn P, Young B, Jones DR, Hubbard SJ, Cooper NJ. The effectiveness of different interventions to promote poison prevention behaviours in households with children: a network meta-analysis. PLoS One 2015; 10:e0121122. [PMID: 25894385 PMCID: PMC4404249 DOI: 10.1371/journal.pone.0121122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is evidence from 2 previous meta-analyses that interventions to promote poison prevention behaviours are effective in increasing a range of poison prevention practices in households with children. The published meta-analyses compared any intervention against a “usual care or no intervention” which potentially limits the usefulness of the analysis to decision makers. We aim to use network meta-analysis to simultaneously evaluate the effectiveness of different interventions to increase prevalence of safe storage of i) Medicines only, ii) Other household products only, iii) Poisons (both medicines and non-medicines), iv) Poisonous plants; and v) Possession of poison control centre (PCC) telephone number in households with children. Methods Data on the effectiveness of poison prevention interventions was extracted from primary studies identified in 2 newly-undertaken systematic reviews. Effect estimates were pooled across studies using a random effects network meta-analysis model. Results 28 of the 47 primary studies identified were included in the analysis. Compared to usual care intervention, the intervention with education and low cost/free equipment elements was most effective in promoting safe storage of medicines (odds ratio 2.51, 95% credible interval 1.01 to 6.00) while interventions with education, low cost/free equipment, home safety inspection and fitting components were most effective in promoting safe storage of other household products (2.52, 1.12 to 7.13), safe storage of poisons (11.10, 1.60 to 141.50) and possession of PCC number (38.82, 2.19 to 687.10). No one intervention package was more effective than the others in promoting safe storage of poisonous plants. Conclusion The most effective interventions varied by poison prevention practice, but education alone was not the most effective intervention for any poison prevention practice. Commissioners and providers of poison prevention interventions should tailor the interventions they commission or provide to the poison prevention practices they wish to promote. Highlights
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Affiliation(s)
- Felix A. Achana
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Alex J. Sutton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- * E-mail:
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - David R. Jones
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Stephanie J. Hubbard
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Nicola J. Cooper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
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Mack KA, Liller KD, Baldwin G, Sleet D. Preventing unintentional injuries in the home using the Health Impact Pyramid. HEALTH EDUCATION & BEHAVIOR 2015; 42:115S-122S. [PMID: 25829110 PMCID: PMC4396653 DOI: 10.1177/1090198114568306] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best.
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Affiliation(s)
- Karin A Mack
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Grant Baldwin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Sleet
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Osborne JM, Shibl R, Cameron CM, Kendrick D, Lyons RA, Spinks AB, Sipe N, McClure RJ. Validity of parent's self-reported responses to home safety questions. Int J Inj Contr Saf Promot 2015; 23:229-39. [PMID: 25715735 DOI: 10.1080/17457300.2014.992348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the study was to describe the validity of parent's self-reported responses to questions on home safety practices for children of 2-4 years. A cross-sectional validation study compared parent's self-administered responses to items in the Home Injury Prevention Survey with home observations undertaken by trained researchers. The relationship between the questionnaire and observation results was assessed using percentage agreement, sensitivity, specificity, positive predictive value, negative predictive value and intraclass correlation coefficients. Percentage agreements ranged from 44% to 100% with 40 of the total 45 items scoring higher than 70%. Sensitivities ranged from 0% to 100%, with 27 items scoring at least 70%. Specificities also ranged from 0% to 100%, with 33 items scoring at least 70%. As such, the study identified a series of self-administered home safety questions that have sensitivities, specificities and predictive values sufficiently high to allow the information to be useful in research and injury prevention practice.
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Affiliation(s)
- Jodie M Osborne
- a School of Medicine , Griffith University , Meadowbrook , Australia
| | - Rania Shibl
- b School of Accountancy, Faculty of Business , Queensland University of Technology , Brisbane , Australia
| | - Cate M Cameron
- c Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute , Griffith University , Meadowbrook , Australia
| | - Denise Kendrick
- d School of Medicine, Division of Primary Care , University of Nottingham , Nottingham , United Kingdom
| | - Ronan A Lyons
- e Farr Institute of Health Informatics Research , Swansea University , Swansea , United Kingdom
| | - Anneliese B Spinks
- a School of Medicine , Griffith University , Meadowbrook , Australia.,f Ecosystem Sciences , Commonwealth Scientific and Industrial Research Organisation (CSIRO) , Dutton Park , Australia
| | - Neil Sipe
- g School of Geography, Planning and Environmental Management , The University of Queensland , St Lucia , Australia
| | - Roderick J McClure
- h Harvard Injury Control Research Center , Harvard School of Public Health , Boston , USA
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Nguyen-Thanh V, Clément J, Thélot B, Richard JB, Lamboy B, Arwidson P. Les interventions efficaces en prévention des accidents de la vie courante chez les enfants : une synthèse de littérature. SANTE PUBLIQUE 2015. [DOI: 10.3917/spub.154.0481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Spanier AJ, Kahn RS, Kunselman AR, Schaefer EW, Hornung R, Xu Y, Calafat AM, Lanphear BP. Bisphenol a exposure and the development of wheeze and lung function in children through age 5 years. JAMA Pediatr 2014; 168:1131-7. [PMID: 25286153 PMCID: PMC4535321 DOI: 10.1001/jamapediatrics.2014.1397] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bisphenol A (BPA), a prevalent endocrine-disrupting chemical, has been associated with wheezing in children, but few studies have examined its effect on lung function or wheeze in older children. OBJECTIVES To test whether BPA exposure is associated with lung function, with wheeze, and with pattern of wheeze in children during their first 5 years. DESIGN, SETTING, AND PARTICIPANTS A birth cohort study, enrolled during early pregnancy in the greater Cincinnati, Ohio, area among 398 mother-infant dyads. We collected maternal urine samples during pregnancy (at 16 and 26 weeks) and child urine samples annually to assess gestational and child BPA exposure. MAIN OUTCOMES AND MEASURES We assessed parent-reported wheeze every 6 months for 5 years and measured child forced expiratory volume in the first second of expiration (FEV1) at age 4 and 5 years. We evaluated associations of BPA exposure with respiratory outcomes, including FEV1, child wheeze, and wheeze phenotype. RESULTS Urinary BPA concentrations and FEV1 data were available for 208 children and urinary BPA concentrations and parent-reported wheeze data were available for 360 children. The mean maternal urinary BPA concentration ranged from 0.53 to 293.55 µg/g of creatinine. In multivariable analysis, every 10-fold increase in the mean maternal urinary BPA concentration was associated with a 14.2% (95% CI, -24.5% to -3.9%) decrease in the percentage predicted FEV1 at 4 years, but no association was found at 5 years. In multivariable analysis, every 10-fold increase in the mean maternal urinary BPA concentration was marginally associated with a 54.8% increase in the odds of wheezing (adjusted odds ratio, 1.55; 95% CI, 0.91-2.63). While the mean maternal urinary BPA concentration was not associated with wheeze phenotype, a 10-fold increase in the 16-week maternal urinary BPA concentration was associated with a 4.27-fold increase in the odds of persistent wheeze (adjusted odds ratio, 4.27; 95% CI, 1.37-13.30). Child urinary BPA concentrations were not associated with FEV1 or wheeze. CONCLUSIONS AND RELEVANCE These results provide evidence suggesting that prenatal but not postnatal exposure to BPA is associated with diminished lung function and the development of persistent wheeze in children.
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Affiliation(s)
- Adam J. Spanier
- Department of Pediatrics, Penn State University Hershey Medical Center, Hershey, PA,Department of Public Health Sciences, Penn State University Hershey Medical Center, Hershey, PA
| | - Robert S. Kahn
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Allen R. Kunselman
- Department of Public Health Sciences, Penn State University Hershey Medical Center, Hershey, PA
| | - Eric W. Schaefer
- Department of Public Health Sciences, Penn State University Hershey Medical Center, Hershey, PA
| | - Richard Hornung
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta GA
| | - Bruce P. Lanphear
- Child and Family Research Institute, BC Children’s Hospital and Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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Hubbard S, Cooper N, Kendrick D, Young B, Wynn PM, He Z, Miller P, Achana F, Sutton A. Network meta-analysis to evaluate the effectiveness of interventions to prevent falls in children under age 5 years. Inj Prev 2014; 21:98-108. [PMID: 25062752 DOI: 10.1136/injuryprev-2013-041135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to simultaneously evaluate the effectiveness of a range of interventions to increase the possession of safety equipment or behaviours to prevent falls in children under 5 years of age in the home. METHODS A recently published systematic review identified studies to be included in a network meta-analysis; an extension of pairwise meta-analysis that enables comparison of all evaluated interventions simultaneously, including comparisons not directly compared in individual studies. RESULTS 29 primary studies were identified, of which 16 were included in at least 1 of 4 network meta-analyses. For increasing possession of a fitted stair gate, the most intensive intervention (including education, low cost/free home safety equipment, home safety inspection and fitting) was the most likely to be the most effective, with an OR versus usual care of 7.80 (95% CrI 3.08 to 21.3). For reducing possession or use of a baby walker: education only was most likely to be most effective, with an OR versus usual care of 0.48 (95% CrI 0.31 to 0.84). Little difference was found between interventions for possession of window locks (most intensive intervention versus usual care OR=1.56 (95% CrI 0.02 to 89.8)) and for not leaving a child alone on a high surface (education vs usual care OR=0.89 (95% CrI 0.10 to 9.67)). There was insufficient evidence for network meta-analysis for possession and use of bath mats. CONCLUSIONS These results will inform healthcare providers of the most effective components of interventions and can be used in cost-effectiveness analyses.
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Affiliation(s)
- Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Zhimin He
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Philip Miller
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
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Russell K, Morrongiello B, Phelan KJ. Commentaries on 'Home safety education and provision of safety equipment for injury prevention'. ACTA ACUST UNITED AC 2014; 8:940-3. [PMID: 23877911 DOI: 10.1002/ebch.1912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
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Phelan KJ, Morrongiello BA, Khoury JC, Xu Y, Liddy S, Lanphear B. Maternal supervision of children during their first 3 years of life: the influence of maternal depression and child gender. J Pediatr Psychol 2013; 39:349-57. [PMID: 24357732 DOI: 10.1093/jpepsy/jst090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The present study examined the effect of child gender and maternal depressive symptoms on routine supervisory practices of mothers longitudinally. METHOD Self-report supervision practices were obtained at various time points from 3 months through 3 years of age. RESULTS From 3 to 36 months, the quantity of time mothers reported supervising decreased from 7.1 to 6.3 hours, and the proportion of time spent in an intense style decreased from 63 to 46%, whereas that spent in a peripheral style increased from 14 to 32%. Mothers reported more time supervising girls and a greater proportion of this was in an intense style. Mothers with elevated depressive symptoms reported more time supervising but a lower proportion in an intense style. CONCLUSION Over the first 36 months of life, routine patterns of supervision change and these vary as a function of maternal depression symptoms and child gender. Implications for child injury risk are discussed.
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Affiliation(s)
- Kieran J Phelan
- MD, MS, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, MLC 7014, Rm. 2.347 S Building, 3333 Burnett Avenue, Cincinnati, OH 45229-3039, USA.
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Young B, Wynn PM, He Z, Kendrick D. Preventing childhood falls within the home: overview of systematic reviews and a systematic review of primary studies. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:158-171. [PMID: 24080473 DOI: 10.1016/j.aap.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 06/05/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
In most countries falls are the most common medically attended childhood injury and the majority of injuries in pre-school children occur at home. Numerous systematic reviews have reviewed evidence of the effectiveness of falls prevention interventions, but this evidence has not been synthesised into an overview, making it difficult for policy makers and practitioners to easily access the evidence. To synthesise all available evidence, we conducted an overview of reviews of home safety interventions targeting childhood falls, extracted data from primary studies included in the reviews and supplemented this with a systematic review of primary studies published subsequent to the reviews. Bibliographic databases, websites, conference proceedings, journals and bibliographies of included studies were searched for systematic reviews of studies with experimental or controlled observational designs. Thirteen reviews were identified containing 24 primary studies. Searches for additional primary studies identified five further studies not included in reviews. Evidence of the effect of interventions on falls or fall injuries was sparse, with only one of three primary studies reporting this outcome finding a reduction in falls. Interventions were effective in promoting the use of safety gates and furniture corner covers. There was some evidence of a reduction in baby walker use. The effect on the use of window safety devices, non-slip bath mats/decals and the reduction of tripping hazards was mixed. There was limited evidence that interventions were effective in improving lighting in corridors, altering furniture layout and restricting access to roofs. Most interventions to prevent childhood falls at home have not been evaluated in terms of their effect on reducing falls. Policy makers and practitioners should promote use of safety gates and furniture covers and restriction of baby walker use. Further research evaluating the effect of interventions to reduce falls and falls-related injuries is urgently required.
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Affiliation(s)
- Ben Young
- University of Nottingham, Division of Primary Care, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
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Hatamabadi HR, Mahfoozpour S, Alimohammadi H, Younesian S. Evaluation of factors influencing knowledge and attitudes of mothers with preschool children regarding their adoption of preventive measures for home injuries referred to academic emergency centres, Tehran, Iran. Int J Inj Contr Saf Promot 2013; 21:252-9. [PMID: 23886078 DOI: 10.1080/17457300.2013.816325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Excessive dependence of preschool children on their parents has led to a significant increase in the incidence of home injuries. Therefore, the present study aimed to evaluate factors influencing the knowledge and attitudes of mothers in this group regarding their adoption of preventive measures for home injuries. The subjects in this descriptive/analytical study consisted of all mothers of preschool children with home injuries, who had referred to the emergency department of Imam Hussein Hospital and Shohada-e-Haftome Tir Hospital in Tehran, Iran. After knowledge levels and attitudes of mothers were divided into two groups, multivariate logistic regression analysis and chi-squared test were used. Finally, 230 mothers, with a mean age of 29.4 ± 5.2 years, were evaluated, 75.0% of whom had good knowledge and 46.2% had positive attitudes. High school education, mothers' employment and mothers' absence from home for at least 8 hours a day were the factors predicting poor attitudes of mothers. There was a close correlation between mothers' knowledge and attitudes. The results of this study showed that mothers' high educational status, absence, occupation and the number of children in the family and history of accidents during the previous 3 weeks are important predicting factors.
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Affiliation(s)
- Hamid Reza Hatamabadi
- a Emergency Department , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Disseminating childhood home injury risk reduction information in Pakistan: results from a community-based pilot study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1113-24. [PMID: 23502323 PMCID: PMC3709307 DOI: 10.3390/ijerph10031113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 02/02/2023]
Abstract
Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries.
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