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Khudadad U, Karbakhsh M, Yau A, Rajabali F, Zheng A, Giles AR, Pike I. Home injuries in British Columbia: patterns across the deprivation spectrum. Int J Inj Contr Saf Promot 2024:1-12. [PMID: 39028119 DOI: 10.1080/17457300.2024.2378124] [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: 11/21/2023] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
The significant burden of home injuries has become a growing concern that affect thousands of people every year across Canada. This study examined the relationship between neighbourhood deprivation and unintentional injuries occurring at home leading to hospitalizations in British Columbia (BC) between 2015 and 2019. This study used de-identified hospitalization data on unintentional home-related injuries from the Discharge Abstract Database (DAD) and population data for each dissemination area from Statistics Canada's 2016 Census Profiles. Hospitalization rates were computed for unintentional home-related injuries across four dimensions specified in the Canadian Index of Multiple Deprivation (CIMD) for BC. For three CIMD dimensions (situational vulnerability, economic dependency, and residential instability), unintentional home injury rates were higher in areas with higher deprivation, while the inverse was observed for ethno-cultural diversity. Understanding socio-economic disparities within neighbourhoods enables injury prevention partners to identify vulnerable populations and prioritize the development and implementation of evidence-based injury prevention interventions.
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Affiliation(s)
| | - Mojgan Karbakhsh
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
| | - Anita Yau
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
| | - Audrey R Giles
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
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Mottla ME, Bowler ME, Asgary R. Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review. J Glob Health 2023; 13:04173. [PMID: 38154015 PMCID: PMC10754493 DOI: 10.7189/jogh.13.04173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Background There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis. Results Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings. Registration PROSPERO: CRD42022315686.
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Affiliation(s)
- Mary Elizabeth Mottla
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Mary-Ellis Bowler
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ramin Asgary
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Omaki E, Brown B, Shargo I, Moreno H, McKnight M, McDonald E, Stewart W, Shiang E, Norton RA, Shields WC. CHASE (Children's Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children's homes. Inj Epidemiol 2023; 10:47. [PMID: 37817290 PMCID: PMC10565964 DOI: 10.1186/s40621-023-00460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Decades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety. METHODS This is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children's Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation. DISCUSSION Better data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | - Brendan Brown
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Isabel Shargo
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Hector Moreno
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | | | - Eileen McDonald
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | - Wes Stewart
- Green and Healthy Homes Initiative, Baltimore, MD, USA
| | - Evelyn Shiang
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
| | | | - Wendy C Shields
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA.
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Singh G, Rao V, Thamba A, Pahwa B, Zaazoue M. Spine Injuries in Household Environments: A Comprehensive Analysis. Cureus 2023; 15:e44275. [PMID: 37645670 PMCID: PMC10462396 DOI: 10.7759/cureus.44275] [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: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.
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Affiliation(s)
- Gurbinder Singh
- Department of Orthopaedic Surgery, University of California-San Francisco School of Medicine, San Francisco, USA
| | - Varun Rao
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Aish Thamba
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bhavya Pahwa
- Medical School, University College of Medical Sciences, New Delhi, Delhi, IND
| | - Mohamed Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
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Baumgartner J, Rodriguez J, Berkhout F, Doyle Y, Ezzati M, Owusu G, Quayyum Z, Solomon B, Winters M, Adamkiewicz G, Robinson BE. Synthesizing the links between secure housing tenure and health for more equitable cities. Wellcome Open Res 2023; 7:18. [PMID: 37654603 PMCID: PMC10466000 DOI: 10.12688/wellcomeopenres.17244.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 09/02/2023] Open
Abstract
Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.
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Affiliation(s)
- Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Judith Rodriguez
- Graduate School of Design, Harvard University, Cambridge, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Frans Berkhout
- Department of Geography, Faculty of Social Science & Public Policy, King’s College London, London, UK
| | | | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
- Centre for Urban Management Studies, University of Ghana, Accra, Ghana
| | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bethlehem Solomon
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Brian E. Robinson
- Department of Geography, Faculty of Social Science & Public Policy, King’s College London, London, UK
- Department of Geography, McGill University, Montreal, Canada
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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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Baumgartner J, Rodriguez J, Berkhout F, Doyle Y, Ezzati M, Owuso G, Quayyum Z, Solomon B, Winters M, Adamkiewicz G, Robinson BE. Synthesizing the links between secure housing tenure and health for more equitable cities. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17244.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.
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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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Abstract
We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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Daniels H, Hollinghurst J, Fry R, Clegg A, Hillcoat-Nallétamby S, Nikolova S, Rodgers SE, Williams N, Akbari A. The Value of Routinely Collected Data in Evaluating Home Assessment and Modification Interventions to Prevent Falls in Older People: Systematic Literature Review. JMIR Aging 2021; 4:e24728. [PMID: 33890864 PMCID: PMC8105762 DOI: 10.2196/24728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Falls in older people commonly occur at home. Home assessment and modification (HAM) interventions can be effective in reducing falls; however, there are some concerns over the validity of evaluation findings. Routinely collected data could improve the quality of HAM evaluations and strengthen their evidence base. OBJECTIVE The aim of this study is to conduct a systematic review of the evidence of the use of routinely collected data in the evaluations of HAM interventions. METHODS We searched the following databases from inception until January 31, 2020: PubMed, Ovid, CINAHL, OpenGrey, CENTRAL, LILACS, and Web of Knowledge. Eligible studies were those evaluating HAMs designed to reduce falls involving participants aged 60 years or more. We included study protocols and full reports. Bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. RESULTS A total of 7 eligible studies were identified in 8 papers. Government organizations provided the majority of data across studies, with health care providers and third-sector organizations also providing data. Studies used a range of demographic, clinical and health, and administrative data. The purpose of using routinely collected data spanned recruiting and creating a sample, stratification, generating independent variables or covariates, and measuring key study-related outcomes. Nonhome-based modification interventions (eg, in nursing homes) using routinely collected data were not included in this study. We included two protocols, which meant that the results of those studies were not available. MeSH headings were excluded from the PubMed search because of a reduction in specificity. This means that some studies that met the inclusion criteria may not have been identified. CONCLUSIONS Routine data can be used successfully in many aspects of HAM evaluations and can reduce biases and improve other important design considerations. However, the use of these data in these studies is currently not widespread. There are a number of governance barriers to be overcome to allow these types of linkage and to ensure that the use of routinely collected data in evaluations of HAM interventions is exploited to its full potential.
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Affiliation(s)
- Helen Daniels
- Population Data Science, Swansea University, Swansea, United Kingdom
| | - Joe Hollinghurst
- Population Data Science, Swansea University, Swansea, United Kingdom
| | - Richard Fry
- Population Data Science, Swansea University, Swansea, United Kingdom
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, United Kingdom
| | | | - Silviya Nikolova
- Leeds Institute of Health Sciences, Swansea University, Leeds, United Kingdom
| | - Sarah E Rodgers
- Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | | | - Ashley Akbari
- Population Data Science, Swansea University, Swansea, United Kingdom
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11
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Lo Bianco M, Layton N, Renda G, McDonald R. "I think I could have designed it better, but I didn't think that it was my place": a critical review of home modification practices from the perspectives of health and of design. Disabil Rehabil Assist Technol 2020; 15:781-788. [PMID: 32275166 DOI: 10.1080/17483107.2020.1749896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The research presented demonstrates the disharmony between end user goals and their consideration in service outcomes within ageing-in-place and asks "what can design offer health" within this domain.Methods: Data was collected using semi-structured interviews with various stakeholders within the context of ageing in place. All data are thematically analysed through a theoretical lens of control theory.Results: The results demonstrate a contrast between purported patient-centred care models, and a human-centred design model. This contrast in cultures causes a disconnect between the health practitioners and the end users, with a lack of clarity about the end user's intended engagement within the modification of their environment. Consequently, the goals of older adults are inadequately represented as typical home modification design processes often fail to support the reflection of goals in practice, in turn, restricting client engagement and control. Reviewing occupational therapy practices through the critical lens of control has highlighted opportunities for service improvements.Conclusion: The consideration of co-design methodologies within home modification design is a way to reinforce client engagement and provide better pathways for older adults to remain in control and raise acceptability of modification through a better-informed decision-making process.Implications for RehabilitationThe following points detail the implications of this research upon the rehabilitation practice and theory: Compliance with recommendations is deeply connected to a person's intrinsic sense of control within the clinical decision-making process.Co-design practices between practitioners and clients provide and novel pathway to achieve truly person-centred care and create better service experiences and clinical outcomes.The human-centred design methodology is highly applicable within clinical practice and provides an opportunity for clinicians to see and learn about their patients through a holistic lens centred around goals and motivations rather than physical impairments.The scoping of health literacy should be inclusive of all service artefacts and touchpoints that a client may encounter throughout the entire duration of experience, this includes design artefacts such as architectural drawings and other home modification designs.
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Affiliation(s)
- Michael Lo Bianco
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Natasha Layton
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Gianni Renda
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Tiefenbachová P, Zeleníková R. The effect of educational intervention by nurses on home environmental risk factors for falls. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Carnemolla P, Bridge C. Housing Design and Community Care: How Home Modifications Reduce Care Needs of Older People and People with Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111951. [PMID: 31159396 PMCID: PMC6604004 DOI: 10.3390/ijerph16111951] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/16/2022]
Abstract
The extent to which housing design can minimise levels of community caregiving has remained largely unmeasured. This paper reports the potential for home modifications to reduce caregiving in the peoples' homes, particularly older people and people with a disability. It contributes to new knowledge in understanding how housing can play a role in community caregiving and acknowledges the role of the built environment in managing care levels in ageing societies. This paper analyses self-reported care data from 157 Australian community care recipients (average age: 72 years) who had received home modifications within the past 6 months. A before/after comparison of care provided revealed that home modifications reduced hours of care provided by 42% per week. More detailed analysis revealed that the positive association of home modifications with care reduction is stronger with informal care (46% reduction) followed by formal care (16% reduction). These results suggest the role that home modifications, and housing design in general, play in reducing care needs in a community setting.
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Affiliation(s)
- Phillippa Carnemolla
- School of Built Environment, Faculty of Design, Architecture and Building, University of Technology Sydney, Harris St, Ultimo, NSW 2007, Australia.
| | - Catherine Bridge
- Faculty of Built Environment, University of New South Wales, Kensington, NSW 2052, Australia.
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Gustavsson J, Jernbro C, Nilson F. There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring. Int J Qual Stud Health Well-being 2018; 13:1479586. [PMID: 29869973 PMCID: PMC5990953 DOI: 10.1080/17482631.2018.1479586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. METHOD We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). RESULTS The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. CONCLUSIONS The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
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Affiliation(s)
- Johanna Gustavsson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Hollinghurst J, Akbari A, Fry R, Watkins A, Berridge D, Clegg A, Hillcoat-Nalletamby S, Williams N, Lyons R, Mizen A, Walters A, Johnson R, Rodgers S. Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage. BMJ Open 2018; 8:e026290. [PMID: 30381314 PMCID: PMC6224723 DOI: 10.1136/bmjopen-2018-026290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and fall prevention. METHODS AND ANALYSIS All individuals living in Wales, UK, aged 60 years and over, will be included in the study using anonymised linked data from the Secure Anonymised Information Linkage Databank. We will use a national database of home modifications implemented by the charity organisation Care & Repair Cymru (C&R) from 2009 to 2017 to define an intervention cohort. We will use the electronic Frailty Index to assign individual levels of frailty (fit, mild, moderate or severe) and use these to create a comparator group (non-C&R) of people who have not received a C&R intervention. Coprimary outcomes will be quarterly numbers of emergency hospital admissions attributed to falls at home, and the associated length of stay. Secondary outcomes include the time in moving to a care home following a fall, and the indicative financial costs of care for individuals who had a fall. We will use appropriate multilevel generalised linear models to analyse the number of hospital admissions related to falls. We will use Cox proportional hazard models to compare the length of stay for fall-related hospital admissions and the time in moving to a care home between the C&R and non-C&R cohorts. We will assess the impact per frailty group, correct for population migration and adjust for confounding variables. Indicative costs will be calculated using financial codes for individual-level hospital stays. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and prevention. ETHICS AND DISSEMINATION Information governance requirements for the use of record-linked data have been approved and only anonymised data will be used in our analysis. Our results will be submitted for publication in peer-reviewed journals. We will also work with lay members and the knowledge transfer team at Swansea University to create communication and dissemination materials on key findings.
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Affiliation(s)
- Joe Hollinghurst
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Ashley Akbari
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- Administrative Data Research Centre Wales, Swansea University Medical School, Swansea, UK
| | - Richard Fry
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Alan Watkins
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Damon Berridge
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Andy Clegg
- University of Leeds (Bradford Teaching Hospital), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | - Ronan Lyons
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Amy Mizen
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Angharad Walters
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Rhodri Johnson
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
| | - Sarah Rodgers
- Health Data Research UK (HDR-UK), Swansea University, Swansea, UK
- Public Health and Policy, University of Liverpool, Liverpool, UK
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Lessons Learned from Implementing a Programme of Home Modifications to Prevent Falls amongst the General Population. SAFETY 2018. [DOI: 10.3390/safety4020026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Howden-Chapman P, Roebbel N, Chisholm E. Setting Housing Standards to Improve Global Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1542. [PMID: 29232827 PMCID: PMC5750960 DOI: 10.3390/ijerph14121542] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
Abstract
Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure.
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Affiliation(s)
- Philippa Howden-Chapman
- He Kainga Oranga, Housing and Health Programme, University of Otago, Wellington 6242, New Zealand.
| | - Nathalie Roebbel
- WHO, Department of Public Health, Environmental and Social Determinants of Health, 1202 Geneva, Switzerland.
| | - Elinor Chisholm
- He Kainga Oranga, Housing and Health Programme, University of Otago, Wellington 6242, New Zealand.
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Lewis MG, Guddattu V, Kamath A, Biju S, Noronha J, Nayak B, Nair NS. Pooling of effect estimates obtained from various study designs in systematic reviews of public health interventions: A Bayesian approach to meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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What Does the Cochrane Collaboration Say About Interventions for Falls Prevention? Physiother Can 2017; 69:186. [PMID: 28539699 DOI: 10.3138/ptc.69.2.cochrane] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Boland L, Légaré F, Perez MMB, Menear M, Garvelink MM, McIsaac DI, Painchaud Guérard G, Emond J, Brière N, Stacey D. Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews. BMC Geriatr 2017; 17:20. [PMID: 28088166 PMCID: PMC5237488 DOI: 10.1186/s12877-016-0395-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes. Methods We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively. Results The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11). Conclusions The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0395-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Boland
- Population Health, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 7 K4, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada.
| | - Maria Margarita Becerra Perez
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Matthew Menear
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Mirjam Marjolein Garvelink
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology, Faculty of Medicine University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm B311, Ottawa, ON, K1Y 4E9, Canada
| | - Geneviève Painchaud Guérard
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Julie Emond
- Centre de santé et de services sociaux de la Vieille-Capitale, 880, rue Père-Marquette, Québec, G1M 2R9, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 880, rue Père-Marquette, Québec, G1M 2R9, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada
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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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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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Al-Rousan TM, Rubenstein LM, Wallace RB. Disability levels and correlates among older mobile home dwellers, an NHATS analysis. Disabil Health J 2015; 8:363-71. [PMID: 25766655 DOI: 10.1016/j.dhjo.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although remarkably understudied, manufactured or mobile homes are the housing choice for nearly 20 million Americans and little is known about the health of older persons living in mobile homes. OBJECTIVE We sought to investigate disability levels and other health correlates among older adults living in mobile or manufactured homes compared to their counterparts living in other types of homes. METHODS We sampled non-institutional adults aged 65 years or older (n = 7609), of whom 344 lived in mobile homes, from the 2011 National Health and Aging Trends Study (NHATS). RESULTS Respondents living in mobile homes (average age = 75.1 years; SD = 0.5) had lower education and income and medical insurance than older adults living in other types of community residence (average age = 77.5 years; SD = 0.2). They were more likely to smoke, have lung and heart disease, and report fair or poor general health status. Mobile home dwellers reported more difficulty or inability in performing the following activities of daily living when compared to their counterparts: stooping and kneeling (64.9% vs 60.8%, p = 0.007), walking 6 blocks (46.5% vs 41.5%, p = 0.001), walking 3 blocks (37.7% vs 33.5%, p = 0.002), and climbing up to 20 stairs (39.2% vs 34.8%, p = 0.02). Among those reporting disability, mobile home dwellers had fewer bathroom safety modifications. CONCLUSION There is higher prevalence of chronic conditions, functional and cognitive impairment in older mobile home dwellers compared to older adults living in other types of housing.
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Affiliation(s)
- Tala M Al-Rousan
- University of Iowa College of Public Health, Department of Epidemiology, E100, USA.
| | - Linda M Rubenstein
- University of Iowa College of Public Health, Department of Epidemiology, S400, USA; University of Iowa College of Public Health, Department of Epidemiology, S422, USA
| | - Robert B Wallace
- University of Iowa College of Public Health, Department of Epidemiology, S422, USA
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Agarwal M, Williams J, Tavoulareas D, Studnek JR. A Brief Educational Intervention Improves Medication Safety Knowledge in Grandparents of Young Children. AIMS Public Health 2015; 2:44-55. [PMID: 29546094 PMCID: PMC5690368 DOI: 10.3934/publichealth.2015.1.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Increasing grandparent-grandchild interactions have not been targeted as a potential contributing factor to the recent surge in pediatric poisonings. We hypothesized that in grandparents with a young grandchild, a single educational intervention based on the PROTECT "Up & Away" campaign will improve safe medication knowledge and storage at follow-up from baseline. METHODS This prospective cohort study validated the educational intervention and survey via cognitive debriefing followed by evaluation of the educational intervention in increasing safe medication storage. Participants had to read and speak English and have annual contact with one grandchild ≤ 5-years-old. Participants were recruited from a convenience sample of employees in a regional healthcare system. They completed a pre-intervention survey querying baseline demographics, poisoning prevention knowledge, and medication storage, followed by the educational intervention and post-intervention survey. Participants completed a delayed post-intervention survey 50-90 days later assessing medication storage and poisoning prevention knowledge. Storage sites were classified as safe or unsafe a priori; a panel classified handwritten responses. RESULTS 120 participants were enrolled; 95 (79%) completed the delayed post-intervention survey. Participants were predominantly female (93%) and white (76%); 50% had a clinical degree. Participants averaged 1.9 grandchildren. Initially, 23% of participants reported safe medication storage; this improved to 48% after the intervention (OR 6.4; 95% CI = 2.5-21.0). 78% of participants made at least one improvement in their medication storage after the intervention even if they did not meet all criteria for safe storage. Participants also demonstrated retention of poisoning prevention knowledge. CONCLUSIONS This brief educational intervention improved safe medication storage and poisoning prevention knowledge in grandparents of young children; further evaluation of this intervention is warranted.
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Affiliation(s)
- Maneesha Agarwal
- Pediatric Emergency Medicine, Emory University & Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Janice Williams
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA
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Affiliation(s)
| | - Vicky Scott
- British Columbia Ministry of Health, Victoria, BC, Canada
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Keall MD, Pierse N, Howden-Chapman P, Cunningham C, Cunningham M, Guria J, Baker MG. Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: a cluster-randomised controlled trial. Lancet 2015; 385:231-8. [PMID: 25255696 DOI: 10.1016/s0140-6736(14)61006-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. METHODS We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. FINDINGS Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group (relative rate 0.86, 95% CI 0.66-1.12). The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group (0.66, 0.43-1.00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0.74, 95% CI 0.58-0.94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0.61, 0.41-0.91). INTERPRETATION Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. FUNDING Health Research Council of New Zealand.
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Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis. PLoS One 2014; 9:e89257. [PMID: 24622676 PMCID: PMC3951196 DOI: 10.1371/journal.pone.0089257] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/16/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. METHODS AND FINDINGS DATA SOURCES Ten databases including CENTRAL and Medline searched through December 2012. STUDY SELECTION Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data. Outcomes were pooled using random effects. MAIN OUTCOMES AND MEASURES Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. RESULTS Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important. CONCLUSIONS Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.
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Affiliation(s)
- Evan Mayo-Wilson
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Sean Grant
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jennifer Burton
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Amanda Parsons
- Yale Law School, New Haven, Connecticut, United States of America
| | - Kristen Underhill
- Yale Law School, Yale Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, United States of America
| | - Paul Montgomery
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention (Review). ACTA ACUST UNITED AC 2014; 8:761-939. [PMID: 23877910 DOI: 10.1002/ebch.1911] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD. There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92). Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96). Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Nyman SR, Ballinger C, Phillips JE, Newton R. Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatr 2013; 13:125. [PMID: 24245830 PMCID: PMC3835551 DOI: 10.1186/1471-2318-13-125] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
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Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Psychology Research Centre, School of Design, Engineering & Computing, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK.
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Khan UR, Chandran A, Zia N, Huang CM, De Ramirez SS, Feroze A, Hyder AA, Razzak JA. Home injury risks to young children in Karachi, Pakistan: a pilot study. Arch Dis Child 2013; 98:881-6. [PMID: 23995075 PMCID: PMC4316730 DOI: 10.1136/archdischild-2013-303907] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To pilot an in-home unintentional injury hazard assessment tool and to quantify potential injury risks for young children in a low-income urban setting. METHODS Two low-income neighbourhoods in Karachi, Pakistan, were mapped, and families with at least one child between the ages of 12 and 59 months were identified. Using existing available home injury risk information, an in-home injury risk assessment tool was drafted and tailored to the local setting. Home injury assessments were done in June-July 2010 after obtaining informed consent. RESULTS Approximately 75.4% of mothers were educated through at least grade 12. The main risks identified were stoves within the reach of the child (n=279, 55.5%), presence of open buckets in the bathroom (n=240, 47.7%) within the reach of the child, and pedestal fans accessible to the child (n=242, 48.1%). In terms of safety equipment, a first-aid box with any basic item was present in 70% of households, but only 4.8% of households had a fire extinguisher in the kitchen. CONCLUSIONS This was the first time that an in-home, all-unintentional injury risk assessment tool was tailored and applied in the context of a low-income community in Pakistan. There was a significant burden of hazards present in the homes in these communities, representing an important opportunity for injury prevention. This pilot may have future relevance to other LMICs where child injury prevention is a critical need.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Aruna Chandran
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nukhba Zia
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan,International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cheng-Ming Huang
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Stewart De Ramirez
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Asher Feroze
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Adnan Ali Hyder
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan,Aman Healthcare Services, Karachi, Sindh, Pakistan
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Gielen AC, Shields W, McDonald E, Frattaroli S, Bishai D, Ma X. Home safety and low-income urban housing quality. Pediatrics 2012; 130:1053-9. [PMID: 23147973 PMCID: PMC3507257 DOI: 10.1542/peds.2012-1531] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Living in substandard housing may be one factor that increases the risk of fire and burn injuries in low-income urban environments. The purposes of this study are to (1) describe the frequency and characteristics of substandard housing in urban homes with young children and (2) explore the hypothesis that better housing quality is associated with a greater likelihood of having working smoke alarms and safe hot water temperatures. METHODS A total 246 caregivers of children ages 0 to 7 years were recruited from a pediatric emergency department and a well-child clinic. In-home observations were completed by using 46 items from the Housing and Urban Development's Housing Quality Standards. RESULTS Virtually all homes (99%) failed the housing quality measure. Items with the highest failure rates were those related to heating and cooling; walls, ceilings, and floors; and sanitation and safety domains. One working smoke alarm was observed in 82% of the homes, 42% had 1 on every level, and 62% had safe hot water temperatures. For every increase of 1 item in the number of housing quality items passed, the odds of having any working smoke alarm increased by 10%, the odds of having 1 on every level by 18%, and the odds of having safe hot water temperatures by 8%. CONCLUSIONS Many children may be at heightened risk for fire and scald burns by virtue of their home environment. Stronger collaboration between housing, health care, and injury prevention professionals is urgently needed to maximize opportunities to improve home safety.
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Affiliation(s)
- Andrea C. Gielen
- Johns Hopkins Center for Injury Research and Policy,,Departments of Health, Behavior, and Society
| | - Wendy Shields
- Johns Hopkins Center for Injury Research and Policy,,Health Policy and Management, and
| | - Eileen McDonald
- Johns Hopkins Center for Injury Research and Policy,,Departments of Health, Behavior, and Society
| | - Shannon Frattaroli
- Johns Hopkins Center for Injury Research and Policy,,Health Policy and Management, and
| | - David Bishai
- Johns Hopkins Center for Injury Research and Policy,,Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xia Ma
- Johns Hopkins Center for Injury Research and Policy,,Health Policy and Management, and
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2012; 2012:CD005014. [PMID: 22972081 PMCID: PMC9758703 DOI: 10.1002/14651858.cd005014.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK.
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What Does the Cochrane Collaboration Say about Preventing Falls and Injuries? Physiother Can 2012; 63:490. [PMID: 22942527 DOI: 10.3138/physio.63.4.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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