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Khan UR, Ali A, Khudadad U, Raheem Buksh A, Zia N, Azam I, Chandran A, Razzak JA, Hyder AA. Follow-up household assessment for child unintentional injuries two years after the intervention: A community-based study from Karachi, Pakistan. Injury 2023; 54 Suppl 4:110519. [PMID: 36481051 DOI: 10.1016/j.injury.2022.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions. METHODS This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age. RESULTS A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]). CONCLUSION An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem Buksh
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iqbal Azam
- Community Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Junaid Abdul Razzak
- Centre of Excellence for Trauma and Emergencies, Aga Khans University, Karachi 74800, Pakistan; Weill Cornell Medicine, New York, NY, USA
| | - Adnan Ali Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Torbey A, Shibani M, Alzabibi MA, Eddin AS, Mdawr E, Mouhanna W, Sawaf B, Alakhrass D, Asaad SA, Alhouri AN, Zahrawi H, Bakdounes A, Bakdounes D, Kahal F, Safieh H, Swed S, Ammar A. The epidemiology of in-hospital burn patients in a tertiary hospital in Damascus, Syria. A retrospective cohort study. Injury 2023; 54:435-441. [PMID: 36509564 DOI: 10.1016/j.injury.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syria has been facing a dreadful crisis for the past 11 years, which has had a significant toll on the healthcare system of the country, and its ability to adequately manage acute injuries. In this research, we study the epidemiology and outcomes of burn patients admitted to the burn center of Al-Mouwasat Hospital in Damascus, Syria. METHODS A retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degrees. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes. RESULTS Of the 641 patients, 367 (57.3%) were males and 274 (42.7%) were females. Children represented more than half of our sample 377 (58.8%). The most common cause of burns was flame 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511 (79.7%). 209 (32.6%) patients had a moderate ABSI score, followed by moderately severe in 149 (23.2%) patients. Children, patients who had high ABSI scores, and those who needed respiratory support were more likely to die than others 2.545 (1.079-6.004), 9.208 (4.061-20.879), respectively. CONCLUSION Death was the outcome of third of the hospitalized patients. Furthermore, Children made up more than half of the sample, and had the highest rates of leaving the hospital against medical advice. These results underline the importance of an updated nationally uniformed protocol for the management of burn patients.
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Affiliation(s)
- André Torbey
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria.
| | | | | | - Elian Mdawr
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Wajed Mouhanna
- Faculty of Medicine, University of Damascus, Damascus, Syria
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Suja Al Asaad
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Hanaa Zahrawi
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Anan Bakdounes
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Duaa Bakdounes
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Fares Kahal
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Homam Safieh
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Sarya Swed
- Faculty of Medicine, Aleppo Syria, Aleppo, Syria
| | - Ali Ammar
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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3
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Roberts KJ, McAdams RJ, McKenzie LB. Stay-at-home, Safe at Home? A survey of parental home safety practices before and during the COVID-19 pandemic. Inj Epidemiol 2022; 9:43. [PMID: 36544172 PMCID: PMC9768763 DOI: 10.1186/s40621-022-00396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To slow the spread of COVID-19, many nonessential businesses, daycares, and schools closed, and areas imposed "stay-at-home" orders. Closures led to young children spending more time at home, traditionally, the place where more than one-half of unintentional pediatric injuries occur. The objective of the current study was to describe parental safety perceptions and confidence, safety device purchase and installation, and injury prevention practices and behaviors, in homes with children 6 years of age and younger, before and during the COVID-19 pandemic. METHODS A cross-sectional survey with a convenience sample of US participants, 18 years or older, was conducted from November 2020 to February 2021. Parents of children (≤ 6 years) were recruited via social media ads and posts on Facebook and Twitter and invited to complete an anonymous, online survey about their home safety practices before and during the COVID-19 stay-at-home order. Upon completion, parents could participate in a prize drawing to receive one of five $100 gift cards. RESULTS A total of 499 participants completed the survey. Most (47.9%) were 45-54 years of age and reported the amount of time at home increased for them (93.9%) and their children (90.6%) during the stay-at-home period. Thirty-seven percent (36.9%) of parents considered their homes safe but recognized room for improvement and felt confident in their ability to make their homes safe for their children (72.8%). From the time before until the COVID-19 stay-at-home orders were in place, parents increased their home injury prevention practices (42.3%). Parents that had identified unsafe areas in the home before the stay-at-home order were significantly more likely to increase their safety behaviors, take childproofing actions, and purchase or install safety devices during the stay-at-home order (p < 0.0001). Parents with younger children (5 years) were significantly more likely than parents with older children to take childproofing actions (p < .0001) including purchasing and installing safety devices (p < 0.0001). CONCLUSIONS Spending more time at home during the COVID-19 pandemic may have helped the sampled parents, especially those with younger children, identify unsafe areas in their homes and encourage them to modify their behaviors, and purchase and install safety devices to help make their homes safer for their children.
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Affiliation(s)
- Kristin J. Roberts
- grid.240344.50000 0004 0392 3476Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Research Building III, Columbus, OH 43205 USA
| | - Rebecca J. McAdams
- grid.240344.50000 0004 0392 3476Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Research Building III, Columbus, OH 43205 USA
| | - Lara B. McKenzie
- grid.240344.50000 0004 0392 3476Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Research Building III, Columbus, OH 43205 USA ,grid.261331.40000 0001 2285 7943Department of Pediatrics, The Ohio State University, College of Medicine, 370 W. 9th Ave., Columbus, OH 43210 USA ,grid.261331.40000 0001 2285 7943Division of Epidemiology, The Ohio State University, College of Public Health, 250 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210 USA
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Wright MF, Azar ST, Whyte EM, Lopez C. Home safety hero: testing reaction time differences among teen mothers for single versus multiple game play. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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5
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Graziani R, Venturini S. A Bayesian approach to discrete multiple outcome network meta-analysis. PLoS One 2020; 15:e0231876. [PMID: 32343711 PMCID: PMC7188248 DOI: 10.1371/journal.pone.0231876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
In this paper we suggest a new Bayesian approach to network meta-analysis for the case of discrete multiple outcomes. The joint distribution of the discrete outcomes is modeled through a Gaussian copula with binomial marginals. The remaining elements of the hierarchial random effects model are specified in a standard way, with the logit of the success probabilities given by the sum of a baseline log-odds and random effects comparing the log-odds of each treatment against the reference and having a Gaussian distribution centered at the vector of pooled effects. An adaptive Markov Chain Monte Carlo algorithm is devised for running posterior inference. The model is applied to two datasets from Cochrane reviews, already analysed in two papers so to assess and compare its performance. We implemented the model in a freely available R package called netcopula.
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Affiliation(s)
- Rebecca Graziani
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Bocconi Institute for Data Science and Analytics, Bocconi University, Milan, Italy
- * E-mail:
| | - Sergio Venturini
- Dipartimento di Management, Università degli Studi di Torino, Torino, Italy
- Centre for Research on Health and Social Care Management (CeRGAS), SDA Bocconi School of Management, Milan, Italy
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6
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Seah R, Holland AJ, Curtis K, Mitchell R. Hospitalised burns in children up to 16 years old: A 10-year population-based study in Australia. J Paediatr Child Health 2019; 55:1084-1090. [PMID: 30548712 DOI: 10.1111/jpc.14347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/15/2018] [Accepted: 11/18/2018] [Indexed: 11/29/2022]
Abstract
AIM Globally, burns remain a significant public health issue that disproportionately affect young children. The current study examines the 10-year epidemiological profile of burn hospitalisations, hospital treatment cost and health outcomes by age group for children ≤16 years in Australia. METHODS National, population-based, linked hospital and mortality data from 1 July 2002 to 30 June 2012 were used to identify burn-related hospitalisations. Age-standardised hospitalisation rates and hospital treatment costs were estimated. RESULTS There were 25 098 children aged ≤16 years hospitalised after sustaining a burn. The age-standardised hospitalisation rate was 54.4 per 100 000 (95% confidence interval (CI): 53.7-55.1). Children aged 1-5 years had the highest burn hospitalisation rate (105.6 per 100 000; 95% CI: 103.8-107.3). The burn hospitalisation rate of infants <1 year declined by 3.1% per annum (95% CI: -4.84, -1.37, P < 0.001). Contact with heat and other substances, hot drinks, food, fats and cooking oils was the most common burn mechanism, and the home was the most common place of occurrence for children ≤10 years. Exposure to the ignition of highly flammable material was the most common burn mechanism for children aged 11-16 years. There were 7260 hospital readmissions within 28 days and 11 deaths within 30 days of the index burn hospitalisation. Total hospital treatment costs were estimated at $168 million. CONCLUSIONS Childhood burns continue to account for a large proportion of hospitalised morbidity. To assist in reducing burn hospitalisations, the development, implementation and resourcing of national multi-sectorial childhood injury prevention is needed in Australia.
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Affiliation(s)
- Rebecca Seah
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Ja Holland
- Children's Hospital at Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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7
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Roberts KJ, McAdams RJ, Kristel OV, Szymanski AM, McKenzie LB. Qualitative and Quantitative Evaluation of the Make Safe Happen App: Mobile Technology-Based Safety Behavior Change Intervention for Parents. JMIR Pediatr Parent 2019; 2:e12022. [PMID: 31518322 PMCID: PMC6715056 DOI: 10.2196/12022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with proper injury prevention information that is easily accessible may help them make their homes safer for children. OBJECTIVE The aim of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen mobile app. METHODS A total of 40 parents with children aged 0-12 years living in Columbus, Ohio, participated in 1 of 5 focus group discussions following the completion of (1) a pretest survey, (2) use of the Make Safe Happen app, and (3) a posttest survey. RESULTS Following the use of the Make Safe Happen app, parents reported a significant increase in injury prevention awareness and completed 45% more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. CONCLUSIONS The combination of qualitative and quantitative data collection allowed for rich data capture and provided a deeper understanding of parents' safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may occur in and around their homes.
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Affiliation(s)
- Kristin J Roberts
- Center for Injury Research and Policy, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Rebecca J McAdams
- Center for Injury Research and Policy, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | | | | | - Lara B McKenzie
- Center for Injury Research and Policy, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States
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8
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Mohammadinia L, Khorasani-Zavareh D, Gharibzadeh S, Roshanferk P, Malekafzali H. Social Determinants of Health and Home Safety for Under-five Children in a Neighbor's Tehran, Iran. Int J Prev Med 2019; 9:109. [PMID: 30687460 PMCID: PMC6326020 DOI: 10.4103/ijpvm.ijpvm_60_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Social determinants of health (SDH) provide a platform in improving health society such as safety. Safety is essential for children because it is directly related to the health and development. The objective of this study was to evaluate the current home safety in the capital city of Iran for children below five years by community-based initiative and its association with common SDH variables. Methods: This is a cross-sectional study, considering community- and family-based initiative. According this five domains checklist which was including physical, kitchen, bath, toys, and first-aid kit, 200 family home safety were evaluated. Moreover, the relation between children safety and social determinants of health was assessed. Furthermore, the research team designed an attractive record card for each child that was distributed among families by community volunteers. Results: The result was extracted into two age groups: less and more than 6 months. We designed an attractive card for each child and distributed among families by volunteers. It showed that children of age above 6 months had higher home safety score. We found a positive association between mother's education and total safety score. Conclusions: This study was a part of MAZDAK project which means friendly environment for children in Persian word. It showed that an effective way for promoting children safety in the community would be community engagement and family cooperation. As the family education can help reduce children injuries, MAZDAK as a model can been run in the other places to check the effects of SDH on home safety for children. This was an experience of improving community knowledge and behavior about home safety by the parents themselves to improve their children safety environment, and it is going to continue the efficacy of Intervention.
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Affiliation(s)
- Leila Mohammadinia
- Department of Disaster Public Health, School of Public Health, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.,Health Human Resource Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disaster and Emergency, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden
| | - Safoora Gharibzadeh
- Research Centre for Emerging and Reemerging Infectious Disease, Pasteur Institute of Iran, Tehran, Iran.,Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | - Payam Roshanferk
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hossein Malekafzali
- Social Determinants of Health Research Center, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
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9
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Abstract
Unintentional injury prevention research focuses on parental supervision as critical to reducing toddler injury. We examine how the promotion of childproofing-as a mode of supervision-sells mothers "peace of mind" while also increasing "intensive mothering" and the "privatization of risk." Drawing on the childproofing literature and meaning centered interviews with mothers of toddlers and childproofing business owners, we argue that the connection made by these groups between childproofing and "good parenting" ultimately obscures how this form of harm reduction economically and socially individualizes responsibility for child care.
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Affiliation(s)
- Amy Dao
- a Department of Geography and Anthropology , California State Polytechnic University , Pomona , California , USA
| | - Juliet McMullin
- b Department of Anthropology , University of California, Riverside , Riverside , California , USA
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10
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Maßnahmen zur Vermeidung von Kinderunfällen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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El Seifi OS, Mortada EM, Abdo NM. Effect of community-based intervention on knowledge, attitude, and self-efficacy toward home injuries among Egyptian rural mothers having preschool children. PLoS One 2018; 13:e0198964. [PMID: 29927950 PMCID: PMC6013117 DOI: 10.1371/journal.pone.0198964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/28/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Parent's level of knowledge, state of their attitude, and their self-efficacy are the most incriminated reasons for the faulty application of the first aid measures, particularly in children's home injuries. OBJECTIVES To assess the effect of a health education intervention on improving knowledge, attitude and self- efficacy of mothers having preschool children about home injuries and the basic first aid measures. METHODS A pre-posttest evaluation of the effect of a health education intervention on changing knowledge, attitude, and self-efficacy about home injuries and the basic first aid measures of 244 rural Egyptian mothers having preschool children. RESULTS About 35% of the male children had home injuries 8 weeks earlier to the study. Mean score of total knowledge increased from 10.21±3.1 in pretest to 18.90 ± 2.6 in posttest, total attitude from 6.19±1.8 to 10.26±2.3 and self-efficacy from 20.75±6.1 to 34.43 ± 10.1 with (p < 0.001) for all changes. Age, education level and previous home injuries were the significant predicting factors for total knowledge, attitude and self- efficacy of the mothers. CONCLUSION Health education improves knowledge, attitude, and self-efficacy of the mothers which were obvious regarding home injuries than first aid measures. There is a need for including knowledge about home injuries in the educational curriculum of high schools and universities and to perform training courses to mothers about first aid measures.
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Affiliation(s)
- Omnia S. El Seifi
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig city, Arab Republic of Egypt
| | - Eman M. Mortada
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig city, Arab Republic of Egypt
- Health Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh city, Kingdom of Saudi Arabia
| | - Naglaa M. Abdo
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig city, Arab Republic of Egypt
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12
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Berry S, Carr PA, Kool B, Mohal J, Morton S, Grant C. Housing tenure as a focus for reducing inequalities in the home safety environment: evidence from Growing Up in New Zealand. Aust N Z J Public Health 2017; 41:530-534. [PMID: 28749605 DOI: 10.1111/1753-6405.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/01/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine whether specific demographic characteristics are associated with the presence or absence of household safety strategies. METHODS This study was conducted within Growing Up in New Zealand, a contemporary longitudinal study of New Zealand (NZ) children. Multivariable analyses were used to examine the maternal (self-prioritised ethnicity, education, age, self-reported health) and household (area-level deprivation, tenure, crowding, residential mobility, dwelling type) determinants of household safety strategies being present in the homes of young children. RESULTS In comparison to family-owned homes, privately owned rental homes were less likely (OR=0.78; 95%CI 0.65-0.92), and government-owned rental homes were more likely (OR=1.74, 95%CI 1.25-2.41) to have eight or more household safety strategies present. CONCLUSIONS Living in a privately owned rental home in NZ exposes children to an environment where there are fewer household safety strategies in place. Implications for public health: Housing tenure provides a clear target focus for improving the household safety environment for NZ children.
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Affiliation(s)
- Sarah Berry
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, New Zealand.,Growing Up in New Zealand, The University of Auckland, New Zealand
| | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, The University of Waikato, New Zealand
| | - Bridget Kool
- Department of Epidemiology and Biostatistics, The University of Auckland, New Zealand
| | - Jatender Mohal
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, New Zealand.,Growing Up in New Zealand, The University of Auckland, New Zealand
| | - Susan Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, New Zealand.,Growing Up in New Zealand, The University of Auckland, New Zealand
| | - Cameron Grant
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
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13
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Falcone RA, Edmunds P, Lee E, Gardner D, Price K, Gittelman M, Pomerantz W, Besl J, Madhavan G, Phelan KJ. Volunteer driven home safety intervention results in significant reduction in pediatric injuries: A model for community based injury reduction. J Pediatr Surg 2016; 51:1162-9. [PMID: 26792663 DOI: 10.1016/j.jpedsurg.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Home based injuries account for a significant number of injuries to children between 1 and 5years old. Evidence-based safety interventions delivered in the home with installation of safety equipment have been demonstrated to reduce injury rates. The aim of this study was to evaluate the impact of a community based volunteer implemented home safety intervention. METHODS In partnership with a community with high injury rates for children between 1 and 5years old, a home safety bundle was developed and implemented by volunteers. The safety bundle included installing evidence based safety equipment. Monthly community emergency room attended injury rates as well as emergency room attended injuries occurring in intervention and nonintervention homes was tracked throughout the study. RESULTS Between May 2012 and May 2014 a total of 207 homes with children 1-5years old received the home safety bundle. The baseline monthly emergency room attended injury rate for children aged 1-5years within our target community was 11.3/1000 and that within our county was 8.7/1000. Following the intervention current rates are now 10.3/1000 and 9.2/1000 respectively. Within intervention homes the injury rate decreased to 4.2/1000 while the rate in the homes not receiving the intervention experienced an increase in injury rate to 12/1000 (p<0.05). When observed vs. expected injuries were examined the intervention group demonstrated 59% fewer injuries while the nonintervention group demonstrated a 6% increase (p<0.05). CONCLUSION Children in homes that received a volunteer-provided, free home safety bundle experienced 59% fewer injuries than would have been expected. By partnering with community leaders and organizing volunteers, proven home safety interventions were successfully provided to 207 homes during a two-year period, and a decline in community injury rates for children younger than 5years was observed compared to county wide injury rates.
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Affiliation(s)
- Richard A Falcone
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Patrick Edmunds
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Emily Lee
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Dawne Gardner
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kimberly Price
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Michael Gittelman
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Wendy Pomerantz
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - John Besl
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Gowri Madhavan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kieran J Phelan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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Trefan L, Houston R, Pearson G, Edwards R, Hyde P, Maconochie I, Parslow RC, Kemp A. Epidemiology of children with head injury: a national overview. Arch Dis Child 2016; 101:527-532. [PMID: 26998632 PMCID: PMC4893082 DOI: 10.1136/archdischild-2015-308424] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury. METHOD Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided. RESULTS Details of 5700 children, median age 4 years (range 0-14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0-14.9 years)). CONCLUSIONS The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.
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Affiliation(s)
- L Trefan
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - R Houston
- Placements Manager at Kids Company, London, UK
| | - G Pearson
- Birmingham Children's Hospital, Birmingham, UK
| | - R Edwards
- Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK
| | - P Hyde
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | - I Maconochie
- Imperial College NHS Healthcare Trust, London, UK
| | - R C Parslow
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - A Kemp
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
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15
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Carlsson A, Dykes AK, Jansson A, Bramhagen AC. Mothers' awareness towards child injuries and injury prevention at home: an intervention study. BMC Res Notes 2016; 9:223. [PMID: 27091157 PMCID: PMC4836089 DOI: 10.1186/s13104-016-2031-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most injuries to young children happen in the home. Therefore, this study aimed to investigate if extended individual information to mothers' related to injury to children in the home and possible preventative actions has any effect on their awareness of the problem and if Sense of Coherence has an influence. METHODS This was a quasi-experimental designed intervention study with a comparison group. Extended individual information with empowerment as the approach was used. RESULTS Ninety-nine mothers of children under the age of 7 months participate. A questionnaire with sociodemographic data and questions regarding awareness towards prevention was used. Mothers who took part in the intervention significantly increased their awareness of the fact that child injuries take place at home when compared with the mothers in the comparison group, [OR 2.3, CI 1.3-4.3]. However, no significant improvement of awareness towards prevention was noted, neither any association to the mothers' SOC-scores. CONCLUSION This study showed that the intervention had a positive effect on mothers' awareness towards the fact that child injuries are taking place at home, but it did not increase the mothers' awareness towards prevention of child injury.
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Affiliation(s)
- Anna Carlsson
- />Faculty of Health and Society, Department of Care Science, Malmö University, Jan Waldenströmsgata 25, 205 06 Malmö, Sweden
| | - Anna-Karin Dykes
- />Faculty of Health and Society, Department of Care Science, Malmö University, Jan Waldenströmsgata 25, 205 06 Malmö, Sweden
- />Faculty of Medicine, Department of Health Sciences Centre, Lund University, Lund, Sweden
| | - Annkristin Jansson
- />Faculty of Medicine, Department of Health Sciences Centre, Lund University, Lund, Sweden
| | - Ann-Cathrine Bramhagen
- />Faculty of Health and Society, Department of Care Science, Malmö University, Jan Waldenströmsgata 25, 205 06 Malmö, Sweden
- />Skane University Hospitals, Malmö, Sweden
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16
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Nicks SE, Weaver NL, Recktenwald A, Jupka KA, Elkana M, Tompkins R. Translating an Evidence-Based Injury Prevention Program for Implementation in a Home Visitation Setting. Health Promot Pract 2016; 17:578-85. [PMID: 26826110 DOI: 10.1177/1524839915622196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Safe N' Sound (SNS), a computer-based childhood injury prevention program, provides individually tailored information to parents about their child's injury risks with specific behavioral recommendations. We translated SNS for implementation in a home visitation organization in order to increase its capacity to effectively address injury prevention and decrease the burden of injury experienced by high-need families. The aim of this study was to identify behavioral and organizational barriers and facilitators to translating and implementing SNS in a home visitation setting. Nurse home visitors (NHVs) participated in semistructured interviews that examined perceptions of program implementation, intervention characteristics, individual characteristics of NHVs, and recommendations for improving implementation. The utility of the program for promoting injury prevention systematically and its alignment with the organization's mission were facilitators of successful implementation. Barriers included NHVs' concerns about overburdening clients and missed educational opportunities related to injury risks not addressed by the program and delayed delivery of educational reports. Findings illustrate the dynamic interactions of intervention characteristics with organizational and individual factors and suggest that customizing implementation to organizational capacity and specific needs may better support successful program implementation in home visitation settings.
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Affiliation(s)
- Shannon E Nicks
- Saint Louis University College for Public Health & Social Justice, St. Louis, MO, USA
| | - Nancy L Weaver
- Saint Louis University College for Public Health & Social Justice, St. Louis, MO, USA
| | | | - Keri A Jupka
- Saint Louis University College for Public Health & Social Justice, St. Louis, MO, USA
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17
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Achana FA, Sutton AJ, Kendrick D, Wynn P, Young B, Jones DR, Hubbard SJ, Cooper NJ. The effectiveness of different interventions to promote poison prevention behaviours in households with children: a network meta-analysis. PLoS One 2015; 10:e0121122. [PMID: 25894385 PMCID: PMC4404249 DOI: 10.1371/journal.pone.0121122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is evidence from 2 previous meta-analyses that interventions to promote poison prevention behaviours are effective in increasing a range of poison prevention practices in households with children. The published meta-analyses compared any intervention against a “usual care or no intervention” which potentially limits the usefulness of the analysis to decision makers. We aim to use network meta-analysis to simultaneously evaluate the effectiveness of different interventions to increase prevalence of safe storage of i) Medicines only, ii) Other household products only, iii) Poisons (both medicines and non-medicines), iv) Poisonous plants; and v) Possession of poison control centre (PCC) telephone number in households with children. Methods Data on the effectiveness of poison prevention interventions was extracted from primary studies identified in 2 newly-undertaken systematic reviews. Effect estimates were pooled across studies using a random effects network meta-analysis model. Results 28 of the 47 primary studies identified were included in the analysis. Compared to usual care intervention, the intervention with education and low cost/free equipment elements was most effective in promoting safe storage of medicines (odds ratio 2.51, 95% credible interval 1.01 to 6.00) while interventions with education, low cost/free equipment, home safety inspection and fitting components were most effective in promoting safe storage of other household products (2.52, 1.12 to 7.13), safe storage of poisons (11.10, 1.60 to 141.50) and possession of PCC number (38.82, 2.19 to 687.10). No one intervention package was more effective than the others in promoting safe storage of poisonous plants. Conclusion The most effective interventions varied by poison prevention practice, but education alone was not the most effective intervention for any poison prevention practice. Commissioners and providers of poison prevention interventions should tailor the interventions they commission or provide to the poison prevention practices they wish to promote. Highlights
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Affiliation(s)
- Felix A. Achana
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Alex J. Sutton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
- * E-mail:
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - David R. Jones
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Stephanie J. Hubbard
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Nicola J. Cooper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
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Achana FA, Cooper NJ, Bujkiewicz S, Hubbard SJ, Kendrick D, Jones DR, Sutton AJ. Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes. BMC Med Res Methodol 2014; 14:92. [PMID: 25047164 PMCID: PMC4142066 DOI: 10.1186/1471-2288-14-92] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Background Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. Methods The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Results Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on outcomes not directly considered by the studies included in the analysis. Conclusions Accounting for the dependency between outcomes in a multivariate meta-analysis may or may not improve the precision of effect estimates from a network meta-analysis compared to analysing each outcome separately.
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Affiliation(s)
- Felix A Achana
- Biostatistics Group, Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK.
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Ellsäßer G, Trost-Brinkhues G, Albrecht M. [Injury prevention in young children]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:681-6. [PMID: 24863710 DOI: 10.1007/s00103-014-1971-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Epidemiological studies in Germany show that infants and toddlers are at most risk of injury and in need of protection. Of all children under the age of 15 years, they have the highest rates of fatal and severe injuries. Therefore, this article aims to show which injury prevention measures have been proven successful for this age group. International specialist recommendations are described and evidence-based knowledge of interventions is presented from the Cochrane Reviews. For the four most frequent child injury mechanisms (drowning, poisoning, burning, and falling), the World Health Organization recommends a set of measures covering legislation, regulations, changes of environment, education, and emergency medical care. Meta-analyses on the effectiveness of interventions related to safety at home conclude that informing parents personally (face-to-face) and in combination with free safety equipment (e.g., safety gates, smoke alarms) increased parents' safety practices significantly. This included advice on not using baby walkers. Multifaceted education programs for parents (e.g., visiting programs at home or in pediatric clinics) proved to have the highest effect in reducing home accidents to children. The prevention of injuries in young children should be driven by a multifaceted and data-based approach. Postnatal interventions (Frühe Hilfen) at the community level are especially useful to integrate accident prevention at home, because they are connected with family visiting programs.
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Affiliation(s)
- G Ellsäßer
- Abteilung Gesundheit, Landesamt für Umwelt, Gesundheit und Verbraucherschutz, Wünsdorfer Platz 3, 15806, Zossen, Deutschland,
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Waksman RD, Carrera RM, Santos E, Abramovici S, Schvartsman C. Morbidity due trauma in children of the community of Paraisopolis, São Paulo, Brazil. EINSTEIN-SAO PAULO 2014; 12:1-5. [PMID: 24728237 PMCID: PMC4898230 DOI: 10.1590/s1679-45082014ao2434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 10/29/2013] [Indexed: 11/22/2022] Open
Abstract
Objective: To identify the factors that determine unintentional injuries in children living in the community of Paraisopolis, in the city of São Paulo, Brazil. Methods: A cross-sectional and non-controlled study. Data collected during 4 consecutive months through questionnaires filled out for the Einstein Program in Paraisopolis Community included identification of the patient and his/her family, scholarity level, housing conditions, storage of hazardous products, access to the streets and concrete slab ceilings, supervision, and trauma mechanism involved. The observed data were treated as absolute and relative frequencies; χ2, Fisher's exact test, Student's t test, and Mann-Whitney's tests were implemented, with a significance level of 5% (p<0.05). Results: A total of 1,490 questionnaires were analyzed. There was a predominance of trauma within boys (59.6%) and the medium age was 5.2 years. The predominant educational level of the parents was incomplete junior school education. The main caregiver identified was the mother (69.4%). Among the children that suffered trauma, 56.4% belonged to large families (≥6 people), lived in houses up to three rooms, and a family income up to R$ 1,000.00 (76.6%). Easy access to hazardous materials was considerable and free access to concrete slab ceilings was reported in 92.8% of the cases. The main trauma mechanisms were falls and burns. In this study, the child victim of a fall was aged under 5 years. Conclusion: Small children that live in a hazardous environment have a significant tendency to suffering trauma
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Affiliation(s)
| | | | - Erica Santos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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21
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Children at risk of medicinal and non-medicinal poisoning: a population-based case-control study in general practice. Br J Gen Pract 2013; 62:e827-33. [PMID: 23211263 DOI: 10.3399/bjgp12x659303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Preschool children have a high risk of poisoning. While medicines prescribed by primary care are potential poisoning agents, the risk factors for poisoning from medication are not well described. AIM To identify risk factors for medicinal and non-medicinal poisoning in preschool children. DESIGN AND SETTING Population-based nested case-control study using The Health Improvement Network primary care database 1988-2004. METHOD Conditional logistic regression was used to identify child, maternal, and social risk factors for medicinal (1316 cases) and non-medicinal poisoning (503 cases), using 17 709 controls matched on general practice. RESULTS Poisoning by medicines was independently associated with deprivation (test for trend P<0.001), maternal age (P<0.001), birth order (P<0.001), maternal alcohol misuse (odds ratio [OR] = 5.44, 95% confidence interval [CI] = 1.99 to 14.91), and perinatal depression (OR = 1.54, 95% CI = 1.26 to 1.88). Living in a household with two or more adults lowered the odds of injury compared to single-parent households (OR = 0.85, 95% CI = 0.74 to 0.96) and the odds varied by age, being highest in 2 year olds (OR = 9.61, 95% CI = 7.73 to 11.95). Non-medicinal poisoning was associated with deprivation (P = 0.001), maternal age (P<0.001), and birth order (P<0.001). The odds were raised in 1 year olds (OR = 5.44, 95% CI = 4.07 to 7.26) and 2 year olds (OR = 5.07, 95% CI = 3.73 to 6.90) compared to those aged <1 year. CONCLUSION Primary care data can be used to target interventions to children at risk of poisoning. This is pertinent when prescribing for children/family members, as prescribed medications may become poisoning agents. Prompt identification of maternal depression and alcohol misuse, and delivery of poisoning-prevention interventions at this stage may help prevent poisonings.
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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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Young B, Wynn PM, He Z, Kendrick D. Preventing childhood falls within the home: overview of systematic reviews and a systematic review of primary studies. ACCIDENT; ANALYSIS AND PREVENTION 2013; 60:158-171. [PMID: 24080473 DOI: 10.1016/j.aap.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 06/05/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
In most countries falls are the most common medically attended childhood injury and the majority of injuries in pre-school children occur at home. Numerous systematic reviews have reviewed evidence of the effectiveness of falls prevention interventions, but this evidence has not been synthesised into an overview, making it difficult for policy makers and practitioners to easily access the evidence. To synthesise all available evidence, we conducted an overview of reviews of home safety interventions targeting childhood falls, extracted data from primary studies included in the reviews and supplemented this with a systematic review of primary studies published subsequent to the reviews. Bibliographic databases, websites, conference proceedings, journals and bibliographies of included studies were searched for systematic reviews of studies with experimental or controlled observational designs. Thirteen reviews were identified containing 24 primary studies. Searches for additional primary studies identified five further studies not included in reviews. Evidence of the effect of interventions on falls or fall injuries was sparse, with only one of three primary studies reporting this outcome finding a reduction in falls. Interventions were effective in promoting the use of safety gates and furniture corner covers. There was some evidence of a reduction in baby walker use. The effect on the use of window safety devices, non-slip bath mats/decals and the reduction of tripping hazards was mixed. There was limited evidence that interventions were effective in improving lighting in corridors, altering furniture layout and restricting access to roofs. Most interventions to prevent childhood falls at home have not been evaluated in terms of their effect on reducing falls. Policy makers and practitioners should promote use of safety gates and furniture covers and restriction of baby walker use. Further research evaluating the effect of interventions to reduce falls and falls-related injuries is urgently required.
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Affiliation(s)
- Ben Young
- University of Nottingham, Division of Primary Care, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK.
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Disseminating childhood home injury risk reduction information in Pakistan: results from a community-based pilot study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1113-24. [PMID: 23502323 PMCID: PMC3709307 DOI: 10.3390/ijerph10031113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 02/02/2023]
Abstract
Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries.
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Housing interventions and control of injury-related structural deficiencies: a review of the evidence. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:S34-43. [PMID: 20689373 DOI: 10.1097/phh.0b013e3181e28b10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect safety and injury outcomes, such as falls, fire-related injuries, burns, drowning, carbon monoxide poisoning, heat-related deaths, and noise-related harm, associated with structural housing deficiencies. Structural deficiencies were defined as those deficiencies for which a builder, landlord, or home-owner would take responsibility (ie, design, construction, installation, repair, monitoring). Three of the 17 interventions reviewed had sufficient evidence for implementation: installed, working smoke alarms; 4-sided isolation pool fencing; and preset safe hot water temperature. Five interventions needed more field evaluation, 8 needed formative research, and 1 was found to be ineffective. This evidence review shows that housing improvements are likely to help reduce burns and scalds, drowning in pools, and fire-related deaths and injuries.
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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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Collins NC, Molcho M, Carney P, McEvoy L, Geoghegan L, Phillips JP, Nicholson AJ. Are boys and girls that different? An analysis of traumatic brain injury in children. Emerg Med J 2012; 30:675-8. [PMID: 22962053 PMCID: PMC3717585 DOI: 10.1136/emermed-2011-200496] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome. METHODS A national prospective, observational study was conducted over a 2-year period. All patients under 17 years of age referred to a neurosurgical service following TBI were included. Data on patient demographics, events surrounding injury, injury type and severity, patient management and outcome were collected from 'on-call' logbooks and neurosurgical admissions records. RESULTS 342 patients were included. Falls were the leading cause of injury for both sexes. Boys' injuries tended to involve greater energy transfer and involved more risk-prone behaviour resulting in a higher rate of other (non-brain) injury and a higher mortality rate. Intentional injury occurred only in boys. While injury severity was similar for boys and girls, significant gender differences in injury type were present; extradural haematomas were significantly higher in boys (p=0.014) and subdural haematomas were significantly higher in girls (p=0.011). Mortality was 1.8% for girls and 4.3% for boys. CONCLUSIONS Falls were responsible for most TBI, the home is the most common place of injury and non-operable TBI was common. These findings relate to all children. Significant gender differences exist from infancy. Boys sustained injuries associated with a greater energy transfer, were less likely to use protective devices and more likely to be injured deliberately. This results in a different pattern of injury, higher levels of associated injury and a higher mortality rate.
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Affiliation(s)
- Niamh C Collins
- Department of Emergency Medicine, Connolly Hospital, Dublin, Ireland.
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28
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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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Saramago P, Sutton AJ, Cooper NJ, Manca A. Mixed treatment comparisons using aggregate and individual participant level data. Stat Med 2012; 31:3516-36. [PMID: 22764016 DOI: 10.1002/sim.5442] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 04/23/2012] [Indexed: 11/06/2022]
Abstract
Mixed treatment comparisons (MTC) extend the traditional pair-wise meta-analytic framework to synthesize information on more than two interventions. Although most MTCs use aggregate data (AD), a proportion of the evidence base might be available at the individual level (IPD). We develop a series of novel Bayesian statistical MTC models to allow for the simultaneous synthesis of IPD and AD, potentially incorporating study and individual level covariates. The effectiveness of different interventions to increase the provision of functioning smoke alarms in households with children was used as a motivating dataset. This included 20 studies (11 AD and 9 IPD), including 11 500 participants. Incorporating the IPD into the network allowed the inclusion of information on subject level covariates, which produced markedly more accurate treatment-covariate interaction estimates than an analysis solely on the AD from all studies. Including evidence at the IPD level in the MTC is desirable when exploring participant level covariates; even when IPD is available only for a fraction of the studies. Such modelling may not only reduce inconsistencies within networks of trials but also assist the estimation of intervention subgroup effects to guide more individualised treatment decisions.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, UK.
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30
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Preventing unintentional injuries: what does NICE guidance mean for primary care? Br J Gen Pract 2012; 62:62-3. [PMID: 22520763 DOI: 10.3399/bjgp12x625012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Kendrick D, Maula A, Stewart J, Clacy R, Coffey F, Cooper N, Coupland C, Hayes M, McColl E, Reading R, Sutton A, M L Towner E, Craig Watson M. Keeping children safe at home: protocol for three matched case-control studies of modifiable risk factors for falls. Inj Prev 2012; 18:e3. [PMID: 22628151 PMCID: PMC4770251 DOI: 10.1136/injuryprev-2012-040394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. OBJECTIVES To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. DESIGN Three multicentre case-control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0-4 years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. MAIN OUTCOME MEASURES Falls on stairs, on one level and from furniture. DISCUSSION As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, Tower Building, University Park, Nottingham, UK
| | - Asiya Maula
- Division of Primary Care, Tower Building, University Park, Nottingham, UK
| | - Jane Stewart
- Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, Tower Building, University Park, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, Tower Building, University Park, Nottingham, UK
| | - Mike Hayes
- Child Accident Prevention Trust, Child Accident Prevention Trust, London, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Reading
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth M L Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael Craig Watson
- School of Nursing, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Childhood unintentional injuries: need for a community-based home injury risk assessments in pakistan. Int J Pediatr 2012; 2012:203204. [PMID: 22577399 PMCID: PMC3332195 DOI: 10.1155/2012/203204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 11/21/2022] Open
Abstract
Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.
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Saadat S, Mafi M, Sharif-Alhoseini M. Population based estimates of non-fatal injuries in the capital of Iran. BMC Public Health 2011; 11:608. [PMID: 21801449 PMCID: PMC3171366 DOI: 10.1186/1471-2458-11-608] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/31/2011] [Indexed: 11/10/2022] Open
Abstract
Background Fatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran). Methods Using the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital. Results This study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD. Conclusion This population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.
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Affiliation(s)
- Soheil Saadat
- Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP. A randomized controlled trial of home injury hazard reduction: the HOME injury study. ACTA ACUST UNITED AC 2011; 165:339-45. [PMID: 21464382 DOI: 10.1001/archpediatrics.2011.29] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices. DESIGN A nested, prospective, randomized controlled trial. SETTING Indoor environment of housing units. PARTICIPANTS Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, 1263 (14.2%) were eligible, 413 (32.7%) agreed to participate, and 355 were randomly assigned to the intervention (n = 181) or control (n = 174) groups. INTERVENTION Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey. MAIN OUTCOME MEASURE Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury). RESULTS The mean age of children at intervention was 6.3 months. Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% confidence interval [CI], 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03). CONCLUSION An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00129324.
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Affiliation(s)
- Kieran J Phelan
- Center for Children's Environmental Health, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Ziraba AK, Kyobutungi C, Zulu EM. Fatal injuries in the slums of Nairobi and their risk factors: results from a matched case-control study. J Urban Health 2011; 88 Suppl 2:S256-65. [PMID: 21630106 PMCID: PMC3132230 DOI: 10.1007/s11524-011-9580-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.
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Affiliation(s)
- Abdhalah Kasiira Ziraba
- Faculty of Epidemiology and Population Health, Department of Population Studies, London School of Hygiene and Tropical Medicine, Room LG21, Keppel Street, London WC1E 7HT, UK.
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Embry DD. Behavioral vaccines and evidence-based kernels: nonpharmaceutical approaches for the prevention of mental, emotional, and behavioral disorders. Psychiatr Clin North Am 2011; 34:1-34. [PMID: 21333837 PMCID: PMC3064963 DOI: 10.1016/j.psc.2010.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the United States the rates for some mental, emotional, and behavioral problems (MEBs) have objectively increased over the past 20 to 50 years. The attributes of a public health approach to the treatment of MEBs are defined in this article. Multiple examples of how public health approaches might reduce or prevent MEBs using low-cost evidence-based kernels, which are fundamental units of behavior, are discussed. Such kernels can be used repeatedly, which then act as "behavioral vaccines" to reduce morbidity or mortality and/or improve human wellbeing. The author calls for 6 key policy actions to improve MEBs in young people.
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Home visits reduce the number of hazards for childhood home injuries in Karachi, Pakistan: a randomized controlled trial. Int J Emerg Med 2010; 3:333-9. [PMID: 21373302 PMCID: PMC3047837 DOI: 10.1007/s12245-010-0238-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 09/06/2010] [Indexed: 11/11/2022] Open
Abstract
Background Although unintentional injuries are major causes of morbidity and mortality in less developed countries, they have received scant attention, and injury prevention policies and programs have just begun to be addressed systemically. Aims To reduce hazards associated with home injuries due to falls and ingestions through an injury prevention program administered by home visitors. Methods Non-blinded randomized controlled trial design of two interventions where one branch of the study group served as the control for the other in an urban neighborhood in Karachi, Pakistan. The study participants included 340 families with at least one child aged 3 years or less, discharged home from the Emergency Department following a visit for any reason other than an injury. The interventions included: (1) counseling to reduce falls; (2) counseling to reduce poisoning and choking. The primary outcome measure for each intervention was the relative risk of change in the home status from “unsafe” to “safe” after the intervention. Results There were 170 families in the fall prevention and 170 families in the ingestion prevention branch of the study. The percentage of homes deemed “safe” in which the families had received fall intervention counseling was 13.5% compared to 3.5% in the control group (relative risk 3.8; 95% CI: 1.5 to 10.0; p = 0.002), whereas the percentage of homes deemed “safe” in which the families had received the ingestions intervention counseling was 18.8% compared to 2.4% in the control group (relative risk 7.8; 95% CI: 2.4 to 25.3; p < 0.001). Effectiveness did not depend on education or the socioeconomic status of the study participants. The mean number of fall hazards was reduced from 3.1 at baseline to 2.4 in the fall intervention counseling group, and the mean number of ingestion hazards decreased from 2.3 to 1.9. (p < 0.001). Conclusions Our study demonstrates the effectiveness of an educational intervention aimed at improving the home safety practices of families with young children.
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Hutchings H, Barnes PM, Maddocks A, Lyons R, James-Ellison MY. Burns in young children: a retrospective matched cohort study of health and developmental outcomes. Child Care Health Dev 2010; 36:787-94. [PMID: 20642806 DOI: 10.1111/j.1365-2214.2010.01106.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unintentional injuries are a major cause of death and disability in childhood. Most burns are unintentional, the majority occurring in pre-school children. Little is known about the outcomes of young children following burns. The purpose of this study was to examine the presenting features of burned children and compare their health and developmental outcomes with controls. METHODS Children under 3 years admitted to the Welsh Regional Burns Centre between September 1994 and August 1997 were studied up to their sixth birthday (final data collection 2003) to ascertain the nature, course and cause of their burn. One hundred and forty-five burned children were matched with 145 controls. Their physical, psychosocial and educational health status was compared. Retrospective data were gathered from hospital notes, social services, emergency department databases, child health surveillance records and schools. RESULTS Burns peaked at age 13-18 months were typically sustained by scalding, drink spillage and contact with hot objects. They occurred most frequently at mealtimes and 89.7% were judged to be unintentional. There was a high rate of non-attendance for follow-up - 24%. The families of children admitted with burns were more likely to have moved home than those of controls (P = 0.001). By age 6 significantly more cases were admitted to hospital with an unrelated condition (P = 0.018). There were no differences between the cases and controls in immunization status, development, school attendance and educational progress up to the age of 6 years (P > 0.05). CONCLUSIONS We found important findings in relation to unintentional injury prevention and also noted markers that may indicate inequalities in health service utilization between cases and controls. There were no major differences between developmental and educational outcomes in the two groups.
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Affiliation(s)
- H Hutchings
- School of Medicine, Swansea University, CHIRAL, Swansea
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Abstract
BACKGROUND There are no validated observational surveys to assess injury hazards in the home environment. OBJECTIVE To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children. METHODS A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child's bathroom and child's bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland-Altman analysis of agreement, analysis of variance and kappa statistics. RESULTS There were 163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r = 0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r = 0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child's bathroom. Inter-rater reliability between research assistants, as measured by the kappa statistic, was excellent with a mean of 0.81. CONCLUSIONS The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.
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Affiliation(s)
- K J Phelan
- Division of Health Policy & Clinical Effectiveness, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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van Beelen MEJ, Beirens TMJ, Struijk MK, den Hertog P, Oenema A, van Beeck EF, Raat H. 'BeSAFE', effect-evaluation of internet-based, tailored safety information combined with personal counselling on parents' child safety behaviours: study design of a randomized controlled trial. BMC Public Health 2010; 10:466. [PMID: 20696070 PMCID: PMC2924290 DOI: 10.1186/1471-2458-10-466] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/09/2010] [Indexed: 11/17/2022] Open
Abstract
Background Injuries in or around the home are the most important cause of death among children aged 0-4 years old. It is also a major source of morbidity and loss of quality of life. In order to reduce the number of injuries, the Consumer Safety Institute introduced the use of Safety Information Leaflets in the Netherlands to provide safety education to parents of children aged 0-4 years. Despite current safety education, necessary safety behaviours are still not taken by a large number of parents, causing unnecessary risk of injury among young children. In an earlier study an E-health module with internet-based, tailored safety information was developed and applied. It concerns an advice for parents on safety behaviours in their homes regarding their child. The aim of this study is to evaluate the effect of this safety information combined with personal counselling on parents' child safety behaviours. Methods/Design Parents who are eligible for the regular well-child visit with their child at child age 5-8 months are invited to participate in this study. Participating parents are randomized into one of two groups: 1) internet-based, tailored safety information combined with personal counselling (intervention group), or 2) personal counselling using the Safety Information Leaflets of the Consumer Safety Institute in the Netherlands for children aged 12 to 24 months (control group). All parents receive safety information on safety topics regarding the prevention of falling, poisoning, drowning and burning. Parents of the intervention group will access the internet-based, tailored safety information module when their child is approximately 10 months old. After completion of the assessment questions, the program compiles a tailored safety advice. The parents are asked to devise and inscribe a personal implementation intention. During the next well-child visit, the Child Health Clinic professional will discuss this tailored safety information and the implementation intention with the parents. The control group will receive usual care, i.e. the provision of Safety Information Leaflets during their well-child visit at the child's age of 11 months. Discussion It is hypothesized that the intervention, internet-based, tailored safety information combined with personal counselling results in more parents' child safety behaviours. Trial registration Current Controlled Trials NTR1836
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Affiliation(s)
- Mirjam E J van Beelen
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, PO BOX 2040, 3000 CA Rotterdam, the Netherlands.
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Laflamme L, Hasselberg M, Burrows S. 20 Years of Research on Socioeconomic Inequality and Children's-Unintentional Injuries Understanding the Cause-Specific Evidence at Hand. Int J Pediatr 2010; 2010:819687. [PMID: 20706660 PMCID: PMC2913857 DOI: 10.1155/2010/819687] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/18/2010] [Accepted: 06/04/2010] [Indexed: 11/25/2022] Open
Abstract
Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty.
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Affiliation(s)
- Lucie Laflamme
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 76 Stockholm, Sweden
| | - Marie Hasselberg
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 76 Stockholm, Sweden
| | - Stephanie Burrows
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, 1301 Rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3
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Van Niekerk A, Menckel E, Laflamme L. Barriers and Enablers to the Use of Measures to Prevent Pediatric Scalding in Cape Town, South Africa. Public Health Nurs 2010; 27:203-20. [DOI: 10.1111/j.1525-1446.2010.00846.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Kam-Lun Ellis Hon
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Shatin, Hong Kong.
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Chan EYY, Kim JH, Griffiths SM, Lau JTF, Yu I. Does living density matter for nonfatal unintentional home injury in Asian urban settings? Evidence from Hong Kong. J Urban Health 2009; 86:872-86. [PMID: 19636708 PMCID: PMC2791815 DOI: 10.1007/s11524-009-9389-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 06/26/2009] [Indexed: 11/28/2022]
Abstract
Injury is a major global disease burden for the twenty-first century. There are, however, few studies of unintentional household injury in Asian urban settings where living environments are characterized by extremely compact, high-living-density, multistory apartments. This study investigated the association between nonfatal unintentional household injuries with the resident's sociodemographic attributes and household characteristics in Hong Kong, the city with the world's highest population density. A cross-sectional retrospective recall study was conducted in May 2007 using a random telephone survey with a modified Chinese version of the World Health Organization Injury and Violence instrument. The study sample included 1,001 noninstitutionalized Cantonese-speaking Hong Kong residents of all ages, including foreign live-in domestic helpers. Multivariate regression was conducted to identify risk factors for nonfatal unintentional injuries in Hong Kong. Among a predominantly adult sample, household size and time spent at home were not associated with nonfatal unintentional household injuries in the general population in Hong Kong. The multivariate analyses indicated that female gender, owners of private homes, lower square footage of living space per person, and those with slip prevention devices in the bathroom were significantly associated with household injuries. Injured and noninjured groups were found to have adopted different injury prevention strategies toward household injuries. The results identified potential target groups for household injury prevention programs.
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Affiliation(s)
- Emily Y Y Chan
- School of Public Health, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Thomson H, Thomas S, Sellstrom E, Petticrew M. The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 2007. Am J Public Health 2009; 99 Suppl 3:S681-92. [PMID: 19890174 PMCID: PMC2774202 DOI: 10.2105/ajph.2008.143909] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a systematic review of the health impacts of housing improvement. METHODS Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality. RESULTS Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health. CONCLUSIONS Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.
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Affiliation(s)
- Hilary Thomson
- MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, UK, G12 8RZ.
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Van de Velde S, Heselmans A, Roex A, Vandekerckhove P, Ramaekers D, Aertgeerts B. Effectiveness of Nonresuscitative First Aid Training in Laypersons: A Systematic Review. Ann Emerg Med 2009; 54:447-57, 457.e1-5. [DOI: 10.1016/j.annemergmed.2008.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 11/17/2022]
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Obeng C. Injuries in preschool classrooms. HEALTH EDUCATION 2009. [DOI: 10.1108/09654280910984825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe primary purpose of this paper is to examine the kinds of injuries that preschool teachers working in Indiana, USA, believed to be the most common in their preschool (3‐6 year olds) classrooms, the causes of such injuries, and the most important precautions they take to prevent them. Also examined are the measures the teachers take when an injury occurs.Design/methodology/approachA total of 155 preschool teachers take part in the research by completing a questionnaire. The data are analyzed using basic descriptive statistics.FindingsOn the question of what constituted the most important classroom injury prevention measure, 26 percent of the respondents report “close supervision of children”, 24 percent select “ensuring classroom safety”, 23 percent pick “cautioning children”, 17 percent choose “setting and enforcing rules” in the classroom, 7 percent select “modeling for social behavior” and 3 percent “safe gross motor activities”. With respect to action taken when an injured occurs, 36.1 percent of the respondents report “first aid”, 15.5 percent “comforting children”, 11.6 percent “referring children to school nurse” and “writing injury report”, 10.3 percent “cautioning against running and pushing”, 8.4 percent “explaining injury to children” (8.4 percent) and 6.5 percent “checking the nature of injury”.Originality/valueThis study sheds light on injury causation in preschool classrooms as well as management of such injuries. Results from this data can be used in helping to improve preschool teachers' knowledge of injury in general and of classroom injury in particular.
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Čelko AM, Grivna M, Dáňová J, Barss P. Severe childhood burns in the Czech Republic: risk factors and prevention. Bull World Health Organ 2009; 87:374-81. [PMID: 19551256 PMCID: PMC2678775 DOI: 10.2471/blt.08.059535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess risk factors for paediatric burn injuries in the Czech Republic and to suggest preventive measures. METHODS This study included all children aged 0-16 years hospitalized during 1993-2000 at the Prague Burn Centre and data from the Czech Ministry of Health on national paediatric burn hospitalizations during 1996-2006. Personal, equipment and environmental risk factors were identified from hospital records. FINDINGS The incidence of burn admissions among 0-14 year-olds increased from 85 to 96 per 100,000 between 1996 and 2006, mainly due to a 13% increase among 1-4 year-olds. Between 1993-2000 and 2006, the proportion of burn victims in the country hospitalized at the Prague Burn Centre increased from 9% to 21%. Detailed data were available on 1064 children (64% boys). Around 31% of all burn hospitalizations were in 1 year-olds. Some 79% of burns occurred at home: 70% in the kitchen, 14% in the living room or bedroom and 11% in the bathroom. Of the 18% occurring outdoors, 80% involved boys. Scalds from hot liquids accounted for 70% of all burns. The mean hospital stay was 22 days for boys and 18 days for girls. CONCLUSION Most burns involved scalds from hot liquids at home: beverages in kitchens and water in bathrooms. There is a need for passive preventive measures, such as redesigned domestic cooking and eating areas, safer electrical kettles and temperature control devices for bathrooms. Educational programmes should be developed for parents and caregivers. A national plan for child burn prevention with specific targets would be helpful.
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Affiliation(s)
| | - Michal Grivna
- Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates
| | - Jana Dáňová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Barss
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
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Sutton AJ, Cooper NJ, Jones DR. Evidence synthesis as the key to more coherent and efficient research. BMC Med Res Methodol 2009; 9:29. [PMID: 19405972 PMCID: PMC2681473 DOI: 10.1186/1471-2288-9-29] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 04/30/2009] [Indexed: 12/25/2022] Open
Abstract
Background Systematic review and meta-analysis currently underpin much of evidence-based medicine. Such methodologies bring order to previous research, but future research planning remains relatively incoherent and inefficient. Methods To outline a framework for evaluation of health interventions, aimed at increasing coherence and efficiency through i) making better use of information contained within the existing evidence-base when designing future studies; and ii) maximising the information available and thus potentially reducing the need for future studies. Results The framework presented insists that an up-to-date meta-analysis of existing randomised controlled trials (RCTs) should always be considered before future trials are conducted. Such a meta-analysis should inform critical design issues such as sample size determination. The contexts in which the use of individual patient data meta-analysis and mixed treatment comparisons modelling may be beneficial before further RCTs are conducted are considered. Consideration should also be given to how any newly planned RCTs would contribute to the totality of evidence through its incorporation into an updated meta-analysis. We illustrate how new RCTs can have very low power to change inferences of an existing meta-analysis, particularly when between study heterogeneity is taken into consideration. Conclusion While the collation of existing evidence as the basis for clinical practice is now routine, a more coherent and efficient approach to planning future RCTs to strengthen the evidence base needs to be developed. The framework presented is a proposal for how this situation can be improved.
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