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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
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Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
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Pammer K, Freire M, Gauld C, Towney N. Keeping Safe on Australian Roads: Overview of Key Determinants of Risky Driving, Passenger Injury, and Fatalities for Indigenous Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052446. [PMID: 33801405 PMCID: PMC7967563 DOI: 10.3390/ijerph18052446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Social and cultural barriers associated with inequitable access to driver licensing and associated road safety education, as well as socioeconomic issues that preclude ongoing vehicle maintenance and registration, result in unsafe in-car behaviours such as passenger overcrowding. This in turn is associated with improper seatbelt usage, noncompliance with child restraint mandates, and driver distraction. For example, in Australia, where seatbelt use is mandatory, Indigenous road users are three times less likely to wear seatbelts than non-Indigenous road users. This is associated with a disproportionately high fatality rate for Indigenous drivers and passengers; 21% of Indigenous motor-vehicle occupants killed on Australian roads were not wearing a seatbelt at the time of impact. In addition, inequitable access to driver licensing instruction due to financial and cultural barriers results in Indigenous learner drivers having limited access to qualified mentors and instructors. A consequent lack of road safety instruction results in a normalising of risky driving behaviours, perpetuated through successive generations of drivers. Moreover, culturally biased driver instruction manuals, which are contextualised within an English written-language learning framework, fail to accommodate the learning needs of Indigenous peoples who may encounter difficulties with English literacy. This results in difficulty understanding the fundamental road rules, which in turn makes it difficult for young drivers to develop and sustain safe in-car behaviours. This paper considers the literature regarding road safety for Indigenous road users and critically evaluates strategies and policies that have been advanced to protect Indigenous drivers. Novel solutions to increasing road safety rule compliance are proposed, particularly in relation to passenger safety, which are uniquely embedded within Indigenous ways of knowing, being, and doing. Safe driving practices have crucial health and social implications for Indigenous communities by allowing more Indigenous people to participate in work and education opportunities, access healthcare, maintain cultural commitments, and engage with families and friends, qualities which are essential for ongoing health and wellbeing.
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Affiliation(s)
- Kristen Pammer
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
- Correspondence: ; Tel.: +61-1249-217-980
| | - Melissa Freire
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
| | - Cassandra Gauld
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
| | - Nathan Towney
- Vice-Chancellor’s Division, The University of Newcastle, Callaghan, NSW 2308, Australia;
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Hunter K, Bestman A, Dodd M, Prinsloo M, Mtambeka P, van As S, Peden MM. Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4974. [PMID: 32664272 PMCID: PMC7400026 DOI: 10.3390/ijerph17144974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups.
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Affiliation(s)
- Kate Hunter
- The George Institute for Global Health, The University of New South Wales, Sydney 2042, Australia; (A.B.); (M.D.)
| | - Amy Bestman
- The George Institute for Global Health, The University of New South Wales, Sydney 2042, Australia; (A.B.); (M.D.)
| | - Madeleine Dodd
- The George Institute for Global Health, The University of New South Wales, Sydney 2042, Australia; (A.B.); (M.D.)
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Cape Town 8000, South Africa;
| | - Pumla Mtambeka
- Woolworths Childsafe Research and Educational Centre, Cape Town 7701, South Africa; (P.M.); (S.v.A.)
| | - Sebastian van As
- Woolworths Childsafe Research and Educational Centre, Cape Town 7701, South Africa; (P.M.); (S.v.A.)
- Department of Paediatric Surgery, University of Cape Town, Cape Town 7701, South Africa
| | - Margaret Mary Peden
- The George Institute for Global Health UK, Oxford University, Oxford OX1 2BQ, UK;
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
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Glerum KM, Zonfrillo MR, Fleisher L, McDonald CC. Systematic review of child restraint system interventions (2007-2018). TRAFFIC INJURY PREVENTION 2019; 20:866-872. [PMID: 31725324 DOI: 10.1080/15389588.2019.1666372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/22/2019] [Accepted: 09/07/2019] [Indexed: 06/10/2023]
Abstract
Objective: To systematically review and summarize articles evaluating the effectiveness of child restraint system (CRS) interventions targeting parents/caregivers' knowledge of, overall rates of and/or proper use of CRSs published in a recent time period.Methods: Using multiple databases, we identified peer-reviewed journal articles published between January 1, 2007 and December 31, 2018 using selected key search terms. Inclusion criteria were: (1) evaluation of an intervention/program for child passenger safety targeting a parent or caregiver of a child (2) quantitative data-based results (i.e., change in knowledge, behavior, or observed outcomes), (3) English-language, and (4) peer-reviewed journal publication. Through a systematic review process and peer consensus, n = 23 articles met inclusion criteria. References of these articles were reviewed for inclusion using the same process and n = 12 additional articles were identified.Results: A total of n = 35 articles met inclusion criteria. Of the n = 35 articles, n = 9 were randomized controlled trials (RCTs), n = 4 were cluster RCTs, n = 11 were nonrandomized trials, and n = 11 were pretest post-test studies. Types of interventions included face-to-face education (n = 26), web/video-based education (n = 8) or written educational materials (n = 1). Of the articles reviewed, n = 20 involved distribution of free or subsidized CRSs to some or all subjects. N = 20 articles involved trained CRS technicians and/or CRS installation check-points. In terms of outcomes measured, n = 3 articles assessed changes in knowledge of CRS use, n = 22 assessed changes in CRS behaviors (which includes self-report or observed behavior change), and n = 10 assessed changes in both CRS knowledge and behaviors. All articles (n = 3) that measured changes in knowledge as their only outcome demonstrated positive effects while articles measuring behavioral outcomes (self-report or observed) (n = 32) had mixed results.Conclusions: This review included a wide range of articles of heterogeneous methodologies, sample sizes, and outcomes measured. Although different approaches to CRS interventions were effective in increasing awareness and knowledge, the effects on CRS use behaviors - whether self-reported or observed - were mixed. Future research is needed to increase appropriate CRS use and reduce the burden of motor vehicle crash-related injuries among children.
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Affiliation(s)
- Kimberly M Glerum
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Linda Fleisher
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine C McDonald
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Sartin E, Bell TR, McDonald CC, Mirman JH. Assessment of Caregiver-Targeted Interventions for Use of Motor Vehicle Passenger Safety Systems for Children: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1914180. [PMID: 31664445 PMCID: PMC6824219 DOI: 10.1001/jamanetworkopen.2019.14180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Caregiver-targeted interventions to improve the use of child restraint systems (CRS) in motor vehicles are common and heterogeneous in their implementation. The effectiveness of these interventions is unknown. OBJECTIVES To quantify the effects of caregiver-targeted interventions using meta-analytic methods, assess the quality of published studies, and assess for publication bias. DATA SOURCES PubMed and PsychINFO (January 1, 2004, to April 1, 2019) were searched for English-language studies using a list of search terms. The search and screening process was completed between May 25, 2018, and April 1, 2019. STUDY SELECTION Studies met inclusion criteria if they included a caregiver-targeted intervention that focused on increasing CRS use for children (age, ≤9 years) and report the use of CRS before and after the intervention. DATA EXTRACTION AND SYNTHESES Cochrane and PRISMA guidelines were used for the meta-analysis and risk-of-bias review. Information was extracted on intervention type, setting, implementation, and attributes of the study independently between 2 coders. Data were pooled from independent samples, with 1 outcome measure from each intervention implementation or study. MAIN OUTCOMES AND MEASURES This study was an exploratory random-effects meta-analysis. Unadjusted odds ratios were calculated using the sample size and the observed number of children in incorrect or correct restraints in motor vehicles before and after the intervention to determine the odds of incorrect CRS use after completing an intervention. Setting, measurement method, randomization, use of vouchers, and types of restraint were tested as moderators. A funnel plot was used to assess for publication bias. RESULTS Of 1240 potential articles, 51 were deemed eligible for screening and 10 (8238 participants total) were included in the meta-analysis. Caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS (odds ratio, 0.51; 95% CI, 0.36-0.71; P < .001). Variance in the averaged effect size was driven by self-report methods (when removed from analyses, I2 = 61.8%; R2 change = 26.3; P = .02) and hospital settings (when removed from analyses, I2 = 70.7%; R2 change = 17.4; P = .002). Risk of bias was high in most studies; however, there was low evidence for publication bias. CONCLUSIONS AND RELEVANCE In this meta-analysis, caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS in motor vehicles; however, the methodological rigor of intervention studies should be enhanced.
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Affiliation(s)
- Emma Sartin
- Department of Psychology, University of Alabama at Birmingham
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler R. Bell
- College of Nursing, Pennsylvania State University, Philadelphia
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Jessica Hafetz Mirman
- Department of Psychology, University of Alabama at Birmingham
- The School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
- The Scottish Collaboration for Health Research and Policy, University of Edinburgh, Edinburgh, Scotland
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Evaluation of a Road Safety Education Program Based on Driving Under Influence and Traffic Risks for Higher Secondary School Students in Belgium. SAFETY 2019. [DOI: 10.3390/safety5020034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Road safety education has been recognized as an instrument for reducing road accidents. This study aims to evaluate the road safety education program “Traffic Weeks” among higher secondary school students (age 16–19) in Belgium. The program focuses on driving under influence (DUI) and traffic risks. This study investigates whether the program has an effect on socio-cognitive variables using a questionnaire based on the theory of planned behavior. During the pre-test, 445 students filled in the questionnaire, while 253 students filled in the questionnaire during the post-test. Of these, 175 questionnaires could be matched. The results indicate that the students already had quite a supportive view of road safety at pre-test, with female students showing a more supportive view of road safety than male students. The DUI workshop had a positive effect on most socio-cognitive variables (attitude, subjective norm-friends, and intention) of female students in general education, while the traffic risks workshop only affected perceived behavioral control of female students. In terms of appreciation, students had a significantly higher appreciation of the DUI workshop compared to the traffic risks workshop. During the focus groups, students gave recommendations to improve the program.
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Keay L, Hunter K, Ralph M, Porykali B, Lyford M, Clapham K, Lo W, Ivers R. Overcoming barriers to use of child car seats in an urban Aboriginal community-formative evaluation of a program for Aboriginal Community Controlled Health Services. Pilot Feasibility Stud 2018; 4:161. [PMID: 30377536 PMCID: PMC6195719 DOI: 10.1186/s40814-018-0351-z] [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: 05/28/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats. Methods Focus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members. Results Parents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge. Conclusions We developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial.
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Affiliation(s)
- Lisa Keay
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Kate Hunter
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia.,2The Poche Centre for Indigenous Health, The University of Sydney, Room 224, Edward Ford Building (A27), Sydney, Australia
| | - Martyn Ralph
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Bobby Porykali
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Marilyn Lyford
- 3Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia
| | - Kathleen Clapham
- 4Australian Health Services Research Institute, University of Wollongong, Building 234 (iC Enterprise 1) Innovation Campus, Wollongong, NSW 2522 Australia
| | - Winston Lo
- 5School of Public Health and Community Medicine, University of New South Wales, Sydney, Samuels Avenue, Kensington, Sydney, 2033 Australia
| | - Rebecca Ivers
- 1Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street Newtown, Sydney, 2042 Australia.,5School of Public Health and Community Medicine, University of New South Wales, Sydney, Samuels Avenue, Kensington, Sydney, 2033 Australia
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Clapham K, Bennett-Brook K, Hunter K. The role of Aboriginal family workers in delivering a child safety-focused home visiting program for Aboriginal families in an urban region of New South Wales. Health Promot J Austr 2018; 29:173-182. [PMID: 29742300 DOI: 10.1002/hpja.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/27/2018] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Aboriginal Australian children experience higher rates of injury than other Australian children. However, few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of New South Wales. Delivered by Aboriginal Family Workers (AFWs), the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This study reports on the qualitative interviews which explored the ways in which clients, IAMS staff and external service providers experienced the program and assessed its delivery by the AFWs. METHODS A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. RESULTS The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. CONCLUSIONS Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by AFWs to vulnerable families. Clients, IAMS staff and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT&QUEST This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children.
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Affiliation(s)
- Kathleen Clapham
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, Australia
| | - Keziah Bennett-Brook
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, Australia
| | - Kate Hunter
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Development, Implementation and Evaluation of an Educational Intervention to Prevent Low Speed Vehicle Run-Over Events: Lessons Learned. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040685. [PMID: 29621163 PMCID: PMC5923727 DOI: 10.3390/ijerph15040685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Abstract
There is a growing body of literature regarding low speed vehicle runover (LSVRO) events among children. To date, no literature exists on evaluation of interventions to address this serious childhood injury. Knowledge, attitudes, and behaviour regarding LSVROs were assessed via survey at a shopping centre (pre-intervention), then five months later (post-intervention), to investigate the effect of a population level educational intervention in Queensland, Australia. Participants’ knowledge regarding frequency of LSVRO events was poor. No participant demonstrated ‘adequate behaviour’ in relation to four safe driveway behaviours pre-intervention; this increased at post-intervention (p < 0.05). Most of the sample perceived other’s driveway behaviour as inadequate, and this reduced significantly (<0.05). Perceived effectiveness of LSVRO prevention strategies increased from pre- to post-intervention, but not significantly. TV was the greatest source of knowledge regarding LSVROs pre- and post-intervention. This study provides some evidence that the educational campaign and opportunistic media engagement were successful in increasing awareness and improving behaviour regarding LSVROs. While there are several limitations to this study, our experience reflects the ‘real-world’ challenges associated with implementing prevention strategies. We suggest a multi-faceted approach involving media (including social media), legislative changes, subsidies (for reversing cameras), and education to prevent LSVROs.
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Hunter K, Keay L, Clapham K, Brown J, Bilston LE, Lyford M, Gilbert C, Ivers RQ. "He's the Number One Thing in My World": Application of the PRECEDE-PROCEED Model to Explore Child Car Seat Use in a Regional Community in New South Wales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101206. [PMID: 28994725 PMCID: PMC5664707 DOI: 10.3390/ijerph14101206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/04/2022]
Abstract
We explored the factors influencing the use of age-appropriate car seats in a community with a high proportion of Aboriginal families in regional New South Wales. We conducted a survey and three focus groups with parents of children aged 3–5 years enrolled at three early learning centres on the Australian south-east coast. Survey data were triangulated with qualitative data from focus groups and analysed using the PRECEDE-PROCEED conceptual framework. Of the 133 eligible families, 97 (73%) parents completed the survey including 31% of parents who reported their children were Aboriginal. Use of age-appropriate car seats was reported by 80 (83%) of the participants, and awareness of the child car seat legislation was high (91/97, 94%). Children aged 2–3 years were less likely reported to be restrained in an age-appropriate car seat than were older children aged 4–5 years (60% versus 95%: χ2 = 19.14, p < 0.001). Focus group participants highlighted how important their child’s safety was to them, spoke of the influence grandparents had on their use of child car seats and voiced mixed views on the value of authorised child car seat fitters. Future programs should include access to affordable car seats and target community members as well as parents with clear, consistent messages highlighting the safety benefits of using age-appropriate car seats.
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Affiliation(s)
- Kate Hunter
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Julie Brown
- Neuroscience Research Australia and University of New South Wales, NSW 2052, Sydney, Australia.
| | - Lynne E Bilston
- Neuroscience Research Australia and University of New South Wales, NSW 2052, Sydney, Australia.
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Marilyn Lyford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Celeste Gilbert
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Rebecca Q Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
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Margeson A, Gray S. Interventions Aimed at the Prevention of Childhood Injuries in the Indigenous Populations in Canada, Australia and New Zealand in the Last 20 Years: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060589. [PMID: 28574464 PMCID: PMC5486275 DOI: 10.3390/ijerph14060589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022]
Abstract
Globally, Indigenous children are found to be at a significantly higher risk of injury compared to non-Indigenous children. It has been suggested that mainstream injury prevention strategies are ineffective within Indigenous communities. The aim of this review is to identify existing interventions aimed at preventing injury in Indigenous children in the hope that it guides future strategies. To the best of the authors’ knowledge, no prior systematic reviews exist looking at interventions specifically aimed at preventing injury in Indigenous child populations in the three chosen countries. Electronic databases were systematically searched for relevant childhood interventions aimed at the prevention of injuries in Indigenous populations based in Canada, Australia and New Zealand from 1996 to 2016. A manual search of the reference lists of relevant articles and a manual search of relevant websites were also completed. After 191 records were screened, six interventions were identified meeting the criteria for inclusion. Eligible papers underwent a quality appraisal using adapted assessment checklists and key information was extracted. Findings were then synthesized using a narrative approach. The interventions mainly promoted child safety through activities focusing on education and awareness. Only three of the six studies measured changes in injury hospitalization rates, all but one evaluation reporting a significant decrease. Studies which measured awareness all demonstrated positive changes. Results suggest that interventions delivered in a culturally appropriate manner acted as a main success factor. Barriers identified as hindering intervention success included lack of cohesion within the intervention due to staff turnover and lack of experienced staff with Indigenous knowledge. This review revealed a limited amount of evaluated interventions for the prevention of Indigenous childhood injuries. Conclusive evidence of the effectiveness of existing interventions is lacking due to the predominantly small-scale evaluations of pilot interventions. Future research is needed to provide more rigorous evidence of the mechanisms driving the successful implementation, delivery and uptake of such strategies tailored to Indigenous children.
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Affiliation(s)
- Alyssa Margeson
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Selena Gray
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
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Möller H, Falster K, Ivers R, Falster MO, Clapham K, Jorm L. Closing the Aboriginal child injury gap: targets for injury prevention. Aust N Z J Public Health 2016; 41:8-14. [DOI: 10.1111/1753-6405.12591] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/01/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Holger Möller
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
| | - Kathleen Falster
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
- National Centre for Epidemiology and Population Health; The Australian National University; Australian Capital Territory
- The Sax Institute; New South Wales
| | - Rebecca Ivers
- The George Institute for Global Health; New South Wales
| | - Michael O. Falster
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
| | - Kathleen Clapham
- The Australian Health Services Research Institute; University of Wollongong; New South Wales
| | - Louisa Jorm
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
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Möller H, Falster K, Ivers R, Falster M, Randall D, Clapham K, Jorm L. Inequalities in Hospitalized Unintentional Injury Between Aboriginal and Non-Aboriginal Children in New South Wales, Australia. Am J Public Health 2016; 106:899-905. [PMID: 26890169 DOI: 10.2105/ajph.2015.303022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify inequalities in rates of unintentional injury-related hospitalizations between Australian Aboriginal and non-Aboriginal children. METHODS We used linked hospital and mortality data to construct a retrospective whole-of-population birth cohort including 1,124,717 children born in the state of New South Wales, Australia, between July 1, 2000 and December 31, 2012. We adjusted hazard ratios (HRs) of first injury hospitalization for geographic clustering and individual- and area-level factors. RESULTS Aboriginal children were 1.6 times more likely than were non-Aboriginal children to be hospitalized for an unintentional injury. The largest inequalities were for poisoning (HR = 2.7; 95% CI = 2.4, 3.0) and injuries stemming from exposure to fire, flames, heat, and hot substances (HR = 2.4; 95% CI = 2.1, 2.7). Adjustment reduced the inequality for all unintentional injury overall (HR = 1.4; 95% CI = 1.3, 1.4) and within leading injury mechanisms. CONCLUSIONS Australian Aboriginal children suffer a disproportionately high burden of unintentional injury.
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Affiliation(s)
- Holger Möller
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Kathleen Falster
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Rebecca Ivers
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Michael Falster
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Deborah Randall
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Kathleen Clapham
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Louisa Jorm
- Holger Möller, Michael Falster, Deborah Randall, and Louisa Jorm are with the Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Kathleen Falster is with National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Rebecca Ivers is with the Injury Division, George Institute for Global Health, Sydney, Australia. Kathleen Clapham is with the Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
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