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Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, Hayes M, Jones M, Coupland C, Kendrick D. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-233. [PMID: 36720631 DOI: 10.1136/ip-2022-044745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the effectiveness of systematically delivered evidence-based home safety promotion for improving child home safety practices. DESIGN Controlled before-and-after study. SETTING Nine electoral wards in Nottingham, UK. PARTICIPANTS 361 families with children aged 2-7 months at recruitment living in four intervention wards with high health, education and social need; and 401 in five matched control wards. INTERVENTION Evidence-based home safety promotion delivered by health visiting teams, family mentors and children's centres including 24 monthly safety messages; home safety activity sessions; quarterly 'safety weeks'; home safety checklists. OUTCOMES Primary: composite measure comprising having a working smoke alarm, storing poisons out of reach and having a stairgate. Secondary: other home safety practices; medically attended injuries. Parents completed questionnaires at 12 and 24 months after recruitment plus optional three monthly injury questionnaires. RESULTS At 24 months there was no significant difference between groups in the primary outcome (55.8% vs 48.8%; OR 1.58, 95% CI 0.98 to 2.55) or medically attended injury rates (incidence rate ratio 0.89, 95% CI 0.51 to 1.56), but intervention families were more likely to store poisons safely (OR 1.81, 95% CI 1.06 to 3.07), have a fire escape plan (OR 1.81, 95% CI 1.06 to 3.08), use a fireguard or have no fire (OR 3.17, 95% CI 1.63 to 6.16) and perform more safety practices (β 0.46, 95% CI 0.13 to 0.79). CONCLUSIONS Systematic evidence-based home safety promotion in areas with substantial need increases adoption of some safety practices. Funders should consider commissioning evidence-based multicomponent child home safety interventions. TRIAL REGISTRATION NUMBER ISRCTN31210493.
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Affiliation(s)
- Michael James Taylor
- Healthcare Public Health Team, NHS England and NHS Improvement Midlands, Nottingham, UK .,Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elizabeth Orton
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tina Patel
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Timblin
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Clarke
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Matthew Jones
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Shalev L, Luder A, Spitzer S, Krupik D, Essa-Hadad J, Rudolf MCJ. Keeping our children safe: piloting a hospital-based home-visitation program in Israel. Isr J Health Policy Res 2022; 11:21. [PMID: 35410306 PMCID: PMC8995883 DOI: 10.1186/s13584-022-00525-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety. Methods The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of each visit. Results 352 of 773 eligible families agreed to be contacted. 135 participated, 98 completed both home visits. Significant improvement in home-safety items was observed 4 months after the first visit (14 [IQR12-16]) vs. (17 [IQR15-19]; p < 0.001), accompanied by an overall increase in home safety (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; p < 0.001). 64% reported greater awareness of dangers, 60% affirmed home was safer, and 70% valued the equipment. No difference was found in the prevalence of injuries (14 of 98 families prior and 8 after the visit; p = 0.17). Home visitors reported benefiting from the experience of working with disadvantaged families. Conclusion The program, which included recruitment in a hospital emergency setting and use of healthcare students as home visitors, was successfully implemented and accompanied by significant improvement in home safety with a non-significant trend of child injury decrease.
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Hill T, Coupland C, Kendrick D, Jones M, Akbari A, Rodgers S, Watson MC, Tyrrell E, Merrill S, Orton E. Impact of the national home safety equipment scheme 'Safe At Home' on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022; 76:53-59. [PMID: 34158405 PMCID: PMC8666806 DOI: 10.1136/jech-2021-216613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a 'natural experiment' for evaluating the scheme's impact on hospital admissions for unintentional injuries. METHODS Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision. RESULTS 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11%-0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended. CONCLUSIONS A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.
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Affiliation(s)
- Trevor Hill
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sarah Rodgers
- Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Edward Tyrrell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sheila Merrill
- Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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4
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Safdar O, Filemban A, Hijan B, Alaydarous S, Alharbi A, Ghanem A, Alghamdi R, Bawadood M, Alghamdi S, Saleh S, Aaidarous G, Kadi M, Saif S. Knowledge and attitude of children safety at home among population in Saudi Arabia. J Family Med Prim Care 2022; 11:955-962. [PMID: 35495850 PMCID: PMC9051739 DOI: 10.4103/jfmpc.jfmpc_508_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Unintentional injury to children at home is a public health problem and it is a significant cause of death and disabilities. It accounts for 40% of all child deaths. To our knowledge, there have been no similar studies done on Arabic countries that show the prevalence of home injuries among children. Aim: We aimed to assess the adults’ knowledge and attitude toward child safety at home in Saudi Arabia. Methods: A cross-sectional study was conducted among 1,301 participants, during August 2017, who are older than 18 years old and have at least one child in the family. Data were collected by an online questionnaire assessing the believes, knowledge, and behavior of the participants. Analysis was carried out using IBM SPSS Software version 21, using descriptive analysis, t-test, and one-way ANOVA. Results: It was found that gender, age, marital status, employment status, and the type of accommodation played key roles in the awareness of children safety at home, the study showed that females and age group above 25, married, employees, and those who lived in flats had more awareness than the other groups, respectively. Conclusion: The majority of the population had good awareness about children’s safety at home. Despite the good level of awareness, more public health education is recommended to improve the awareness and the prevention methods of these injuries.
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Babić Ž, Kovačić J, Franić Z, Šakić F, Prester L, Varnai VM, Cvijetić Avdagić S, Bjelajac A, Macan J, Turk R. Prevention of poisonings by educational intervention aimed at parents of preschool children. Int J Inj Contr Saf Promot 2021; 28:486-493. [PMID: 34551681 DOI: 10.1080/17457300.2021.1955936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the study was to assess the effectiveness of the specific design of a poisoning prevention intervention. This controlled before-after study followed Solomon design for educational interventions using two groups (the educational intervention group and the control group). Participants comprised parents of children attending kindergartens under the jurisdiction of the City of Zagreb and in the vicinity of Zagreb. The intervention group (N = 336) underwent an educational intervention during parents' meetings comprising oral presentation by the Croatian Poison Control Centre (CPCC) and distribution of gift packages containing child-proof locks, flyers, and stickers with the CPCC contact number. After the intervention they more frequently started keeping the CPCC's number by their telephone or in the list of important numbers than parents in the control group, and this association remained significant when tested by generalized estimating equations for binary outcomes, after the adjustment for parents' characteristics (age, gender and educational level), and clustered by kindergartens (p < 0.001). This means parents acknowledged the CPCC as an adequate and accessible way for initial management of poisoning incidents.
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Affiliation(s)
- Željka Babić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Kovačić
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Zrinka Franić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Franka Šakić
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Ljerka Prester
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Veda Marija Varnai
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Selma Cvijetić Avdagić
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Adrijana Bjelajac
- Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Macan
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia.,Occupational Health and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Poison Control Centre, Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Abstract
We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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7
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Roberts S, Nolan K, Shearn P, Raynor M, Leng G. NICE update NICE public health guidance update. J Public Health (Oxf) 2020; 42:857-860. [PMID: 31884519 DOI: 10.1093/pubmed/fdz185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
This article covers recently published National Institute for Health and Care Excellence (NICE) guidance relevant to public health and a review of evidence published since we released the NICE guidance on unintentional injury prevention in under 15 year olds. The article features some of this evidence that was found to reinforce published recommendations on safety in the home and on the roads, indicating the guidance remains up to date and relevant. In addition, it importantly highlights that there is great opportunity to prevent future unintentional injury through integrated and coordinated, evidence and intelligence-informed approaches.
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Orton E, Watson MC, Hayes M, Patel T, Jones M, Coupland C, Timblin C, Carpenter H, Kendrick D. Evaluation of the effectiveness, implementation and cost-effectiveness of the Stay One Step Ahead home safety promotion intervention for pre-school children: a study protocol. Inj Prev 2020; 26:573-580. [PMID: 33067223 DOI: 10.1136/injuryprev-2020-043877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unintentional injuries in children under the age of 5 years commonly occur in the home and disproportionately affect those living in disadvantaged circumstances. Targeted home safety promotion should be offered to families most at risk but there is a paucity of standardised evidence-based resources available for use across family-support practitioners. OBJECTIVE To assess the effectiveness, implementation and cost-effectiveness of a 2-year home safety programme (Stay One Step Ahead) developed by parents, practitioners and researchers, and delivered by a range of family support providers in inner-city localities, compared with usual care in matched control localities. METHODS Parents of children aged 0 to 7 months will be recruited to a controlled before and after observational study. The primary outcome is home safety assessed by the proportion of families with a fitted and working smoke alarm, safety gate on stairs (where applicable) and poisons stored out of reach, assessed using parent-administered questionnaires at baseline, 12 and 24 months.Secondary outcomes include: the impact on other parent-reported safety behaviours, medically-attended injuries, self-efficacy for home safety and knowledge of child development and injury risk using questionnaires and emergency department attendance data; implementation (reach, acceptability, barriers, facilitators) of home safety promotion assessed through interviews and observations; and cost-effectiveness using medically-attended injury costs ascertained from healthcare records. CONCLUSION If shown to be effective and cost-effective this study will provide a practical resource to underpin national guidance. The study could inform public health prevention strategies to reduce home injury in children most at risk, while delivering cost savings to health and care services. TRIAL REGISTRATION NUMBER ISRCTN31210493; Pre result.
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Affiliation(s)
- Elizabeth Orton
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | | | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Tina Patel
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | - Matthew Jones
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
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9
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Bhatta S, Mytton J, Deave T. Environmental change interventions to prevent unintentional home injuries among children in low- and middle-income countries: A systematic review and meta-analysis. Child Care Health Dev 2020; 46:537-551. [PMID: 32410304 DOI: 10.1111/cch.12772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/16/2020] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unintentional home injury is an important cause of death and disability among children, especially those living in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs. METHODS Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta-analysis was conducted. RESULTS Four studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta-analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) -0.77; 95% CI [-1.36, -0.19]] and burn-related unsafe practices (MD -0.37; 95% CI [-0.66, -0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD -0.5; 95% CI [-0.66, -0.33]) but not for ingestion hazards. CONCLUSION There is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.
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Affiliation(s)
- Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Toity Deave
- Centre for Academic Child Health, University of the West of England, Bristol, UK
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Rostami-Moez M, Kangavari M, Teimori G, Afshari M, Ebrahimi Khah M. Cultural adaptation for country diversity: A systematic review of injury prevention interventions caused by domestic accidents in children under five years old. Med J Islam Repub Iran 2019; 33:124. [PMID: 32280630 PMCID: PMC7137865 DOI: 10.34171/mjiri.33.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Children under five years old are the most vulnerable in home-injuries. More than half of the accident happens at home. Intervention programs are effective ways to reduce the risk of injuries. The use of cultural strategies has been recommended for effective interventions. The aim of this study was to evaluate cultural adaptability in interventional studies which were performed to prevent injuries caused by domestic accidents in children under five years old in all countries.
Methods: This systematic review has been conducted from June to July 2016. Iran Medex, Magiran, SID from Persian databases and Scopus, Web of Science, Science direct, Pub Med, Biomed central from English databases were employed. Available cultural adaptation guidelines were used to compare the cultural adaptation strategies. A search of studies had been conducted from the creation of databases until July 2016.
Results: Overall, 15 studies were entered into the analyses. The interventional approach in 11 studies was an educational approach. Consequently, 8 studies from 11 reported that they had significantly achieved all expected outcomes. Three studies had used behavioral change models or theories to achieve the desired changes. Seven studies had considered socio-cultural strategy in their interventions, and six studies had reported achieving outcomes. Only seven studies acquired a minimum score of cultural adaptation.
Conclusion: In this systematic review, an educational intervention was effective in preventing child injuries. If cultural strategies are taken into consideration in interventions, they will have a change in behavior in this regard. Also, theoretical frameworks and models can be effective.
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Affiliation(s)
- Masomeh Rostami-Moez
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Kangavari
- Department of Occupational Health and Safety, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamheidar Teimori
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.,Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Maryam Afshari
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marya Ebrahimi Khah
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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11
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Persaud N, Steiner L, Woods H, Aratangy T, Wanigaratne S, Polsky J, Hwang S, Chahal G, Pinto A. Health outcomes related to the provision of free, tangible goods: A systematic review. PLoS One 2019; 14:e0213845. [PMID: 30893372 PMCID: PMC6426236 DOI: 10.1371/journal.pone.0213845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes. METHODS A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463). FINDINGS The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes. INTERPRETATION The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.
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Affiliation(s)
- Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Liane Steiner
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Tatiana Aratangy
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Jane Polsky
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Gurleen Chahal
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Andrew Pinto
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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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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13
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Alrimawi I, Hall C, Watson MC. Palestinian Nurses' and Doctors' Perceptions and Practices Regarding the Prevention of Injuries to Children in the Home: An Explorative Qualitative Study. Compr Child Adolesc Nurs 2018; 42:172-189. [PMID: 29578812 DOI: 10.1080/24694193.2018.1446058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Unintentional injuries are a growing global public health problem that causes mortality, morbidity, and disability among children. These injuries are common among under-fives and form a significant burden on healthcare systems, particularly in low- and middle-income countries. Nurses and doctors have a major role to play in the prevention of home injuries, as expressed in many international reports. In Palestine, there is a paucity of research in this area. Therefore, this study aims to explore nurses' and doctors' perceptions and practices regarding the prevention of home injuries among children aged under-five years. A qualitative approach was followed, whereby semi-structured interviews were undertaken with 24 nurses and doctors who worked with children in a primary health care setting. The derived data were analyzed using thematic analysis. This study found that most of the nurses and doctors who were interviewed reported positive attitudes toward working on this topic; the majority of them attempted to work on injury prevention. Nevertheless, they needed further support to fulfil this potential role, as they faced many barriers in their daily practice in this area. Policy makers could potentially take advantage of this attitude and support them by providing training, resources, and time for them to implement this role.
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Affiliation(s)
- Intima Alrimawi
- School of Nursing, Stratford University , Falls Church , Virginia , USA
| | - Carol Hall
- School of Health Sciences, Queen's Medical Centre, University of Nottingham , Nottingham , UK
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Zonfrillo MR, Gittelman MA, Quinlan KP, Pomerantz WJ. Outcomes after injury prevention counselling in a paediatric office setting: a 25-year review. BMJ Paediatr Open 2018; 2:e000300. [PMID: 29942868 PMCID: PMC6014223 DOI: 10.1136/bmjpo-2018-000300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Injury is the leading cause of death and acquired disability in children. Primary care providers routinely provide age-appropriate injury prevention (IP) counselling during healthcare visits. The objective was to review evaluations of the effectiveness of office-based paediatric IP counselling research. DESIGN This review identified studies from July 1991 to June 2016 of children <5 years and their caretakers to determine the effectiveness of office-based counselling on IP knowledge, behaviours and outcomes. Studies were included if they had: (1) an intervention for a family with a child <5 years of age; (2) an unintentional injury mechanism addressed during counselling; (3) one or more mechanisms recommended to be discussed for children <5 years in the 2007American Academy of Pediatrics Policy Statement; (4) counselling occurring in the office setting; (5) an assessment of an outcome (eg, change in knowledge, behaviour or injury occurrences); and (6) English-language publication. Study characteristics (whether the study was controlled, randomised and/or blinded), target safety behaviours, the sample size, outcomes assessed (injuries, behaviour changes and/or education changes) and demonstrated effects were summarised. RESULTS Sixteen articles met inclusion criteria. Twelve articles were randomised controlled trials, three were non-randomised trials and one was a pretest and post-test study. Fourteen articles measured a change in knowledge or reported behaviour, four included observed behaviour change and five measured change in injury outcomes. Thirteen of the 16 studies had positive effects demonstrated for certain outcomes, including for fall, poisoning, burn, fire, traffic injury and drowning prevention, while 10 showed no differences between study groups for other outcomes. CONCLUSIONS Published outcomes-based IP-related counselling research in the primary care setting for young children is infrequent, and additional research is necessary to further describe the effectiveness of these primary prevention efforts.
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Affiliation(s)
- Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Michael A Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kyran P Quinlan
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Wendy J Pomerantz
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Scholtes B, Schröder-Bäck P. Ethical considerations for the design and implementation of child injury prevention interventions: the example of delivering and installing safety equipment into the home. Inj Prev 2017; 25:217-221. [PMID: 29229774 DOI: 10.1136/injuryprev-2017-042542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Public health ethics is a growing field of academic interest but ethical discussion of injury prevention seems to have received limited attention. Interventions that promise to be effective are not necessarily-without explicit justification-'good' and 'right' interventions in every sense. This paper explores public health ethics in the context of child injury prevention with the objective to initiate interdisciplinary dialogue on the ethics of child safety interventions. METHOD A framework of seven public health ethics principles (non-maleficence, health maximisation, beneficence, respect for autonomy, justice, efficiency and proportionality) were applied to an intervention to promote child safety in the home. RESULTS Preventing child injury in the home is ethically challenging due to the requirement for the state to intervene in the private sphere. Non-maleficence and beneficence are difficult to judge within this intervention as these are likely to be highly dependent on the nature of intervention delivery, in particular, the quality of communication. Respect for autonomy is challenged by an intervention occurring in the home. The socioeconomic gradient in child injury risk is an important factor but a nuanced approach could help to avoid exacerbating inequalities or stigmatisation. Equally, a nuanced approach may be necessary to accommodate the principles of proportionality and efficiency within the local context. CONCLUSION We conclude that this intervention is justifiable from an ethical perspective but that this type of reflection loop is helpful to identify the impact of interventions beyond effectiveness.
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Affiliation(s)
- Beatrice Scholtes
- Department of International Health, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
- Department of Public Health, University of Liège, Liège, Belgium
| | - Peter Schröder-Bäck
- Department of International Health, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
- Faculty for Human Sciences & Health Sciences, University of Bremen, Bremen, Germany
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 2017; 24:41-47. [PMID: 28385953 DOI: 10.1136/injuryprev-2016-042178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Toddler-aged children are vulnerable to unintentional injuries, especially those in low-income families. OBJECTIVE To examine the effectiveness of an intervention grounded in social cognitive theory (SCT) on the reduction of home safety problems among low-income families with toddlers. METHODS 277 low-income mother-toddler dyads were randomised into a safety promotion intervention (n=91) or an attention-control group (n=186). Mothers in the safety promotion intervention group received an eight-session, group-delivered safety intervention targeting fire prevention, fall prevention, poison control and car seat use, through health education, goal-setting and social support. Data collectors observed participants' homes and completed a nine-item checklist of home safety problems at study enrolment (baseline), 6 and 12 months after baseline. A total score was summed, with high scores indicating more problems. Linear mixed models compared the changes over time in home safety problems between intervention and control groups. RESULTS The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up (between-group difference in change over time β=-0.54, 95% CI -0.05 to -1.03, p=0.035), with no significant differences at the 6-month follow-up. CONCLUSIONS A safety promotion intervention built on principles of SCT has the potential to promote toddlers' home safety environment. Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinically important improvement in home safety practices. TRIAL REGISTRATION NUMBER NCT02615158; post-results.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea C Gielen
- The Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,RTI International, Research Triangle Park, North Carolina, USA
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Kendrick D, Zou K, Ablewhite J, Watson M, Coupland C, Kay B, Hawkins A, Reading R. Risk and protective factors for falls on stairs in young children: multicentre case-control study. Arch Dis Child 2016; 101:909-16. [PMID: 26662926 PMCID: PMC5050281 DOI: 10.1136/archdischild-2015-308486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/06/2015] [Indexed: 11/21/2022]
Abstract
AIM To investigate risk and protective factors for stair falls in children aged <5 years. METHODS Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Cases were children with medically attended stair fall injuries. Controls were matched on age, sex, calendar time and study centre. A total of 610 cases and 2658 controls participated. RESULTS Cases' most common injuries were bangs on the head (66%), cuts/grazes not requiring stitches (14%) and fractures (12%). Parents of cases were significantly more likely not to have stair gates (adjusted OR (AOR) 2.50, 95% CI 1.90 to 3.29; population attributable fraction (PAF) 21%) or to leave stair gates open (AOR 3.09, 95% CI 2.39 to 4.00; PAF 24%) both compared with having closed stair gates. They were more likely not to have carpeted stairs (AOR 1.52, 95% CI 1.09 to 2.10; PAF 5%) and not to have a landing part-way up their stairs (AOR 1.34, 95% CI 1.08 to 1.65; PAF 18%). They were more likely to consider their stairs unsafe to use (AOR 1.46, 95% CI 1.07 to 1.99; PAF 5%) or to be in need of repair (AOR 1.71, 95% CI 1.16 to 2.50; PAF 5%). CONCLUSION Structural factors including having landings part-way up the stairs and keeping stairs in good repair were associated with reduced stair fall injury risk. Family factors including having stair gates, not leaving gates open and having stair carpets were associated with reduced injury risk. If these associations are causal, addressing these factors in housing policy and routine child health promotion could reduce stair fall injuries.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - K Zou
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - J Ablewhite
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - M Watson
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - B Kay
- Emergency Department, Bristol Children's Hospital, Bristol, UK
| | - A Hawkins
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Research Unit Level 2, Newcastle upon Tyne, UK
| | - R Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Norfolk Community Health and Care NHS Trust, Norwich, UK
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Morrongiello BA, Bell M, Park K, Pogrebtsova K. Evaluation of the Safety Detective Program: A Classroom-Based Intervention to Increase Kindergarten Children's Understanding of Home Safety Hazards and Injury-Risk Behaviors to Avoid. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:102-11. [PMID: 26245526 DOI: 10.1007/s11121-015-0581-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Home injuries are a leading cause of mortality and morbidity for young children. Most programs that aim to improve their knowledge of home safety have been narrowly focused on one injury type and/or required specialized personnel for delivery. The purpose of the current study was to evaluate the effectiveness of a new Safety Detective Program that was designed to teach young children (4-6 years) about several types of home safety hazards and unsafe behaviors, with the program delivered in a classroom setting by non-experts based on manualized training. The current study used a randomized group, pre-post design to evaluate the effectiveness of the program to increase children's knowledge and understanding of home safety hazards and injury-risk behaviors to avoid. Children participated in six structured sessions, covering burns, falls, drowning, and poisoning. Each session involved play-based activities (storybook, song, and game or craft) to teach main messages about hazards and injury-risk behaviors, a take home activity, and a parent information sheet about the injury type covered that day. An individually administered photo-sort task with follow-up interview was used to measure intervention and control group participants' knowledge and understanding of injury-risk behaviors before and after program delivery. Children in the intervention, but not the control, group exhibited significant gains in their knowledge and understanding of home safety hazards and injury-risk behaviors to avoid, establishing the effectiveness of the program. This evaluation indicates that the Safety Detective Program can be delivered in classrooms without requiring specialized personnel or extensive training and with positive changes obtained. The program holds much promise as a means of improving kindergarten children's understanding of a broad range of home hazards and injury-risk behaviors that are relevant to their safety.
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Affiliation(s)
- Barbara A Morrongiello
- Psychology Department, University of Guelph, MacKinnon Building-Trent Lane, Guelph, Ontario, N1G 2W1, Canada.
| | - Melissa Bell
- Psychology Department, University of Guelph, MacKinnon Building-Trent Lane, Guelph, Ontario, N1G 2W1, Canada
| | - Katey Park
- Psychology Department, University of Guelph, MacKinnon Building-Trent Lane, Guelph, Ontario, N1G 2W1, Canada
| | - Katya Pogrebtsova
- Psychology Department, University of Guelph, MacKinnon Building-Trent Lane, Guelph, Ontario, N1G 2W1, Canada
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Malone M, Whittaker KA, Cowley S, Ezhova I, Maben J. Health visitor education for today's Britain: Messages from a narrative review of the health visitor literature. NURSE EDUCATION TODAY 2016; 44:175-186. [PMID: 27429349 DOI: 10.1016/j.nedt.2016.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 03/28/2016] [Accepted: 04/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This paper draws on a narrative review of the literature, commissioned to support the Health Visitor Implementation Plan, and aimed at identifying messages about the knowledge, skills, and abilities needed by health visitors to work within the current system of health care provision. DESIGN The scoping study and narrative review used three complementary approaches: a broad search, a structured search, and a seminal paper search to identify empirical papers from the health visitor literature for review. The key inclusion criteria were messages of relevance for practice. DATA SOURCES 378 papers were reviewed. These included empirical papers from the United Kingdom (UK) from 2004 to February 2012, older research identified in the seminal paper search and international literature from 2000 to January 2016. REVIEW METHODS The review papers were read by members of the multidisciplinary research team which included health visitor academics, social scientists, and a clinical psychologist managed the international literature. Thematic content analysis was used to identify main messages. These were tabulated and shared between researchers in order to compare emergent findings and to confirm dominant themes. RESULTS The analysis identified an 'orientation to practice' based on salutogenesis (health creation), human valuing (person-centred care), and viewing the person in situation (human ecology) as the aspirational core of health visitors' work. This was realised through home visiting, needs assessment, and relationship formation at different levels of service provision. A wide range of knowledge, skills, and abilities were required, including knowledge of health as a process and skills in engagement, building trust, and making professional judgments. These are currently difficult to impart within a 45week health visitor programme and are facilitated through ad hoc post-registration education and training. The international literature reported both similarities and differences between the working practices of health visitors in the UK and public health nurses worldwide. Challenges related to the education of each were identified. CONCLUSIONS The breadth and scope of knowledge, skills, and abilities required by health visitors make a review of current educational provision desirable. Three potential models for health visitor education are described.
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Affiliation(s)
- Mary Malone
- Dept of Child and Adolescent Nursing and the Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, UK.
| | | | - Sarah Cowley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | | | - Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Wynn PM, Zou K, Young B, Majsak-Newman G, Hawkins A, Kay B, Mhizha-Murira J, Kendrick D. Prevention of childhood poisoning in the home: overview of systematic reviews and a systematic review of primary studies. Int J Inj Contr Saf Promot 2015; 23:3-28. [DOI: 10.1080/17457300.2015.1032978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Gosia Majsak-Newman
- NHS Clinical Research and Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adrian Hawkins
- Great North Children's Hospital, New Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Bryony Kay
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | | | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
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22
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Benford P, Young B, Coupland C, Watson M, Hindmarch P, Hayes M, Goodenough T, Majsak-Newman G, Kendrick D. Risk and protective factors for falls on one level in young children: multicentre case-control study. Inj Prev 2015; 21:381-8. [PMID: 26271259 DOI: 10.1136/injuryprev-2015-041581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood falls are an important global public health problem, but there is lack of evidence about their prevention. Falls on one level result in considerable morbidity and they are costly to health services. OBJECTIVE To estimate ORs for falls on one level in children aged 0-4 years for a range of safety behaviours, safety equipment use and home hazards. DESIGN, SETTING AND PARTICIPANTS Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Participants included 582 children less than 5 years of age with a medically attended fall injury occurring at home and 2460 controls matched on age, sex, calendar time and study centre. MAIN OUTCOME MEASURE Fall on one level. RESULTS Cases' most common injuries were bangs on the head (52%), cuts or grazes not needing stitches (29%) or cuts or grazes needing stitches (17%). Comparing cases to community controls in the adjusted analyses, significant findings were observed for only two exposures. Injured children were significantly less likely to live in a household without furniture corner covers (adjusted OR (AOR) 0.72, 95% CI 0.55 to 0.95), or without rugs and carpets firmly fixed to the floor (AOR 0.76, 95% CI 0.59 to 0.98). CONCLUSIONS We did not find any safety practices, use of safety equipment or home hazards associated with a reduced risk of fall on one level. Our findings do not provide evidence to support changes to current injury prevention practice.
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Affiliation(s)
- P Benford
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - B Young
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Watson
- School of Health Sciences, University of Nottingham, D86, Queen's Medical Centre, Nottingham, UK
| | - P Hindmarch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - M Hayes
- Child Accident Prevention Trust, London, UK
| | - T Goodenough
- Centre for Child & Adolescent Health, University of the West of England, Bristol, UK
| | - G Majsak-Newman
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - D Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Hubbard S, Cooper N, Kendrick D, Young B, Wynn PM, He Z, Miller P, Achana F, Sutton A. Network meta-analysis to evaluate the effectiveness of interventions to prevent falls in children under age 5 years. Inj Prev 2014; 21:98-108. [PMID: 25062752 DOI: 10.1136/injuryprev-2013-041135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to simultaneously evaluate the effectiveness of a range of interventions to increase the possession of safety equipment or behaviours to prevent falls in children under 5 years of age in the home. METHODS A recently published systematic review identified studies to be included in a network meta-analysis; an extension of pairwise meta-analysis that enables comparison of all evaluated interventions simultaneously, including comparisons not directly compared in individual studies. RESULTS 29 primary studies were identified, of which 16 were included in at least 1 of 4 network meta-analyses. For increasing possession of a fitted stair gate, the most intensive intervention (including education, low cost/free home safety equipment, home safety inspection and fitting) was the most likely to be the most effective, with an OR versus usual care of 7.80 (95% CrI 3.08 to 21.3). For reducing possession or use of a baby walker: education only was most likely to be most effective, with an OR versus usual care of 0.48 (95% CrI 0.31 to 0.84). Little difference was found between interventions for possession of window locks (most intensive intervention versus usual care OR=1.56 (95% CrI 0.02 to 89.8)) and for not leaving a child alone on a high surface (education vs usual care OR=0.89 (95% CrI 0.10 to 9.67)). There was insufficient evidence for network meta-analysis for possession and use of bath mats. CONCLUSIONS These results will inform healthcare providers of the most effective components of interventions and can be used in cost-effectiveness analyses.
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Affiliation(s)
- Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Zhimin He
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Philip Miller
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention (Review). ACTA ACUST UNITED AC 2014; 8:761-939. [PMID: 23877910 DOI: 10.1002/ebch.1911] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD. There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92). Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96). Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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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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27
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Morrongiello BA, Zdzieborski D, Sandomierski M, Munroe K. Results of a randomized controlled trial assessing the efficacy of the Supervising for Home Safety program: Impact on mothers' supervision practices. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:587-595. [PMID: 22771287 DOI: 10.1016/j.aap.2012.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/03/2012] [Accepted: 06/05/2012] [Indexed: 06/01/2023]
Abstract
Unintentional injury constitutes a major health risk for young children, with many injuries occurring in the home. Although active supervision by parents has been shown to be effective to prevent injuries, evidence indicates that parents do not consistently apply this strategy. To address this issue, a randomized controlled trial was conducted to evaluate the impact of the Supervising for Home Safety program on parent supervision practices in the home and when unobtrusively observed in a naturalistic laboratory setting. Using a participant-event monitoring procedure, parents of children aged 2 through 5 years completed supervision recording sheets weekly both before and after exposure to the intervention program; Control parents completed the same measures but received a program focusing on child nutrition and active lifestyles. Unobtrusive video recordings of parent supervision of their child in a room containing contrived hazards also were taken pre- and post-intervention. Results indicated that groups did not differ in demographic characteristics. Comparisons of post- with pre-intervention diary reported home supervision practices revealed a significant decrease in time that children were unsupervised, an increase in in-view supervision, and an increase in level of supervision when children were out of view, with all changes found only for the Intervention group. Similarly, only parents in the Intervention group showed a significant increase in attention to the child in the contrived hazards context, with these differences evident immediately after and 3 months after exposure to the intervention. These results provide the first evidence that an intervention program can positively impact caregiver supervision.
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28
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Lee LK, Walia T, Forbes PW, Osganian SK, Samuels R, Cox JE, Mooney DP. Home safety practices in an urban low-income population: level of agreement between parental self-report and observed behaviors. Clin Pediatr (Phila) 2012; 51:1119-24. [PMID: 22967813 DOI: 10.1177/0009922812460083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.
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Affiliation(s)
- Lois K Lee
- Children's Hospital Boston, Boston, MA 02115, USA.
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29
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Othman N, Kendrick D. Risk factors for burns at home in Kurdish preschool children: a case-control study. Inj Prev 2012; 19:184-90. [DOI: 10.1136/injuryprev-2012-040412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2012; 2012:CD005014. [PMID: 22972081 PMCID: PMC9758703 DOI: 10.1002/14651858.cd005014.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK.
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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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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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Cooper NJ, Kendrick D, Achana F, Dhiman P, He Z, Wynn P, Le Cozannet E, Saramago P, Sutton AJ. Network meta-analysis to evaluate the effectiveness of interventions to increase the uptake of smoke alarms. Epidemiol Rev 2011; 34:32-45. [PMID: 22128085 DOI: 10.1093/epirev/mxr015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study is the first known to use network meta-analysis to simultaneously evaluate the effectiveness of interventions to increase the prevalence of functioning smoke alarms in households with children. The authors identified 24 primary studies from a systematic review of reviews and of more recently published primary studies, of which 23 (17 randomized controlled trials and 6 nonrandomized comparative studies) were included in 1 of the following 2 network meta-analyses: 1) possession of a functioning alarm: interventions that were more "intensive" (i.e., included components providing equipment (with or without fitting), home inspection, or both, in addition to education) generally were more effective. The intervention containing all of the aforementioned components was identified as being the most likely to be the most effective (probability (best) = 0.66), with an odds ratio versus usual care of 7.15 (95% credible interval: 2.40, 22.73); 2) type of battery-powered alarms: ionization alarms with lithium batteries were most likely to be the best type for increasing functioning possession (probability (best) = 0.69). Smoke alarm promotion programs should ensure they provide the combination of interventions most likely to be effective.
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Affiliation(s)
- Nicola J Cooper
- Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom.
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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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Turner S, Arthur G, Lyons RA, Weightman AL, Mann MK, Jones SJ, John A, Lannon S. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2011; 2011:CD003600. [PMID: 21328262 PMCID: PMC7003565 DOI: 10.1002/14651858.cd003600.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Injury in the home is common, accounting for approximately a third of all injuries. The majority of injuries to children under five and people aged 75 and older occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained. OBJECTIVES To determine the effect of modifications to the home environment on the reduction of injuries due to environmental hazards. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE and other specialised databases. We also scanned conference proceedings and reference lists. We contacted the first author of all included randomised controlled trials. The searches were last updated to the end of December 2009, and were not restricted by language or publication status. SELECTION CRITERIA Randomised controlled trials. DATA COLLECTION AND ANALYSIS Two authors screened all abstracts for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. We performed meta-analysis to combine effect measures, using a random-effects model. We assessed heterogeneity using an I(2) statistic and a Chi(2) test. MAIN RESULTS We found 28 published studies and one unpublished study. Only two studies were sufficiently similar to allow pooling of data for statistical analyses. Studies were divided into three groups; children, older people and the general population/mixed age group. None of the studies focusing on children or older people demonstrated a reduction in injuries that were a direct result of environmental modification in the home. One study in older people demonstrated a reduction in falls and one a reduction in falls and injurious falls that may have been due to hazard reduction. One meta-analysis was performed which examined the effects on falls of multifactorial interventions consisting of home hazard assessment and modification, medication review, health and bone assessment and exercise (RR 1.09, 95% CI 0.97 to 1.23). AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether interventions focused on modifying environmental home hazards reduce injuries. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials. Researchers should also consider using factorial designs to allow the evaluation of individual components of multifactorial interventions.
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Affiliation(s)
- Samantha Turner
- Swansea UniversitySchool of MedicineGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Geri Arthur
- School of MedicinePublic Health Wales; Swansea UniversityGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Ronan A Lyons
- Swansea UniversitySchool of MedicineGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Alison L Weightman
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Mala K Mann
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Sarah J Jones
- Cardiff UniversityPublic Health Wales; Department of Primary Care and Public HealthHeath ParkCardiffUKCF14 4XN
| | - Ann John
- School of MedicinePublic Health Wales; Swansea UniversityGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Simon Lannon
- Cardiff UniversityWelsh School of ArchitectureBute BuildingCardiffUKCF10 3NB
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Pearson M, Garside R, Moxham T, Anderson R. Preventing unintentional injuries to children in the home: a systematic review of the effectiveness of programmes supplying and/or installing home safety equipment. Health Promot Int 2010; 26:376-92. [DOI: 10.1093/heapro/daq074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Health Visiting—The end of a UK wide service? Health Policy 2009; 93:93-101. [DOI: 10.1016/j.healthpol.2009.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 07/30/2009] [Accepted: 08/02/2009] [Indexed: 11/22/2022]
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Race and ethnic differences in a multicenter study of home safety with vouchers redeemable for free safety devices. ACTA ACUST UNITED AC 2009; 67:S3-11. [PMID: 19590350 DOI: 10.1097/ta.0b013e3181ac1a7d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most injuries to infants occur at home and are known to have a modifiable component. Additional information on safety behaviors, practices, and device ownership could inform prevention programs aimed at reducing injury-related race and ethnic disparities. METHODS This study is a secondary data analysis of race and ethnic differences in home safety using data collected by the Connecticut, Ohio, Pennsylvania, Minnesota, and New York sites of the Injury Free Coalition for Kids. Study participants were English- and Spanish-speaking parents/guardians of infants aged 4 months to 6 months. All participants received a voucher redeemable for free safety devices and educational materials. RESULTS Five hundred forty-two study participants were 37.8% black, 41.7% Hispanic, 10.5% white, and 10.0% other race. Whites more frequently owned/had safety devices including cabinet latches (chi2 =28.9, p < 0.0001), drawer latches (chi2 =21.4, p < 0.0001), bath thermometers (chi2 =22.5, p < 0.0001), electric outlet covers (chi2 =15.9, p = 0.0004), and poison control number (chi 2=93.8, p < 0.0001). Practice of unsafe behaviors, such as stomach sleep position, was higher in blacks (29.3%) than whites (15.8%) or Hispanics (17.7%) (chi2 =11.8, p < 0.0083). Overall, 62.1% redeemed vouchers, but this varied significantly by ethnicity: blacks (42.2%), non-Hispanic whites (64.6%), and Hispanics (76.3%) (chi2 = 48.5, p < 0.0001). CONCLUSIONS Compared with whites, both blacks and Hispanics were less likely to own a variety of safety devices at baseline, but Hispanics were more likely than blacks to redeem vouchers. This one shot voucher program was effective at increasing device ownership, but was not sufficient alone to achieve population saturation of safety devices.
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Morrongiello BA, Zdzieborski D, Sandomierski M, Lasenby-Lessard J. Video messaging: What works to persuade mothers to supervise young children more closely in order to reduce injury risk? Soc Sci Med 2009; 68:1030-7. [DOI: 10.1016/j.socscimed.2008.12.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Indexed: 10/21/2022]
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Kendrick D, Mulvaney C, Watson M. Does targeting injury prevention towards families in disadvantaged areas reduce inequalities in safety practices? HEALTH EDUCATION RESEARCH 2009; 24:32-41. [PMID: 18203681 DOI: 10.1093/her/cym083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Inequalities in childhood injury and safety practices exist, but there is little evidence that targeted interventions can reduce such inequalities. This study examines the effect of a home safety intervention on reducing inequalities in safety practices using a secondary analysis of data from a randomized controlled trial. Families with children <5 years from disadvantaged areas were randomized to receive a standardized health visitor safety consultation and free or low-cost safety equipment fitted in the home or to usual care. The impact of the intervention in terms of stair gate use and functioning smoke alarms was compared by ethnic group, maternal age, housing tenure, family type and receipt of state-provided means-tested benefits at 1-year follow-up. Marked inequalities were found for both safety practices by each socio-economic characteristic prior to the intervention. The intervention significantly reduced inequalities in stair gate use by housing tenure (P = 0.006) and receipt of benefits (P = 0.04), but did not reduce inequalities in functioning smoke alarms. We conclude that a home safety intervention targeted at deprived areas addressing the barriers of cost and needing help to fit equipment was only partially successful in reducing inequalities in safety practices. Other strategies will be required to reduce inequalities especially in relation to functioning smoke alarms.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham, UK.
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Dixon SL, Fowler C, Harris J, Moffat S, Martinez Y, Walton H, Ruiz B, Jacobs DE. An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families. ENVIRONMENTAL RESEARCH 2009; 109:123-130. [PMID: 19038383 DOI: 10.1016/j.envres.2008.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 09/26/2008] [Accepted: 10/03/2008] [Indexed: 05/27/2023]
Abstract
We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting.
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Affiliation(s)
- Sherry L Dixon
- The National Center for Healthy Housing, 10320 Little Patuxent Parkway, Suite 500, Columbia, MD 21044, USA.
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Kendrick D, Watson MC, Mulvaney CA, Smith SJ, Sutton AJ, Coupland CAC, Mason-Jones AJ. Preventing childhood falls at home: meta-analysis and meta-regression. Am J Prev Med 2008; 35:370-379. [PMID: 18779031 DOI: 10.1016/j.amepre.2008.06.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 04/18/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Childhood falls are an important global public health problem, but evidence on their prevention has not been quantitatively synthesized. Despite social inequalities in childhood injury rates, there is a lack of evidence examining the effect of fall-prevention practices by social group. METHODS A systematic review of literature was conducted up to June 2004 and meta-analysis using individual patient data to evaluate the effect of home-safety interventions on fall-prevention practices and fall-injury rates. Meta-regression examined the effect of interventions by child age, gender, and social variables. Included were 21 studies, 13 of which contributed to meta-analyses. RESULTS Home-safety interventions increased stair-gate use (OR=1.26; 95% CI=1.05, 1.51), and there was some evidence of reduced baby-walker use (OR=0.66; 95% CI=0.43, 1.00), but little evidence of increased possession of window locks, screens, or windows with limited opening (OR=1.16, 95% CI=0.84, 1.59) or of nonslip bath mats or decals (OR=1.15; 95% CI=0.51, 2.62). Two studies reported nonsignificant effects on falls (baby-walker-related falls on flat ground [OR=1.35; 95% CI=0.64, 2.83] or down steps or stairs [OR=0.70; 95% CI=0.14, 3.49]) and medically attended falls (OR=0.78; 95% CI=0.61, 1.00). CONCLUSIONS Home-safety education and the provision of safety equipment improved some fall-prevention practices, but the impact on fall-injury rates is unclear. There was some evidence that the effect of home-safety interventions varied by social group.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, School of Nursing, University of Nottingham, Hucknall Primary Care Trust, Hucknall Health Centre, Nottingham, England, UK.
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Morrongiello BA, Schwebel DC. Gaps in Childhood Injury Research and Prevention: What Can Developmental Scientists Contribute? CHILD DEVELOPMENT PERSPECTIVES 2008. [DOI: 10.1111/j.1750-8606.2008.00046.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beirens TMJ, Brug J, van Beeck EF, Dekker R, den Hertog P, Raat H. Assessing psychosocial correlates of parental safety behaviour using Protection Motivation Theory: stair gate presence and use among parents of toddlers. HEALTH EDUCATION RESEARCH 2008; 23:723-731. [PMID: 17947245 PMCID: PMC2446409 DOI: 10.1093/her/cym058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 08/26/2007] [Indexed: 05/25/2023]
Abstract
Unintentional injury due to falls is one of the main reasons for hospitalization among children 0-4 years of age. The goal of this study was to assess the psychosocial correlates of parental safety behaviours to prevent falls from a staircase due to the lack of or the lack of adequate use of a stair gate. Data were collected from a cross-sectional survey using self-administered questionnaires mailed to a population sample of 2470 parents with toddlers. Associations between self-reported habits on the presence and use of stair gates and family and psychosocial factors were analysed, using descriptive statistics and multiple regression models, based on Protection Motivation Theory. The presence of stair gates was associated with family situation, perceived vulnerability, response efficacy, social norms and descriptive norms. The use of stair gates was associated with family situation, response efficacy, self-efficacy and perceived advantages of safe behaviour. The full model explained 32 and 24% of the variance in the presence of stair gates and the use of stair gates, respectively, indicating a large and medium effect size. Programmes promoting the presence and adequate use of stair gates should address the family situation, personal cognitive factors as well as social factors.
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Affiliation(s)
- T M J Beirens
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
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Reading R, Jones A, Haynes R, Daras K, Emond A. Individual factors explain neighbourhood variations in accidents to children under 5 years of age. Soc Sci Med 2008; 67:915-27. [PMID: 18573579 DOI: 10.1016/j.socscimed.2008.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Indexed: 11/26/2022]
Abstract
Previous studies have identified possible neighbourhood-level influences on the risk of injuries to preschool children, but none have had sufficient data at both household and area level to explain these neighbourhood effects. We used data from the Avon Longitudinal Study of Parents and Children, which recruited over 14,062 children at birth in the former county of Avon, UK, and collected information about accidents, as well as extensive social, health and developmental data throughout the first 5 years of life. This information was combined with census and geographical data in order to identify neighbourhood influences on accident risks and then attempt to explain these using multilevel regression modelling. A small but statistically significant amount of between-neighbourhood variance in accident risk was found, with neighbourhood intraclass correlation coefficients of 0.82% for any accident, and 0.84% for accidents resulting in injury requiring medical attention. This was entirely accounted for by a variety of child, parental and household level variables. Independent risk factors for both outcomes were children who were developmentally more advanced or displayed greater conduct and behavioural problems, mothers who were of younger age, who were without work, who were smokers, whose partners were unemployed or drank alcohol excessively, and households in which there had recently been adverse life events, or which were under financial stress. The mother's perceptions of neighbourhood quality also explained some of the risks for any accident, but not for medically attended accidents, and this was a variable that operated at the level of individual households rather than at the level of neighbourhoods. The implications of this study are that differences in accident risk between neighbourhoods are explained by geographical clustering of similar types of children, families and households. Interventions should focus more on parental factors and household social circumstances than on the physical environment or community based risks. However, many of these factors are those most resistant to modification without broader societal change.
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Affiliation(s)
- Richard Reading
- School of Medicine Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
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Abstract
The methodology described here was developed for a systematic review and individual participant-level meta-analysis of home safety education and the provision of safety equipment for the prevention of childhood accidents. This review had a particular emphasis on exploring whether effectiveness was related to socio-demographic characteristics previously shown to be associated with injury risk. Individual participant data were only made available to us for a proportion of the included studies. This resulted in the need for developing a new methodology to combine the available data most efficiently. Our objective was to develop a (random effects) meta-analysis model that could synthesize both individual-level and aggregate-level binary outcome data while exploring the effects of binary covariates also available in a combination of individual participant and aggregate level data. To add further complication, the studies to be combined were a mixture of cluster and individual participant-allocated designs.A Bayesian model using Markov chain Monte Carlo methods to estimate parameters is described which efficiently synthesizes the data by allowing different models to be fitted to the different study design and data format combinations available. Initially we describe a model to estimate mean effects ignoring the influence of the covariates, and then extend it to include a binary covariate. The application of the method is illustrated by application to one outcome from the motivating home safety meta-analysis for illustration. Using the same general approach, it would be possible to develop further 'tailor made' evidence synthesis models to synthesize all available evidence most effectively.
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Affiliation(s)
- A J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Abstract
Unexpected non-significant results from randomised trials can be difficult to accept. Catherine Hewitt, Natasha Mitchell, and David Torgerson find that some authors continue to support interventions despite evidence that they might be harmful
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Affiliation(s)
- Catherine E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD
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Beirens TMJ, Brug J, van Beeck EF, Dekker R, Juttmann RE, Raat H. Presence and use of stair gates in homes with toddlers (11-18 months old). ACCIDENT; ANALYSIS AND PREVENTION 2007; 39:964-8. [PMID: 17324371 DOI: 10.1016/j.aap.2007.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 01/15/2007] [Accepted: 01/16/2007] [Indexed: 05/14/2023]
Abstract
BACKGROUND The aim of this study was to assess demographic correlates of the presence and use of stair gates in homes with toddlers. METHODS In 2004, self-administered questionnaires were mailed to 2470 parents with toddlers living in both urban and rural areas (response rate 70.1%). The questionnaires were sent by the youth healthcare providers that the parents visited regarding their toddler. RESULTS In total, 83% of the parents reported to have at least one stair gate installed; however, 50% of these parents reported that they did not always close the stair gate. Households with a non-Dutch ethnic mother, one child, a female child, a young child or a child who cannot crawl, were less likely to have a stair gate. Households with one child, a toddler who cannot walk, and a mother with a higher educational level were less likely to use the gate adequately. CONCLUSIONS This study shows that parents of toddlers often report to have a stair gate; however, in homes with a gate the parents do not necessarily use the gate adequately. Different demographic characteristics were shown to be correlated with both having a stair gate and the use of a stair gate.
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Affiliation(s)
- Tinneke M J Beirens
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Babul S, Olsen L, Janssen P, McIntee P, Raina P. A randomized trial to assess the effectiveness of an infant home safety programme. Int J Inj Contr Saf Promot 2007; 14:109-17. [PMID: 17510847 DOI: 10.1080/17457300701272474] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to test an intervention aimed at addressing the risk of injury in infants 2 - 12 months of age. A non-blinded, randomized controlled trial was conducted, whereby parents were randomly assigned to either a control or one of two intervention groups. Parents completed questionnaires regarding safety behaviours and injuries at the 2 (baseline), 6 and 12 month immunization visit at the community health unit. During the 2 month visit to the health unit, the two intervention groups received a home safety kit containing nine items, an instructional brochure and a risk assessment checklist. Subjects randomized to the safety kit plus home visit group also received a standardized home visit from a community health nurse. Two of the 14 parental safety behaviours showed a significant increase in use among parents in the intervention groups. Neither of the interventions was associated with a reduction in parent-reported injuries among children. It was concluded that home visitation may provide a beneficial adjunct to the provision of safety devices and may increase use by parents.
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Affiliation(s)
- S Babul
- BC Injury Research & Prevention Unit, Vancouver, BC, Canada.
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Claudet I, Toubal K, Carnet C, Rekhroukh H, Zelmat B, Debuisson C, Cahuzac JP. Quand les portes claquent, les doigts craquent! Arch Pediatr 2007; 14:958-63. [PMID: 17442551 DOI: 10.1016/j.arcped.2007.03.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 02/16/2007] [Accepted: 03/15/2007] [Indexed: 11/25/2022]
Abstract
AIM Epidemiological analysis in a universitary paediatric emergency unit of children admitted after accidental injuries resulting from fingers crushed in a door. MATERIAL AND METHODS Prospective, descriptive cohort study from September 6th, 2004 to July 1st, 2005 included all children admitted for finger injuries crushed in a non-automatic door. EXCLUSIONS included accidents due to automatic doors, toy's or refrigerator doors, families who refused to participate to the study or families who had left the waiting area before medical examination. Collected data were patient and family characteristics, accident characteristics and its management. RESULTS Three hundred and forty children affected by 427 digital lesions were included. The mean age was 5.5+/-3.8 years (range 4 months - 15.5 years). Male/female ratio was equal to 1.2: 1. Fifty-eight percent of patients belonged to families composed of 3 or more siblings. Ninety-three per cent of families came to hospital within the first 2 hours after the accident (mean delay 99+/-162 min, median range 54 minutes). Location of the accident was: domestic (62%, at home (64%)), at school (17%). Locations within the home were: the bedroom (33%), bathroom and toilets (21%). An adult was present in 75% of cases and responsible for the trauma in 25% of accidents, another child in 44%. The finger or fingers were trapped on the hinge side in 57% of patients. No specific safeguard devices were used by 94% of families. Among victims, 20% had several crushed digits; left and right hand were injured with an equal frequency. The commonest involved digits were: the middle finger (29%), the ring finger (23%). The nail plate was damaged in 60% of digital lesions, associated with a wound (50%), a distal phalanx fracture (P3) (12%). Six children had a partial or complete amputation of P3, 2 children a lesion of the extensor tendon, 1 child had a rupture of the external lateral ligament. Three percent of children required an admission to the paediatric orthopaedic surgery unit. Post-traumatic pain was mainly limited to the first 48 h (64%). Early complications included: 16 cases of infected injuries, 3 cases of pulpar necrosis. The total cost of hospital care was 71,500 euros, the average cost for hospitalised patient equal to 2100 euros and for ambulatory cases equal to 141 euros; the annual cost was estimated at 81,600 euros. CONCLUSION Associated with potentially serious digital injuries, functional or inesthetic sequelae, this painful experience still remains too frequent in toddlers for a home accident that could be often prevented by the acquisition of specific protective doors devices and for a reasonable cost compared to the cost of hospital care.
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Affiliation(s)
- I Claudet
- POSU pédiatrique, hôpital des Enfants, Toulouse, France.
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