Homesafety assessment, and the supply and installation of permanent safety equipment such as smoke and carbon monoxide alarms, thermostatic mixing valves and window restrictors reduce the risk of unintentionalinjuries in the home. This may be carried out by a trained assessor, parent, or other householder using an appropriate assessment list. 2
Cost-effective interventions exist to reduce the overall burden of unintentionalinjuries. They have high returns on investment through their saving of economically productive human lives. One study conducted in England demonstrates that significant savings can be made by preventing emergency department attendances and hospital admissions for unintentional injury among children and young people. An 11% national reduction in unintentionalinjuries among children could save enough funding to offset the cost of implementing the preventive interventions (20). Despite striking evidence of the steep social gradient for all types of injuries, it is unusual to find policies and interventions which articulately address the equity dimension in such a way that the impact on different social groups is foreseen (3). This results in a lack of knowledge about whether they are equally effective in all socioeconomic groups and about whether they progressively reduce the injury risk for those most vulnerable. Those interventions that target disadvantaged groups typically involve measures such as the adoption of safe practices and the use of safety equipment. However, these might not suffice in decreasing the injury risk level (21). Equity-oriented interventions should be designed so that they effectively counteract underlying mechanisms of injury, which can be different in each social group. These interventions need to progressively increase the level of safety of the groups most in need, through concerted, multisectoral actions. Safety-for-all strategies such as legislation, regulation and enforcement are effective in reducing injuries in all social groups. These include setting minimum conditions and product standards and imposing safe behaviour and practices, such as wearing seat belts in cars. Whereas it is generally accepted that passive, universally targeted interventions, such as road traffic safety management are most effective in reducing the injury burden, it is not known whether they differentially favour disadvantaged people, thus reducing inequities across socioeconomic groups (3). Effective approaches tend to focus on the distinct pathways and mechanisms by which safety differentials arise. Equity-oriented policies and interventions aim to narrow inequities through action targeted at reducing the exposure to, risk of and consequences of injury for less-affluent people or neighbourhoods (22).
This gender difference is not unlike injury patterns occurring outside the home, but more striking if one considers that females, at least in some subgroups of the population, probably spend more time in the home environment than males. The existing literature does not report clear evidence for why males have higher rates of home injury death than females, although hypotheses for the relationship can be made. For example, males may have riskier behaviors than fe- males, which can expose them to activities that lead to increased injury severity with a greater probability of resulting in death. For instance, males may be more likely to climb a ladder and fall from greater heights, fight a fire with a fire extinguisher rather than flee, or use saws for home improvement, compared with fe- males. More research to identify why males have higher home injury death rates than females could help in the development of tailored behavioral and environmental intervention strategies suited to each group.
pastures or fields, barns or other farm buildings to be part of the home environment. We did not require that injured persons were injured in their own home.
There was some discrepancy in the definition of the home environment across the data sets with respect to college dormitories. Although the NHIS data set includes dormito- ries within the definition of the home, the remaining three data sets do not provide a clear indication of how college dormitories are handled, allowing for the possibility of cate- gorization in either the home or school environment. The NHIS data set is also clear in excluding institutionalized populations (e.g., prisoners, nursing home residents) from the survey, which in effect keeps injuries taking place in those locations from being defined as occurring in the home, thus providing consistency with the choice of a civilian noninstitu- tionalized population as the denominator for rate calcula- tions. Although the NAMCS and NHAMCS data sets theoret- ically exclude institutional settings when defining the home environment, the potential for misinformation is greater than within the NHIS data set. For example, it is feasible that someone who lives in a nursing home could experience an injury requiring medical attention while visiting a home that is not their usual dwelling, and thus be included in the sample.
Although five principal causes of unintentionalinjuries have been prioritised, other causes should not be ignored. For example, exposure to smoke, fire and flames results in a high proportion of deaths among the under-fives in and around the home, but a relatively low level of emergency hospital admissions. Furthermore, hazards change, especially as new products such as hair straighteners or liquid detergent capsules emerge, and as children grow up. 18 Concerns have been raised about harm caused by swallowing powerful button batteries and more recently the dangers of nicotine
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Background: Injury as a cause of significant morbidity and mortality has remained fairly stable in countries with developed economies. Although injury prevention often is conceptualised as a biomedical construct, such a reductionist perspective overlooks the importance of the psychological, environmental, and sociocultural conditions as contributing factors to injury and its consequences. This paper describes the potential of the ecological model for understanding the antecedent causes of unintentionalinjuries and guiding injury prevention approaches. We review the origins and conceptualise the elements of the ecological model and conclude with some examples of applications of ecological approaches to the prevention of unintentional injury and promotion of community safety.
6.5 ISSUES SURROUNDING INJURIES THAT OCCUR WHILST NOT
WEARING EYE PROTECTION 6.5.1 Reasons for not wearing eye protection
Although injured samples may not be representative of the entire population, they offer useful findings. In particular, many of those not wearing eye protection were not actually welding (25.4%) or grinding (6.1%) themselves. They were often walking past, standing near, watching or assisting others who were performing these activities. Other studies have also shown that bystanders account for up to 24% of those with eye injuries (Summerer & Johnson, 1996; Bell, 1994; Owen et al, 1987). This raises a number of prevention strategies. Firstly, it reiterates the importance of wearing eye protection if watching or assisting someone weld or grind. Closing the eyes or looking away at appropriate moments is certainly insufficient protection. The high numbers of trades assistants injured in the workplace, and family and friends injured at home, whilst helping or watching those welding and grinding, suggests the need to target these groups. Secondly, where there is the possibility of others walking by, or working near, someone welding or grinding, care must be taken to prevent stray flashes and foreign bodies from reaching these bystanders. This can be achieved by placing suitable curtains and screens around the person welding or grinding. In the workplace, these activities may be confined to certain areas. Lastly, all persons, including management, visitors and contractors, must wear eye protection throughout any operational areas (Turiff, 1991; Hall, 1987). This rule must be adhered to even when walking through workshop areas.
UnintentionalInjuries in Brazilian Preschool Children Bianca Zimmermann Santos 1 , Carla Miranda 2 , Keila Cristina Pereira Rausch 2 , Vera Lucia Bosco 3 ,
Mabel Mariela Rodríguez Cordeiro 3 , Suely Grosseman 3
Objective: To estimate the prevalence of unintentionalinjuries among children attending public preschools of Florianópolis (Santa Catarina, Brazil) and describe their epidemiological characteristics. Materials and Methods: This is a descriptive cross-sectional study conducted with 398 children in 2009 and data were collected through a questionnaire, filled by parents. Statistical analysis was performed, considering a confidence interval of 95%. Results: Among the 398 children included, 275 (69.1% - 95%: 66.8 to 71.4%) suffered unintentionalinjuries, making a total of 573 cases. The sample comprised 55.5% male children between 13 and 36 months (61.6% - 95% CI: 59.3 to 63.9%) that were affected. Child home was the place where 352 (61.4% - 95% CI: 59.0 to 63.8%) injuries occurred, 372 (64.9% - IC95%: from 59.1 to 73.7%), which were caused by falls, and 342 (59.7% - 95%:57.3 to 62.1%) were considered mild. In 223 (38.9% - 95%: 36.5% -41.3%) cases, the mother accompanied the child at the time of injury. Conclusion: The prevalence of unintentionalinjuries was high. In the context of prevention, combined actions among health professionals, government and civil society should be proposed based on local research on the topic. In the era of family health care performed by multidisciplinary teams, it is critical that these injuries receive adequate importance by health professionals and attention in public health policies.
especially in cases of severe morbidity requiring long- term treatment and care.
This study used data from a pilot child injury surveil- lance system and like other facility based date has potential sampling bias as the study was conducted in only four hospital EDs in a city with a population of over 15 million people. Moreover, these hospitals are likely to see mostly severe cases of injuries; many minor to moderate injuries are treated either at home or by local community clinics. It is also sometimes difficult to assess the intent of injury in ED settings; for example, falls and burns in the database were categorized as unin- tentional injuries however; these may be intentional in nature. Thirdly, there is a likelihood that the number of fatalities seen in this study is an underestimation as many cases of death following an injury are not brought to the hospital due to medico-legal complications.
Planning for an innovative, community-based pilot study takes considerable time and eﬀort in a low-income setting like Pakistan. This paper has introduced the proposed pilot study and provides an initial report of the first phase. The primary outcome of the pretesting phase of the study was the development of three important tools geared for low- income housing communities in Pakistan: (1) an assessment tool to quantify the in-home childhood injury hazards, (2) an educational pamphlet outlining important injury hazard and prevention information geared towards children 12 to 59 months of age, and (3) an in-home tutorial guide focused on providing information on low-cost injury prevention techniques for children ages 12 to 59 months. Of note, community-based participatory qualitative research methodology was not used in the development of these tools. Instead, a process of adapting existing widely utilized tools from high-income countries to the local setting was employed in order to create these pilot materials. This sets up a unique opportunity to engage in a well-constructed qualitative study with the community after they have had exposure to the three tools in a well-structured study setting. These materials are among the first of their kind tailored to a South Asian, LMIC setting. Further study is needed to understand their eﬀectiveness, as well as the feasibility and acceptability of their use. The pilot study is currently under- way in these two low-income neighborhoods in Karachi to respond to these questions. This paper describes these tools to also provide an opportunity for modification of these tools to other LMIC settings and the chance to expand upon existing knowledge regarding home injury risk reduction in low-income settings.
Strengths and weaknesses of this systematic review Our search strategy included searching a large number of biblio- graphic databases, grey literature and handsearching some confer- ence abstracts and journals. However, our search terms included injury and homesafety outcome terms and as these may have been secondary outcomes in some studies, this may have led to some studies being missed by our searches. However, we attempted to contact the authors of all studies excluded on the basis of out- comes to ascertain if they had measured any outcomes relevant for our review. Of the seven papers excluded on the basis of lack of relevant outcomes, the authors of two confirmed that they did not assess unintentional injury, two authors were untraceable and three did not respond. There did not appear to be evidence of publication bias although the number of studies included in this assessment was fairly small (10), hence the funnel plot and Egger’s test should be interpreted with caution. The analysis adjusted for cluster allocated studies and sensitivity analyses were undertaken testing assumptions regarding the potential for bias, uncertainty as to the extent to which the intervention was based on a proto- col, manual or curriculum, follow-up period and injury type. The findings were robust to these assumptions.
The pediatrician ’ s advice is of prime importance because most injuries in children younger than 10 to 12 years occur in the home environment. Ac- cording to one study in the United States, 90% of unintentional fatal injuries that occurred in young chil- dren in and around the home could have been prevented. 6 Homesafety visits were found to signi ﬁ cantly re- duce injuries in children. 7 Parents or caregivers are usually unaware of the typical risks in the different age groups. Appropriate education com- bined with easy access to economical safety products were shown to pro- mote injury prevention among chil- dren. 8 However, more randomized controlled trials with larger study samples are needed to prove suf ﬁ - cient evidence that environmental modi ﬁ cations in the home are fol- lowed by a signi ﬁ cant reduction of injuries in children. 9
9 Assure all infants, toddlers, and children under 12 are appropriately buckled in rear car seats, with those ages four to eight in booster seats and seat belts: buckle up before starting up.
These adaptations are necessary for children who are not old enough or large enough to properly fit in a vehicle’s safety belts. Rear seat placement is best because front seat airbags, which provide protection in head-on collisions, are too potent for delicate little bodies. See www.nhtsa.dot.gov for the best type of child seat by the child’s weight, and the best
Many of these barriers are addressable within, and many facilitators could be exploited by injury prevention programmes.
Strengths of the study were that the sampling strategy ensured a cross-section of parent perspectives with parents living in more and less disadvantaged areas, chil- dren of sexes and varying ages, different injury mecha- nisms and injured and uninjured children. As a multi- centre study, it was also able to capture the perspectives of parents living in a range of localities. The use of a number of study centres also allowed flexibility, for ex- ample, it was possible to recruit additional participants at two study centres when there were low numbers of parents of children with thermal injuries at one study centre. A systematic approach was taken to the data ana- lysis whereby multiple researchers were involved in the analytical process, helping to improve the rigor and quality of the findings . This was facilitated with regular teleconferences and face-to-face meetings.
Fieldwork was carried out to evaluate how relevant and useful NICE's recommendations would be for practitioners and how feasible it would be to put them into practice.
It was conducted with practitioners and commissioners who are involved in preventing
unintentionalinjuries among children and young people. This included those working in primary care trusts (PCTs), local safeguarding children boards and accident prevention and road safety teams. It also included health visitors, nurses and policy leads, within the NHS, those working in the fire and police services, leisure and play services, and environmental health and housing.
To our knowledge, this is the first analysis to look at an association between grandparental caregivers and child injury. Our results provide evidence that children who are cared for by grandparents have a lower inci- dence of a medically attended injury. It may still be the case that the households that choose grandparents as caregivers selectively choose only grandparents who will enforce healthier child safety behaviors; however, we note that when households “choose” relatives other than grandparents to look after their children, the risk for child injury increases slightly. Although additional studies of how households choose relatives to watch their children and the actual caregiving styles of grand- parents are warranted, for now there is no evidence that grandparental care places children at higher risk.
program and distribute child safety seats were the NSKC, the National Easter Seal Society, the Safe America Foundation, and the National Association of Children’s Hospitals and Related Institutions. Through local chapters and constituent members of these organizations, about 200,000 child safety seats were distributed nationwide. The next year, GM donated $10.6 million to the NSKC to promote correct car seat and safety belt use. The NSKC developed and distrib- uted information in English and Spanish to teach parents and caregivers about correct child safety seat and safety belt use. More than 400 local GM dealers participated in two-hour child passenger safety workshops. Dealerships began conducting car seat checkup events where local experts, largely trained by NHTSA staff, reviewed child safety seat hardware for correct size, fit, and instal- lation, and taught its correct use. Based on the success of this program, GM recently committed another $5 million to the NSKC to provide thousands of child safety seats to needy, minority, at-risk families. The NSKC has partnered with the National Council of La Raza and the National Association for the Advancement of Colored People (NAACP) to ensure that the program reaches Hispanic and African-American families and that cor- rect safety seat use is reinforced in culturally appropriate ways. This is an example of part- nership among several nonprofit grassroots organizations, a federal agency, and industry. Professional organizations have also par- ticipated in the child safety seat effort. The AAP initiated the “First Ride Safe Ride” pro- gram in 1980 to encourage parents to use a child safety seat when taking their newborn infant home from the hospital. The AAP also took direct action concerning the child safety seat incompatibility problem by asking the federal government to consider modifying the manner in which child safety seats are secured to vehicles. The AAP formally peti- tioned the NHTSA, requesting it to consider requiring a tether anchor for child safety seats, and provided the NHTSA with formal comments on its proposed rule making for universal child safety seat attachments. (Box 1 explains the rule-making process used by the NHTSA and provides an example of pro- cedures followed by other regulatory agen- cies.) The AAP also keeps its members (and indirectly, the public) informed of current best practices by issuing policy statements
Analyses of longitudinal studies have shown the in ﬂ uence of parents on child outcomes that are related to injury risk. Positive parenting behaviour and parent – child interaction, and a stimulating home environment have been associated with enhanced development by the age of 3 years 25 and improved cognitive and behavioural outcomes in children by age 5 years 26 or children who are well adjusted and developmentally competent. 27 The use of positive parenting practices, such as increased use of praise to encourage desirable behaviours, is associated with a reduction in injuries. 28 Supportive parent training can improve childcare practices for mothers with learning dif ﬁ culties 29 and enhanced carer supervision can reduce injury risk to children. 30,31 Parenting interventions have the potential to reduce poor maternal mental health and increase maternal self-ef ﬁ cacy, 32,33 to improve maternal – child interactions, 34 and to change child behaviour, especially behaviour that is challenging or could place the child at risk of injury. 32,35 – 37 Reductions in injury risk could also be mediated through information to enable parents to make realistic expectations of their child ’ s development and skills, 38 enhanced parental knowledge of safety practices, 39 improvement in the quality of the home environment, 40 or through the use of homesafety practices such as having a ﬁ tted and functioning smoke alarm, using stair gates or keeping sharp objects in a safe place. 41,42 Generic parenting support interventions delivered by health visitors, and which may or may not include a focus on injury prevention, have been shown to reduce injury rates in both prospective observational studies 43 and RCTs. 44 Meta-analyses of RCTs measuring one-to-one parenting interventions that are delivered primarily through home visiting and primarily conducted with high-risk or disadvantaged families have
Helmet use is only a small piece of the puzzle. Safe Kids San Diego has invited the Bike Coalition of San Diego to participate in Safe Kids programming. Currently the bike coalition has been pro- viding interactive bike safety “Rodeos” through the lead agency. These rodeos currently focus on new rider skills and safety awareness. Proposed programming will focus on “tweens” with road safety and bicycling to prepare them for driver’s education. Safe Kids San Diego will continue to collaborate with the Cox Foundation and bicycle helmet distribution with three scheduled events in Kearny Mesa, Oceanside and El Cajon. These events distributed the current law and remind families that ALL wheeled vehicles fall under this legislation, including “heelys”. Children will be fitted with both bike and multisport helmets and families will be educated in proper helmet style for their sport. Through these helmet distribution events parents and children were instructed in safety in and around cars, focusing on prevention of back over injuries, emphasis of never leaving a child or pet in a vehicle unattended and awareness of stopping times in vehicles.