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Introduction : While previous studies on childhood injury focused mainly on the relationship between parents' preventive behavior and its determinants, knowledge about parental risk perception that can help to develop, implement, and evaluate successful interventions to prevent childhood unintentional home injuries is still limited. The aim of this study was to gain a deeper understanding of parental risk perception regarding unintentional home injuries of children under six years of age. Method: A convenience sample of 469 parents, residing in Germany, completed a web-based questionnaire assessing factors potentially associated with parental risk perception on the child, parental, and environmental level. Descriptive statistics, p for trend, and Spearman's Rho correlation coefficients were calculated. Results: Key factors influencing parental risk perception included children's sex, age, migrant status, emotionality, and injury risk as well as parents' parenting style and external locus of control. While parental risk perception was positively associated with children's injury risk, the analyses showed no associations between parental risk perception and parents' preventive behavior. Conclusions: Our findings add to a better understanding of parental risk perception, provide practical implications for injury prevention, and indicate that the relationship between parental risk perception and parents' preventive behavior is based on a complex mechanism which is possibly moderated by parents' locus of control. Practical Applications: The identified key factors help to assess parental risk perception more accurately. Therefore, they should be considered in the development of tailored interventions to prevent unintentional home injuries of children, for instance, by targeting specific groups of parental risk perception. [ABSTRACT FROM AUTHOR]

• Retrospective review of emergency department visits for children 0–19 years old. • Investigation of community-level features for predicting injury rates. • Examined injuries related to bicycles, motor vehicle traffic, falls, and violence. • Injury rates related to community-level features depending on the type of injury. • Knowledge of local community and prevalent injuries can help prevention programming. Background : Community-level factors, including poverty level, minority population, and rurality are predictive of child injury rates. Community-based interventions targeting high-risk communities have been suggested for prevention and are reliant on understanding details of the community and prevalent types of injuries. The present study assessed injury rates based on characteristics of the community and for different types of injuries. Method: A retrospective review of emergency department visits identified zip-code and injury type data for children 0–19. Injuries related to bicycles, falls, motor-vehicle traffic (MTV), and violence were examined. Poverty level, minority population, rural classification, and insured population were obtained at the zip-code level. Regression models examined the association between community features and injury rates for the four categories of injuries. Results: The results showed that the relationship between community features and injury rates was dependent on injury type. Rurality was associated with a lower rate for bicycle and falls, but a higher rate of MVT; higher insured population was associated with higher MVT and violence rates; higher minority population was associated with lower rates for falls and MTV; and higher population in poverty was associated with lower rate for MTV. Conclusions: The findings indicate that injury rates not only cluster among community-level characteristics, but also the type of injury. Variation in community features and injury types offer insight into a holistic approach to child health. Practical Applications: In addition to other factors related to risk for injuries, health providers' knowledge of features of the local community and prevalent injuries in the environment may be helpful additions to programming geared toward lessening the burden of injuries on children and healthcare systems. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. In Nigeria, there is paucity of information about TBI in children. We describe the profile of pediatric TBI in a university hospital in South-West Nigeria. A retrospective study of children who had TBI from 2012 to 2022 was performed. Data were extracted from the neurosurgery database. Patient demographics, etiology/patterns of injuries, clinical/radiologic findings, management, and outcomes were assessed. We performed simple descriptive analyses. Pediatric TBIs represented 20% (128) of the head injury admissions (631). There was male preponderance (male/female = 1.8:1); most patients were adolescents (29%). In total, 61%, 18%, and 21% had mild, moderate, and severe TBI, respectively. Road traffic crashes were responsible for 74% of cases, with motorcycle accidents (46%) much greater than motor vehicular accidents (28%), mostly pedestrian (51%). Fall from heights accounted for 21%, mostly in toddlers. A total of 70% had associated injuries, mainly skull fractures (54%) and soft-tissue injuries (47%). In total, 31% had post-traumatic seizures. Only 40 (31%) had a cranial computed tomography scan. Common findings were contusions in 70%, extradural hematomas in 28%, and intracranial aerocoeles in 18%. There were no neurosurgical lesions in 20%. Six had operative intervention. Mortality rate was 12%. In total, 84% had good recovery. The average follow-up period was 7 months. Children account for a large number of TBIs in our environment, which are mostly from road traffic crashes and falls. Only a few received computed tomography scan of the brain. Most cases had nonoperative care, and outcomes are worse with increasing severity of head injury. Specific preventive measures need to be formulated and/or enforced by governments at all levels. [ABSTRACT FROM AUTHOR]

Introduction: Unintentional home injuries are a major health risk for children. To develop and implement appropriate interventions, both theoretical guidance and empirical evidence are required. While theoretical models informing injury prevention are available, detailed information on unintentional home injuries of children and parental risk perception is still missing. The objective of this study was to identify relevant determinants of unintentional home injuries of children under 6 years of age and parental risk perception from an empirical perspective. Method: The secondary data analysis is based on data from two nationally representative surveys from Germany conducted in 2014–2017 (n = 4,009) and 2019 (n = 411). Both bivariate analyses and multivariate binary logistic regression models were conducted to determine the associations between various factors with unintentional home injuries and parental risk perception. Results: Key determinants of unintentional home injuries included the age and personality of the child, migrant status, and housing tenure. Parental risk perception was significantly associated with children's sex. The number of children living in the household and household net income were identified as determinants for both unintentional home injuries and parent's risk perception. Furthermore, a discrepancy between parent's risk perception and actual risk factors of unintentional home injuries was found. Conclusions: Findings from this study strengthen the evidence base by demonstrating relevant determinants of unintentional home injuries of children and parent's risk perception. Since this study provides first evidence of a distorted parental risk perception, future research should focus on parental risk perception to assess it more accurately in interventions to prevent unintentional home injuries of children. Practical Applications: The present findings may inform health practitioners about which points they should address when interacting with parents. For instance, they should focus on raising parent's awareness of actual risk factors and discuss concrete behavioral or environmental safety precautions. [ABSTRACT FROM AUTHOR]

Injuries are a major public health concern and one of the leading causes of death and disability worldwide. Childhood injuries contribute to a major proportion of this burden. To identify injury hazards within school premises and playgrounds in Karachi, Pakistan. This observational cross-sectional study took place in 107 public and private schools of Karachi, Pakistan using a self-structured standard injury risk assessment tool. This tool was developed after an extensive literature review, expert consultation, and field visits to a few local schools. Data related to school demographics, administrative data and injury hazards within the school boundaries were collected in schools offering education from nursery to secondary grades (through 10th grade, matriculation). Descriptive analysis were calculated. Out of 107 schools, only 12 were recording school-related injuries. A quarter (25%) of schools had some type of disaster drill exercises and built-in fire exits. Fire alarms were placed in 10 schools (9%), all of which were private. In 16 schools (15%), students had access to rooftop doors. There were multiple injury hazards in the school playgrounds. More than half of the schools had hazardous playground surfaces, such as slippery, concrete and uneven ground. Over 80% of schools were not supervising the children during playtime and did not have a separate play area for children under 6 years old. In 38 schools (22%), there were multiple injury hazards in the play rides, such as broken equipment, rusted parts, and sharp edges. Moreover, nine schools (7%) had loose nuts, bolts, edges, belts, steps, or rails in their play rides. Inside, almost a quarter (24%, n = 76) of schools did not have proper insulation of electric wires. Protruded metal nails, which could be high risk for prick and cut injuries, were observed in 20% of the observed furniture. In conclusion, there are multiple injury hazards in the private and public schools of Karachi, Pakistan. [ABSTRACT FROM AUTHOR]

• A tailored injury hazard tool was used to capture context specific vehicle, passenger, and pedestrian related risks. • A majority of the schools (n = 83, 88%) did not have a safe and designated parking, pick-up, and drop-off area. • Other road infrastructure-related hazards included a lack of sidewalks and zebra crossings. • Multiple hazards within vehicles used by students were identified, such as poor installation of CNG cylinders, broken windows and doors, a lack of seatbelts, and absence of supervision of children. • Pedestrians and passengers exhibited a variety of risky behaviors, including crossing the road without looking both ways, not using sidewalks and zebra crossings, not wearing helmets or seatbelts, stepping out in the middle of the road, and running to catch the vehicle. Road traffic injuries are a leading cause of mortality and morbidity among children. Travelling to and from school is a major risk exposure for children around the globe. The purpose of this study was to assess road traffic injury hazards for school children during dropp-off or picked-up times. This observational cross-sectional study included 94 public and private schools in Karachi, Pakistan. A structured observational tool was used to collect data on school demographics, the road traffic environment, infrastructure, injury hazards in vehicles used by school children, and child pedestrian injury risk and road use behaviors. A total of 860 observations of school children, drivers of vehicles transporting children, schools, and vehicles were recorded. Most schools (n = 83, 88%) did not have designated parking spaces around the school; only one public school had a parking area. Only one private school had a zebra crossing around the school premises. Very few schools (n = 13, 14%), mostly private (n = 12) had pedestrian sidewalks. Only 35 (18%) adult motorcyclists, out of 199, were wearing a helmet, and eight (6%), out of 145, car passengers were wearing seatbelts. Compressed natural gas (CNG) cylinders were installed in 83 (35%), out of 235, observed vehicles. The remaining 152 (65%) did not have CNG cylinders or they were not visible to our data collectors. In 55 (23%) observations, bus passengers stepped off the bus in the middle of the road. Most pedestrians (n = 266, 99.5%) did not use a Zebra crossing. More than a quarter (n = 74, 28%) of pedestrians looked left and right before crossing the road. While traveling to school, either by walking or taking vehicular trips, children face many road traffic injury hazards in Karachi. Pedestrians and passengers exhibited risky behaviors while using roads. Further initiatives are advised from a public health viewpoint aiming at minimizing transport-related hazards. [ABSTRACT FROM AUTHOR]

Background: Intentional injuries are the result of violence. This is an important public health issue, particularly in children, and is an unaddressed problem in sub-Saharan Africa. This study sought to describe the characteristics of intentional injury, particularly physical abuse, in children presenting to our tertiary trauma centre in Lilongwe, Malawi and how they compare to children with unintentional injuries.Methods: A retrospective analysis of children (<18 years old) with traumatic injuries presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2009 to 2013 was performed. Children with intentional and unintentional injuries were compared with bivariate analysis and multivariate logistic regression modelling.Results: 67,672 patients with traumatic injuries presented to KCH of which 24,365 were children. 1976 (8.1%) patients presented with intentional injury. Intentional injury patients had a higher mean age (11.1 ± 5.0 vs. 7.1 ± 4.6, p<0.001), a greater male preponderance (72.5 vs. 63.6%, p<0.001), were more often injured at night (38.3 vs. 20.7%, p<0.001), and alcohol was more often involved (7.8 vs. 1.0%, p<0.001). Multivariate logistic regression modelling showed that increasing age, male gender, and nighttime or urban setting for injury were associated with increased odds of intentional injury. Soft tissue injuries were more common in intentional injury patients (80.5 vs. 45.4%, p<0.001) and fist punches were the most common weapon (25.6%). Most patients were discharged in both groups (89.2 vs 80.9%, p<0.001) and overall mortality was lower for intentional injury patients (0.9 vs. 1.2%, p=0.001). Head injury was the most common cause of death (43.8 vs. 32.2%, p<0.001) in both groups.Conclusions: Sub-Saharan African tertiary hospitals are uniquely positioned to play a pivotal role in the identification, clinical management, and alleviation of intentional injuries to children by facilitating access to social services and through prevention efforts. [ABSTRACT FROM AUTHOR]

This study examined the relationship between home risk and hospital treated injury in Australian children up to five years old. Women with children between two and four years of age enrolled in the Environments for Healthy Living (EFHL): Griffith Birth Cohort Study were invited to complete a Home Injury Prevention Survey from March 2013 to June 2014. A total home risk score (HRS) was calculated and linked to the child's injury related state-wide hospital emergency and admissions data and EFHL baseline demographic surveys. Data from 562 households relating to 566 child participants were included. We found an inverse relationship between home risk and child injury, with children living in homes with the least injury risk (based on the absence of hazardous structural features of the home and safe practices reported) having 1.90 times the injury rate of children living in high risk homes (95% CI 1.15–3.14). Whilst this appears counter-intuitive, families in the lowest risk homes were more likely to be socio-economically disadvantaged than families in the highest risk homes (more sole parents, lower maternal education levels, younger maternal age and lower income). After adjusting for demographic and socio-economic factors, the relationship between home risk and injury was no longer significant (p > 0.05). Our findings suggest that children in socio-economically deprived families have higher rates of injury, despite living in a physical environment that contains substantially fewer injury risks than their less deprived counterparts. Although measures to reduce child injury risk through the modification of the physical environment remain an important part of the injury prevention approach, our study findings support continued efforts to implement societal-wide, long term policy and practice changes to address the socioeconomic differentials in child health outcomes. [ABSTRACT FROM AUTHOR]

Introduction Injury is a leading cause of death for infants and children. Teen mothering has been shown to put children at increased risk of injury. The mothers of teen parents often play a predominant role in the lives and caregiving of the children born to their children. Method This article presents the findings of three focus groups conducted with 21 mothers of teen parents. Grounded theory methodology was used to explore family dynamics and how they relate to injury prevention beliefs and practices regarding infants and children. Results Our findings revealed the difficulty mothers of teen parents and the teens themselves have in adjusting to the knowledge of the pregnancy. Unique barriers to injury prevention were also uncovered. Conclusions Our findings provide evidence for the need of a multigenerational approach to programs aimed at improving the safety and well-being of children in this context. [ABSTRACT FROM AUTHOR]

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. [Copyright &y& Elsevier]

Aim: The study investigates the epidemiology of fatal burns in the predominantly rural province of Mpumalanga, South Africa. Method: The study is cross-sectional and investigates region specific data extracted from a National Injury Mortality Surveillance System (NIMSS) and originally gathered at mortuaries. Fatal burns sustained during the 2 year period 2007 and 2008 are analysed (n =304 cases). Mortality rates by age group, sex and district were compiled and attention was paid to manner of death, location, and temporal characteristics (time of day, weekday, season). Results: The overall fatal burn rate was 3.8 per 100,000 inhabitants (95% CI 3.4–4.3). The highest rates were among the oldest age group (8.2/100,000; 95% CI 6.1–10.7), males (5.3/100,000; 95% CI 4.6–6.2) and in one of the three districts, Nkangala (4.8/100,000; 95% CI 3.9–5.6). Most burns were accidental (68.4%) and intentional ones (13.5%) occurred in particular among older people and in the home. Burns were sustained frequently at home (55.6%), between midnight and 5a.m. and towards the end of the week. Seasonal variations were more pronounced in Nkangala. Conclusions: Fatal burns could be less common in rural than urban South Africa. As in urban South Africa, however, older people, young children, and males are more at risk. Not surprisingly, the occurrence of fatal burns is strongly related to living conditions and lifestyle, which vary even within rural areas of South Africa. [Copyright &y& Elsevier]

Abstract: Childhood drowning is a major public health problem that has been neglected in many low- and middle-income countries. In Matlab, rural Bangladesh, more than 40% of child deaths aged 1–4 years are due to drowning. Aim: The main objective of this paper was to develop and evaluate a childhood drowning risk prediction index. Methodology: A literature review was carried out to document risk factors identified for childhood drowning in Bangladesh. The Newacheck model for special health care needs for children was adapted and applied to construct a childhood drowning risk index called “Potential Risk Estimation Drowning Index for Children” (PREDIC). Finally, the proposed PREDIC Index was applied to childhood drowning deaths and compared with the comparison group from children living in Matlab, Bangladesh. This pilot study used t-tests and Receiver Operating Characteristic (ROC) curve to analyze the results. Results: The PREDIC index was applied to 302 drowning deaths and 624 children 0–4 years old living in Matlab. The results of t-test indicate that the drowned children had a statistically (t =−8.58, p =0.0001) significant higher mean PREDIC score (6.01) than those in comparison group (5.26). Drowning cases had a PREDIC score of 6 or more for 68% of the children however, the comparison group had 43% of the children with score of 6 or more which was statistically significant (t =−7.36, p <0.001). The area under the curve for the Receiver Operating Characteristic curve was 0.662. Conclusion: Index score construction was scientifically plausible; and the index is relatively complete, fairly accurate, and practical. The risk index can help identify and target high risk children with drowning prevention programs. PREDIC index needs to be further tested for its accuracy, feasibility and effectiveness in drowning risk reduction in Bangladesh and other countries. [Copyright &y& Elsevier]

Abstract: Background/purpose: To investigate the month and day of the week of injury in common childhood activities using the National Electronic Injury Surveillance System database. Methods: All emergency department visits 2002–2006 from bicycles/tricycles, scooters, playground equipment, swimming/water activities, skiing/snowboarding, trampolines, and skating were analysed. The NEISS weighted and stratified data set was analysed using SUDAAN software. Weekday and month of injury, gender, race, anatomical location of the injury, geographical location of injury, and disposition were tabulated. Simple variation by month or weekday was analysed using cosinor analysis; combined variation for both month and weekday was analysed by topographical analysis. Results: There were an estimated 4.61 million emergency department visits for injuries from these activities in children in the United States. The average age was 9.5 years; there were 1.65 million girls (35.9%) and 2.97 boys (64.1%). Cosinor analysis demonstrated significant single peaks for month of injury for snow activities (January 27), trampolines (June 10), scooters (June 24), cycling (July 6), and water (July 12) activities. Double cosinor peaks were noted for skating (April 13 and September 12) and playground (April 22 and September 21) activities. Cosinor analyses demonstrated that the peak week days of injury were Monday for trampoline and snow activities, Saturday/Sunday for skating activities, Sunday for cycling, and Wednesday for playground equipment. There was no peak injury day for scooter or water activities. Topographical representation of paediatric injuries demonstrated that injuries from slides most frequently occurred April–May on Wednesdays and Saturdays, and those on swings April–May all days except Tuesday. Monkeybar injuries were bimodal, with the spring peak on Wednesday–Thursday in April/May and the fall peak Tuesday–Friday in September. Rollerblade injuries occurred Saturday–Sunday from March/April; rollerskates on Saturday–Sunday in January–April, and skateboards Saturday–Monday in August–October and Sundays in April. Conclusions: These findings can be used to further guide childhood injury prevention programmes/campaigns and especially track improvements after targeted prevention programmes. Public parks and schools should check/correct the status of playground landing surfaces just before the bimodal peaks. Education campaigns reinforcing the need for bicycle helmets could be concentrated immediately before the increase in cycling activity – March on weekends and April/May for weekdays. [Copyright &y& Elsevier]

Abstract: Background/purpose: To investigate the month and day of the week of injury in common childhood activities using the National Electronic Injury Surveillance System database. Methods: All emergency department visits 2002–2006 from bicycles/tricycles, scooters, playground equipment, swimming/water activities, skiing/snowboarding, trampolines, and skating were analysed. The NEISS weighted and stratified data set was analysed using SUDAAN software. Weekday and month of injury, gender, race, anatomical location of the injury, geographical location of injury, and disposition were tabulated. Simple variation by month or weekday was analysed using cosinor analysis; combined variation for both month and weekday was analysed by topographical analysis. Results: There were an estimated 4.61 million emergency department visits for injuries from these activities in children in the United States. The average age was 9.5 years; there were 1.65 million girls (35.9%) and 2.97 boys (64.1%). Cosinor analysis demonstrated significant single peaks for month of injury for snow activities (January 27), trampolines (June 10), scooters (June 24), cycling (July 6), and water (July 12) activities. Double cosinor peaks were noted for skating (April 13 and September 12) and playground (April 22 and September 21) activities. Cosinor analyses demonstrated that the peak week days of injury were Monday for trampoline and snow activities, Saturday/Sunday for skating activities, Sunday for cycling, and Wednesday for playground equipment. There was no peak injury day for scooter or water activities. Topographical representation of paediatric injuries demonstrated that injuries from slides most frequently occurred April–May on Wednesdays and Saturdays, and those on swings April–May all days except Tuesday. Monkeybar injuries were bimodal, with the spring peak on Wednesday–Thursday in April/May and the fall peak Tuesday–Friday in September. Rollerblade injuries occurred Saturday–Sunday from March/April; rollerskates on Saturday–Sunday in January–April, and skateboards Saturday–Monday in August–October and Sundays in April. Conclusions: These findings can be used to further guide childhood injury prevention programmes/campaigns and especially track improvements after targeted prevention programmes. Public parks and schools should check/correct the status of playground landing surfaces just before the bimodal peaks. Education campaigns reinforcing the need for bicycle helmets could be concentrated immediately before the increase in cycling activity – March on weekends and April/May for weekdays. [Copyright &y& Elsevier]

Pediatric emergency centers treat millions of unintentional injuries cases every year, and many of these injuries could have potentially been avoided by proper counseling about trauma safety and prevention. Through such discussions, clinicians have the ability to meaningfully decrease the number of these unintentional injuries. Not enough attention has been placed on critically injured children and adolescents who have a substantial burden on health care resources and morbidity. Emergency medicine providers and pediatricians have the responsibility to educate patients and families about proper child passenger safety and to remain up to date on this information. However, numerous barriers still exist for physicians to fully counsel patients and their families about firearms. Pediatric emergency medicine physicians can play a foundational role in the safety, prevention, and treatment of childhood injuries. Clinicians can become effective instructors for injury prevention by using the Haddon Matrix: host, agent, and environment; and the 3 Es of injury prevention: education, engineering, and enforcement of strategies. Legislative changes, educational approaches, and product modifications must come together to effectively achieve this goal. Although the idea of educating families in the emergency department may seem ideal because the immediacy of the current injury may make the families more receptive to the counseling, the integration of primary care physicians is beneficial for regular follow-ups and maintenance. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the use of an Accident and Emergency (A&E) Department by children from two Local Authority Gypsy sites with that of their neighbours. The study used data from the All Wales Injury Surveillance System. It was shown that children from the Gypsy sites attended more in an A&E than the children living in the adjacent electoral wards.