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Children's centres were established across England to provide a range of services including early education, social care and health to pre-school children and their families. We surveyed children's centres to ascertain the activities they were undertaking to prevent unintentional injuries in the under fives. A postal questionnaire was sent to a sample of children's centre managers ( n = 694). It included questions on current activities, knowledge and attitudes to injury prevention, health priorities and partnership working. Responses were received from 384 (56%) children's centres. Overall, 58% considered unintentional injury prevention to be one of the three main child health priorities for their centre. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 21% did not know if there was a home safety equipment scheme. Knowledge of how child injury deaths occur in the home was poor. Only 11% knew the major cause of injury deaths in children under five. Lack of both staff time and funding were seen as important barriers by children's centre staff to undertake injury prevention activities. Nearly all stated that training (97%) and assistance with planning injury prevention (94%) would be helpful to their centres. Children's centres need further support if they are to effectively tackle this important public health area. [ABSTRACT FROM AUTHOR]

SECONDARY CARE MANAGEMENT PATHWAY Patients referred to the breast clinic with palpable regional lymphadenopathy will receive a breast examination and an ultrasound scan. Regional lymphadenopathy has been rarely reported following the administration of vaccinations for tuberculosis, influenza, and human papillomavirus (<=1-2/100 000 vaccines).[1] SP , sp [2] In the first months of 2021, there seems to have been an increase in the number of women being referred to breast units from primary care and other specialties with clinically enlarged axillary/supraclavicular nodes or with image-detected lymphadenopathy. [Extracted from the article]

A correction to the article "'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme" that was published in the February 2022 issue is presented.

There is clear evidence that healthcare workers (HCWs) are at increased risk of contracting COVID-19. There have been calls for better surveillance data on hospital-acquired COVID-19 deaths of healthcare workers;[7] similar data are also required for the primary care workforce. [Extracted from the article]

Objectives To estimate the likelihood of recovery at 1, 4 and 12 months post injury and investigate predictors of recovery in injured people attending an emergency department (ED) or admitted to hospital in the UK. Methods Participants completed questionnaires at recruitment and 1, 4 and 12 months post injury or until recovered. Data were collected on injury details, sociodemographic characteristics, general health prior to injury and recovery. We compared three age groups: 5-17, 18-64 and 65 years and above. Modified Poisson regression estimated the relative risk of recovery. Multivariable models were built using backward stepwise regression. Sensitivity analyses assessed the effect of missing data. Results We recruited 1517 participants, 55% (n=836) ED attenders and 44% (n=661) hospital admissions. By 1 month after injury, 28% (285/968) had fully recovered, 54% (440/820) at 4 months and 71% (523/738) at 12 months. Recovery was independently associated with gender, admission status, injury severity, body region injured and place of injury for 5-17 year olds and 18-64 year olds and with gender, admission status, injury severity and long-term illness for those aged 65+. Injury severity and hospital admission were associated with recovery across all age groups, but not at every time point in each age group. Other factors varied between age groups or time points. Results were generally robust to imputing missing data. Conclusions A range of factors was found to predict recovery among injured people. These could be used to identify those at risk of delayed recovery and to inform the design of interventions to maximise recovery. [ABSTRACT FROM AUTHOR]

Background: Failure to recruit to target or schedule is common in randomized controlled trials (RCTs). Innovative interventions are not always fully developed before being tested, and maintenance of fidelity to the intervention during trials can be problematic. Missing data can compromise analyses, and inaccurate capture of risks to participants can influence reporting of intervention harms and benefits. In this paper we describe how challenges of recruitment and retention of participants, standardisation and quality control of interventions and capture of adverse events were overcome in the ProAct65+ cluster RCT. This trial compared class-based and home-based exercise with usual care in people aged 65 years and over, recruited through general practice. The home-based exercise participants were supported by Peer Mentors. Results: (1) Organisational factors, including room availability in general practices, slowed participant recruitment so the recruitment period was extended and the number invited to participate increased. (2) Telephone pre-screening was introduced to exclude potential participants who were already very active and those who were frequent fallers. (3) Recruitment of volunteer peer mentors was difficult and time consuming and their acceptable case load less than expected. Lowering the age limit for peer mentors and reducing their contact schedule with participants did not improve recruitment. (4) Fidelity to the group intervention was optimised by introducing quality assurance observation of classes by experienced exercise instructors. (5) Diaries were used to capture data on falls, service use and other exercise-related costs, but completion was variable so their frequency was reduced. (6) Classification of adverse events differed between research sites so all events were assessed by both sites and discrepancies discussed. Conclusions: Recruitment rates for trials in general practice may be limited by organisational factors and longer recruitment periods should be allowed for. Exercise studies may be attractive to those who least need them; additional screening measures can be employed to avoid assessment of ineligible participants. Enrolment of peer mentors for intervention support is challenging and needs to be separately tested for feasibility. Standardisation of exercise interventions is problematic when exercise programmes are tailored to participants' capabilities; quality assurance observations may assure fidelity of the intervention. Data collection by diaries can be burdensome to participants, resulting in variable and incomplete data capture; compromises in completion frequency may reduce missing data. Risk assessments are essential in exercise promotion studies, but categorisation of risks can vary between assessors; methods for their standardisation can be developed. Trial registration: ISRCTN43453770 [ABSTRACT FROM AUTHOR]

Objective: To explore the knowledge and reported thermal injury prevention practices among parents of children aged 0-4 years in disadvantaged areas. Methods: Parents of pre-school children in Children's Centres in four study areas in England (Nottingham, Newcastle, Norwich and Bristol) were interviewed using a structured schedule. Interviews covered smoke alarms, bedtime routines, fire escape plans, other thermal prevention practices and parental knowledge of first aid. Results: Of the 200 respondents, most reported ownership of at least one smoke alarm (n=191, 96%), of which 95% were working. Half reported a fire prevention bedtime routine (n=105, 53%) or fire escape plan (n=81, 42%). Most parents had matches or lighters in the home (n=159, 80%), some stored where children under 5 years of age could reach them (n=30, 19%). There was a high prevalence of irons (n=188, 94%) and hair straighteners (n=140, 70%). A third of both devices were used daily. Just 17 (12%) parents reported leaving hair straighteners, when hot but not in use, in a heatproof bag. Knowledge of correct initial first aid for a small burn was good (n=165, 83%), but parents reported other potentially harmful actions, for example, applying ointment (n=44, 22%). Conclusions: Most families report at least one working smoke alarm, but many do not have fire escape plans or fire prevention bedtime routines. A number of reported practices could compromise child safety, such as storage of matches or lighters and leaving hair straighteners to cool unprotected. Reappraisal of health promotion messages, in light of new household consumables, is necessary. [ABSTRACT FROM AUTHOR]

Background It is globally reported that young children are at a higher risk of burns but little is known about the individual risk factors. This study was undertaken in 2008 to investigate factors associated with burn injuries in children aged 0-5 years. Methods This was a case-control study with cases recruited prospectively from children attending hospital for a new burn injury and controls recruited from children admitted for other conditions. Results A total of 248 cases and 248 controls were recruited. Cases included scalds (79%), contact burns (17%) and flame injuries (4%). Burns were most commonly caused by tea utensils (42%) and kerosene stoves (36%). Multivariable analyses found that a poor living standard (OR 5.4, 95% CI 2.6 to 11.7), having a child with a higher activity score (OR 5.3, 95% CI 3.4 to 8.5), having a history of burns in other family members (OR 2.8, 95% CI 1.5 to 5.2) and a higher number of home hazards (OR for a one unit increase in hazards score 1.32, 95% CI 1.02 to 1.70) were all associated with a significant increase in the odds of a burn injury. The presence of a second carer (OR 0.42, 95% CI 0.2 to 0.7) and having disability (OR 0.14, 95% CI 0.03 to 0.6) were protective factors. Conclusions This information about risk factors for burn injuries can be used to target preventive interventions towards families at the greatest risk of injury. [ABSTRACT FROM AUTHOR]

Baseline risk is a proxy for unmeasured but important patient-level characteristics, which may be modifiers of treatment effect, and is a potential source of heterogeneity in meta-analysis. Models adjusting for baseline risk have been developed for pairwise meta-analysis using the observed event rate in the placebo arm and taking into account the measurement error in the covariate to ensure that an unbiased estimate of the relationship is obtained. Our objective is to extend these methods to network meta-analysis where it is of interest to adjust for baseline imbalances in the non-intervention group event rate to reduce both heterogeneity and possibly inconsistency. This objective is complicated in network meta-analysis by this covariate being sometimes missing, because of the fact that not all studies in a network may have a non-active intervention arm. A random-effects meta-regression model allowing for inclusion of multi-arm trials and trials without a 'non-intervention' arm is developed. Analyses are conducted within a Bayesian framework using the WinBUGS software. The method is illustrated using two examples: (i) interventions to promote functional smoke alarm ownership by households with children and (ii) analgesics to reduce post-operative morphine consumption following a major surgery. The results showed no evidence of baseline effect in the smoke alarm example, but the analgesics example shows that the adjustment can greatly reduce heterogeneity and improve overall model fit. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process. [ABSTRACT FROM PUBLISHER]

Background. Consensus guidelines recommend the use of prospective fall diaries in studies of fall rates. We sought to determine the characteristics associated with return and successful completion of a falls diary and whether characteristics such as gender, education level, native language, income, and falls risk influenced self-reported fall rates. Methods. Two hundred and seventy people aged 65 years and older participating in a randomized controlled trial evaluating two exercise programmes. Fall diaries were collected for 6 months, then evaluated for correct completion and falls reported. Results. An increasing risk of falls was associated with a reducing odds of returning diaries (odds ratio for a one unit increase in Falls Risk Assessment Tool score 0.71, 95% confidence interval 0.53–0.96). Native English speakers were more likely to complete more than half the diaries correctly (odds ratio 2.63, 95% confidence interval 1.20–5.75). Conclusions. Problems arise in the correct completion of falls diaries among those for whom English is not their first language. Diaries may underreport the rate of falls as those at higher risk were less likely to return diaries but more likely to report falls. Careful consideration should be given to the analysis of falls diaries as missing data are unlikely to be missing completely at random. We recommend additional training in the use of falls diaries for these groups or the utilization of simpler instruments. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM PUBLISHER]

Aims To assess the cost-effectiveness of installing thermostatic mixer valves (TMVs) in reducing risks of bath water scalds and estimate the costs of avoiding bath water scalds. Methods The evaluation was undertaken from the perspective of the UK public sector, and conducted in conjunction with a randomised control trial of TMVs installed in social housing in Glasgow. Installation costs were borne by the social housing organisation, while support materials were provided by the UK NHS. Effectiveness was represented by the number of families with at-risk bath water temperatures pre- and post-installation, and the number of bath scalds avoided as a result of installation. Differences in the number of families with at-risk temperatures between groups were derived from the RCT. Cost-effectiveness was assessed and a series of one-way sensitivity analyses were conducted. Results Unit costs associated with installation were calculated to be £13.68, while costs associated with treating bath water scalds ranged from £25 226 to £71 902. The cost of an avoided bath water scald ranged from net savings to public purse of £1887 to £75 520 and at baseline produced a net saving of £3 229 008; that is, £1.41 saved for every £1 spent. Conclusion It is very likely that installing TMVs as standard in social housing in new buildings and major refurbishments accompanied by educational information represents value for money. [ABSTRACT FROM AUTHOR]

Objective: to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme, for community-dwelling older people at high risk of future falls identified through a screening process.Design: multicentre randomised controlled trial.Setting: eight general practices and three day hospitals based in the East Midlands, UK.Participants: three hundred and sixty-four participants, mean age 79 years, with a median of three falls risk factors per person at baseline.Interventions: a day hospital-delivered multifactorial falls prevention programme, consisting of strength and balance training, a medical review and a home hazards assessment.Main outcome measure: rate of falls over 12 months of follow-up, recorded using self-completed monthly diaries.Results: one hundred and seventy-two participants in each arm contributed to the primary outcome analysis. The overall falls rate during follow-up was 1.7 falls per person-year in the intervention arm compared with 2.0 falls per person-year in the control arm. The stratum-adjusted incidence rate ratio was 0.86 (95% CI 0.73–1.01), P = 0.08, and 0.73 (95% CI 0.51–1.03), P = 0.07 when adjusted for baseline characteristics. There were no significant differences between the intervention and control arms in any secondary outcomes.Conclusion: this trial did not conclusively demonstrate the benefit of a day hospital-delivered multifactorial falls prevention programme, in a population of older people identified as being at high risk of a future fall. [ABSTRACT FROM AUTHOR]

Background: multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed.Design: economic evaluation alongside pragmatic randomised controlled trial.Intervention: randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists.Measurements: self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve.Results: in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted.Conclusions: the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life. [ABSTRACT FROM AUTHOR]

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 socioeconomic 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. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effectiveness of non-legislative interventions in increasing bicycle helmet use among children and young people, and to identify possible reasons for differential effectiveness of interventions. Design: Systematic review and meta-analysis. Data sources: 10 electronic databases were searched up to October 2006. Several other sources of potentially relevant information were identified and examined. Review methods: We included randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of interventions to promote bicycle helmet use, which did not require the enactment of legislation. Participants were aged between 0 and 18 years. Main outcome measure: Observed helmet wearing. Results: 13 studies were included in the review and 11 in the meta-analysis. The odds of observed helmet wearing were significantly greater among children and young people in the intervention groups (OR 2.13, 95% Cl 1 .35 to 3.35). Subgroup analysis indicated that the effect might be greater for community-based studies (4.57, 2.37 to 8.81) and those providing free helmets (4.60, 2.25 to 9.43) than for those providing subsidized helmets (2.11, 1.09 to 4.06) and those set in schools (1.73, 1.04 to 2.89). Evidence for the effectiveness of the interventions was stronger in studies with follow-up periods of ⩽6 months (2.23, 1.27 to 3.90) than in those with longer-term follow-up (1.63, 0.91 to 2.91). Conclusions: Non-legislative interventions are effective in increasing bicycle helmet use among children and young people. Community-based helmet promotion programmes that include the provision of free helmets may increase observed helmet wearing to a greater extent than those set in schools or those providing subsidized helmets. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the effectiveness of a school-based injury prevention program. Design: Cluster randomised controlled trial. Setting: 20 primary schools in Nottingham, UK. Participants: 459 children aged 7 to 10 years. Intervention: The ‘Risk Watch’ program delivered by teachers, aimed at improving bike and pedestrian, falls, poisoning and fire and burns safety. Main outcome measures: Safety knowledge, observed safety skills and self-reported safety behaviour. Results: At follow-up, intervention group children correctly answered more fire and burn prevention knowledge questions than control group children (difference between means 7.0% (95% CI 1 .5% to 12.6%)). Children in intervention group schools were more likely to know the correct actions to take if clothes catch fire and the correct way to wear a cycle helmet (difference between school means 35.3% (95% CI 22.7% to 47.9%) and 6.3% (95% CI 1.4% to 11.1%) respectively). They were also more likely to know the correct actions to take in a house fire and on finding tablets (OR 2.80 (95% CI 1 .08 to 7.22) and OR 3.50 (95% Cl 1 .1 8 to 10.38) respectively) and correctly demonstrated more safety skills than control group children (difference between means 11 .9% (95% CI 1 .4% to 22.5%)). There was little evidence to suggest the first year of the program impacted on self-reported safety behaviours. Conclusions: The Risk Watch program delivered by teachers in primary schools increased some aspects of children's safety knowledge and skills and primary schools should consider delivering this program. Longer term, larger scale evaluations are required to examine retention of knowledge and skills and impact on safety behaviours and child injury rates. [ABSTRACT FROM AUTHOR]

Background Good blood pressure (BP) control reduces the risk of complications in people with type 2 diabetes, yet many do not achieve this. Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved, but the effect of such recommendations in routine primary care is unknown. Aim To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes. Design of study A cluster randomised controlled trial of 1534 patients with type 2 diabetes. Setting Forty-two practices in Nottingham, UK. Method Practices were randomised to continue usual care or to use a treatment algorithm designed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached. Participants were assessed by a clinical interview and case note review at recruitment and at 1 year. The primary outcome measure was the proportion of participants achieving target BP at 1 year. Results At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms (36,6% versus 34.3%; P = 0.27), Mean systolic and diastolic blood pressure were identical in the two arms (143/78 mmHg). There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs, although there was no significant difference in the number of different antihypertensive drugs prescribed. Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care {rate ratio = 1.55, 95% confidence interval [Cl} 1.26 to 1.88, P<0.001). Conclusion Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control. Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care settings. [ABSTRACT FROM AUTHOR]

Abstract: There has been little research into the role of neighbourhood effects in childhood injury. We report results from a cohort study, comprising 1717 families (2357 children aged 0–7 years) registered at 47 general practices in Nottingham, UK. Multi-level Poisson regression examined relationships between electoral ward (neighbourhood), family and child characteristics and medically attended injury rates. Primary care attendance rates were higher for children in rented accommodation and those aged 2–3 years. An n-shaped relationship was found between geographical access to services and the primary care attendance rate. Accident and Emergency (A&E) department attendance rates were higher amongst boys, children in rented accommodation, with a teenage mother, aged 2–5 years and living in wards with a higher number of parks and play areas. They were lower for children whose families had a smoke alarm. Hospital admission rates were higher amongst children living in more deprived wards and wards with higher violent crime rates. They were lower in children whose families had smoke alarms, stair gates and stored sharp objects safely. Primary care and A&E attendance rates varied significantly between families. Variation between wards in the A&E attendance rate was explained by family characteristics. We conclude that characteristics of wards, families and children are associated with medically attended childhood injury rates. This study did not find a neighbourhood effect for A&E attendances that could not be explained by family level characteristics. Studies with greater power and a measure of injury severity independent of health service utilisation are needed to explore the relationship between neighbourhood effects and more severe injuries. The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary. [Copyright &y& Elsevier]

Objective To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design Randomized controlled trial. Setting 47 general practices in Nottingham. Participants 3428 families with children under 5. Intervention A standardized safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks. Main outcome measures Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices. Results No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small. Conclusions The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.. [ABSTRACT FROM AUTHOR]

Our objective was to assess accidental injury prevention activity within Primary Care Groups/Trusts (PCG/Ts), and current knowledge and attitudes towards accidental injuries and their prevention amongst PCG/T board members. We used a cross-sectional postal questionnaire survey design. Participants were board members of 51 PCG/Ts in Trent. The main outcome measures were prioritization of accidental injury prevention and factors influencing prioritization, perceptions of the accidental injury rates in the population served by the PCG/T, accidental injury prevention activity undertaken by the PCG/T, attitudes towards accidental injury prevention and towards the PCG/Ts involvement in accidental injury prevention, knowledge of accidental injury mortality, and beliefs in the effectiveness of interventions. Many (66%) PCG/T board members see accident prevention as the least important of the priority areas in the Government's health strategy for England. Half the PCG/Ts (49%) had formally discussed accidents at a PCG/T meeting, 34% had taken action and 29% had written an accident prevention strategy. The median number of agencies PCG/Ts were working with on accident prevention was 2. GPs held less positive attitudes about accident prevention than other board members (Z = -10.01, P < 0.001), but had a greater knowledge about injury mortality (Z = -3.92, P < 0.001). Health promotion leads had more positive attitudes towards accident prevention than other board members (Z = -3.70, P < 0.001). There were misconceptions amongst health promotion leads about the effectiveness of some accident prevention interventions. We conclude that there is little evidence of prioritization of accidents as an area for health improvement. Although some PCG/Ts are undertaking accidental injury prevention, a minority have demonstrated strategic planning with respect to accident prevention or collaboration with a wide range of agencies. Accident prevention and the PCG/Ts role within this are not viewed positively by all board members. Gaps in knowledge about accidents and their prevention are apparent. PCG/Ts will need help and support to fully develop their potential in preventing accidental injuries. [ABSTRACT FROM AUTHOR]

Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care. [ABSTRACT FROM AUTHOR]

Conclusions: Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography. [ABSTRACT FROM AUTHOR]

Background. Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and socio-demographic characteristics, hence this study has been undertaken to examine this relationship. [ABSTRACT FROM PUBLISHER]

Background. The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. [ABSTRACT FROM PUBLISHER]

Focuses on a study which assesses the general practitioner's safety advice about child safety to families with children under the age of five. Details on persons and methods used in the study; Results of the study; Discussion on the study.

Child pedestrian accidents are the most common road traffic accident resulting in injury. Much of the existing work on road traffic accidents is based on analysing clusters of accidents despite evidence that child pedestrian accidents tend to be more dispersed than this. This paper analyses pedestrian accidents in 573 children aged 0-11 years by a locally derived deprivation score for the years 1988-90. The analysis shows a significantly higher accident rate in deprived areas and a dose response relationship between degree of deprivation and accident rates. At the level of individual deprivation zones a strong correlation between accident rates and the degree of deprivation has been demonstrated. It is suggested that area wide engineering and educational schemes should be targeted at areas with high accident rates. Environmental improvements based on analysis of clusters of accidents may not be the most suitable method for reducing child pedestrian accidents. [ABSTRACT FROM AUTHOR]

The reflects on the role of caregiver supervision in decreasing injury risk in young children in the U.S. He cites the case control study and recent systematic review which show that caregiver supervision does in fact reduce child injury risk. He emphasizes that the studies help primary care providers develop a better understanding of the issues around defining and measuring caregiver supervision.

The article focuses on the significance of recruiting participants in emergency departments as samples for injury studies. This highlights on the conviction that acquiring participants in these departments pave way for maximum recruitment efficiency, as well as minimize recruiting costs due to its wide spectrum of injury cases in a single healthcare setting. Further advantages and factors that must be considered in recruiting emergency departments' participants are also considered.

The article examines trends in poisoning attendances at Accident and Emergency departments in Great Britain in children affected by a poisoning agent. The findings show that poisoning was the sixth most common injury mechanism resulting in attendance at the department. There is also a decline in the attendance rates for poisoning for children aged 0-4 and 5-9 years between 1990 and 1999.

Abstract: Objective: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years. Design: Cross sectional survey of routinely collected hospital admission data for injury 1992-7. Setting: 862 electoral wards in Trent Region. Subjects: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14. Main outcome measures: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward. Results: Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was ≥ 3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)). Contusion: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources. [ABSTRACT FROM AUTHOR]