Risk and Protective Factors for Falls From Furniture in Young Children: Multicenter Case-Control Study.

Kendrick D y cols. JAMA pediatr. 2014 Dec 1. doi: 10.1001/jamapediatrics.2014.2374. [Epub ahead of print]

Importance:

Falls from furniture are common in young children but there is little evidence on protective factors for these falls.

Objective:

To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years.

Design, Setting, and Participants:

Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards.

Main Outcomes and Measures:

Falls from furniture occurring at the child's home resulting in attendance at an emergency department, minor injury unit, or hospital admission.

Results:

Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97).

Conclusions and Relevance:

If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects.

Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica

Zoni AC, Dominguez-Berjón MF, Esteban-Vasallo MD, Regidor E.
Gac Sanit. 2014;28(1):55-60

Objetivo: Describir la incidencia de lesiones atendidas en atención primaria y analizar su distribución
según el tipo de lesión por sexo y edad en la Comunidad de Madrid en el año 2011.
Métodos: Estudio descriptivo transversal a partir de la historia clínica electrónica de atención primaria, del sistema sanitario público de la Comunidad de Madrid, en 2011. Se calcularon la incidencia de las lesiones, las tasas específicas de lesiones (fracturas, esguinces, heridas, quemaduras, lesiones por cuerpo extraño, intoxicaciones y contusiones) y las razones de tasas con un intervalo de confianza del 95%, todas estratificadas por sexo y edad.
Resultados: En 2011 se registraron 707.800 episodios de lesiones (3,5% del total de los episodios atendidos en atención primaria). La mayoría afectaron a mujeres (54,0%) y a mayores de 34 años (58,0%). Las más frecuentes fueron las heridas en los hombres (35,3%) y las contusiones en las mujeres (30,6%).
Globalmente, las mujeres presentaron tasas más altas de lesiones en edades avanzadas y los hombres se lesionaron más por debajo de los 15 años de edad. Por tipo de lesión, las tasas más altas de fracturas, quemaduras y contusiones se observaron en la población de mayor edad, las de lesiones por cuerpo extraño y heridas en la infancia, las luxaciones en jóvenes y las intoxicaciones en las edades extremas.
Conclusiones: La vulnerabilidad especial de varones menores de 5 años y de las ancianas sugiere que las intervenciones tienen que dirigirse a las necesidades específicas de estos grupos



Comentario: El análisis de las lesiones atendidas en Atención Primaria es muy importante para conocer la magnitud real del problema y las medidas preventivas necesarias. La calidad de los registros en nuestras consultas son del máximo interés.

Parenting interventions for the prevention of unintentional injuries in childhood.

Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev. 2013 Mar 28;3:CD006020. doi: 10.1002/14651858.CD006020.pub3. (Review) PMID: 23543542

BACKGROUND: Parent education and training programmes can improve maternal psychosocial health, child behavioural problems and parenting practices. This review assesses the effects of parenting interventions for reducing child injury.
OBJECTIVES: To assess the effects of parenting interventions for preventing unintentional injury in children aged under 18 years and for increasing possession and use of safety equipment and safety practices by parents.  
SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, BIOSIS Preview, PsycINFO, Sociological Abstracts, Social Science Citation Index, CINAHL, ProQuest Dissertations and Theses, ERIC, DARE, ASSIA, Web of Science, SIGLE and ZETOC. We also handsearched abstracts from the World Conferences on Injury Prevention & Control and the journal Injury Prevention. The searches were conducted in January 2011.
SELECTION CRITERIA: We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs) and controlled before and after studies (CBAs), which evaluated parenting interventions administered to parents of children aged 18 years and under, and reported outcome data on injuries for children (unintentional or unspecified intent), possession and use of safety equipment or safety practices (including the Home Observation for Measurement of the Environment (HOME) scale which contained an assessment of home safety) by parents. Parenting interventions were defined as those with a specified protocol, manual or curriculum aimed at changing knowledge, attitudes or skills covering a range of parenting topics.
DATA COLLECTION AND ANALYSIS: Studies were selected, data were extracted and quality appraised independently by two authors. Pooled relative risks (RR) were estimated using random effect models.
MAIN RESULTS: Twenty two studies were included in the review: 16 RCTs, two non-RCTs, one partially randomised trial which contained two randomised intervention arms and one non-randomised control arm, two CBA studies and one quasi randomised controlled trial. Seventeen studies provided interventions comprising parenting education and other support services; 15 of which were home visiting programmes and two of which were paediatric practice-based interventions. Two provided solely educational interventions. Nineteen studies recruited families who were from socio-economically disadvantaged populations, were at risk of adverse child outcomes or people who may benefit from extra support, such as single mothers, teenage mothers, first time mothers and mothers with learning difficulties. Ten RCTs involving 5074 participants were included in the meta-analysis, which indicated that intervention families had a statistically significant lower risk of injury than control families (RR 0.83, 95% CI 0.73 to 0.94). Sensitivity analyses undertaken including only RCTs at low risk of various sources of bias found the findings to be robust to including only those studies at low risk of detection bias in terms of blinded outcome assessment and attrition bias in terms of follow up of fewer than 80% of participants in each arm. When analyses were restricted to studies at low risk of selection bias in terms of inadequate allocation concealment the effect size was no longer statistically significant. Several studies found statistically significant fewer home hazards or a greater number of safety practices in intervention families. Of ten studies reporting scores on the HOME scale, data from three RCTs were included in a meta-analysis which found no evidence of a difference in quality of the home environment between treatment arms (mean difference 0.57, 95% CI -0.59 to 1.72). Most of the studies reporting home safety practices, home hazards or composite home safety scores found statistically significant effects favouring intervention arm families. Overall, using GRADE, the quality of the evidence was rated as moderate.
AUTHORS' CONCLUSIONS: Parenting interventions, most commonly provided within the home using multi-faceted interventions are effective in reducing child injury. There is fairly consistent evidence that they also improve home safety. The evidence relates mainly to interventions provided to families from disadvantaged populations, who are at risk of adverse child health outcomes or whose families may benefit from extra support. Further research is required to explore mechanisms by which these interventions may reduce injury, the features of parenting interventions that are necessary or sufficient to reduce injury and the generalisability to different population groups.

Suffocation Deaths Associated with Use of Infant Sleep Positioners — United States, 1997–2011

Morbidity and Mortality Weekly Report (MMWR)
November 23, 2012 / 61(46);933-937

Unintentional suffocation is the leading cause of injury death among children aged less than 1 year in the United States, accounting for nearly 1,000 infant deaths annually. Since 1984, an estimated fourfold increase has been observed in accidental suffocation and strangulation in bed, with many of these deaths linked to unsafe sleep environments (1,2). Infant sleep positioners (ISPs) are devices intended to keep an infant in a specific position while sleeping, yet ISPs have been reported to have been present in the sleep environment in some cases of unintentional infant suffocation (Figure).
To characterize infant deaths associated with ISPs, FDA, the U.S. Consumer Product Safety Commission (CPSC), and CDC examined information reported to CPSC about 13 infant deaths in the past 13 years associated with the use of ISPs.

Headphone use and pedestrian injury and death in the United States: 2004-2011.

Lichenstein R, Smith DC, Ambrose JL, Moody LA.

Headphone use and pedestrian injury and death in the United States: 2004-2011. Inj Prev. 2012 Jan 16. [Epub ahead of print]

Uso de auriculares y lesiones y muerte de peatones en los Estados Unidos: 2004-2011

La asociación ente la distracción causada por el uso de teléfonos móviles en conductores está bien documentada, pero este trabajo aporta la novedad de estudiar el uso de auriculares por peatones, tanto de teléfonos móviles como de otros instrumentos electrónicos, que han sufrido un atropello. Recogen la información tanto de registros oficiales como de archivos de noticias, en EE. UU., sin restricción de edad. Obtienen 116 casos entre 2004 y 2011. La mayoría (68%) son varones y (67%) menores de 30 años, y más de la tercera parte eran menores de 18 años, con resultado de 81 muertes y 24 heridos graves. En el 29% de los casos se refiere que el vehículo emitió una señal sonora antes del accidente. En este trabajo hay una importante representación de los atropellos por trenes, y la mayoría tuvieron lugar en grandes áreas metropolitanas.

Este trabajo, aunque puede sobre representar los atropellos graves, a cambio no recoge casos de “casi accidente”, en los que el peatón evita lo colisión en el último momento, o en los que las consecuencias son leves.

En cualquier caso pone de manifiesto el peligro que representa estar aislado auditivamente del entorno, así como el factor distracción debido tanto a lo que se está oyendo como a la manipulación táctil del instrumento electrónico.

Abstract:

Background: The association between distraction caused by cell phone use while driving and driver/passenger fatalities has been documented, but the safety risks associated with headphone use by pedestrians remains unknown.

Objective: To identify and describe pedestrian-vehicle crashes in which the pedestrian was using headphones.

Methods: A retrospective case series was conducted by searching the National Electronic Injury Surveillance System, US Consumer Product Safety Commission, Google News Archives and Westlaw Campus Research databases for reports published between 2004 and 2011 of pedestrian injuries or fatalities from crashes involving trains or motor vehicles. Cases involving headphones were extracted and summarised. The likelihood of headphone involvement was graded on a three-tier scale based on the information found in the article or report.

Results: There were 116 reports of death or injury of pedestrians wearing headphones. The majority of victims were male (68%) and under the age of 30 (67%). The majority of vehicles involved in the crashes were trains (55%), and 89% of cases occurred in urban counties. 74% of case reports stated that the victim was wearing headphones at the time of the crash. Many cases (29%) mentioned that a warning was sounded before the crash.

Conclusions: The use of headphones with handheld devices may pose a safety risk to pedestrians, especially in environments with moving vehicles. Further research is needed to determine if and how headphone use compromises pedestrian safety.

A Randomized Controlled Trial of Home Injury Hazard Reduction: The HOME Injury Study.

Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP.
A Randomized Controlled Trial of Home Injury Hazard Reduction: The HOME Injury Study.
Arch Pediatr Adolesc Med. 2011 Apr;165(4):339-45.

Abstract
OBJECTIVE:
To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices.

DESIGN:
A nested, prospective, randomized controlled trial.

SETTING:
Indoor environment of housing units.

PARTICIPANTS:
Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, 1263 (14.2%) were eligible, 413 (32.7%) agreed to participate, and 355 were randomly assigned to the intervention (n = 181) or control (n = 174) groups. Intervention Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey. Main Outcome Measure Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury).

RESULTS:
The mean age of children at intervention was 6.3 months. Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% confidence interval [CI], 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).

CONCLUSION:
An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury

Riesgo de muerte por causas no naturales durante la primera infancia en hijos de padres con enferemdad mental

Chen YH, Chiou HY, Tang CH, et al. Risk of death by unnatural causes during early childhood in offspring of parents with mental illness. Am J Psychiatry. 2010 Feb;167(2):198-205. Epub 2009 Dec 1. (Original) PMID: 19952076

OBJECTIVE: Limited evidence reveals an elevated mortality risk in offspring of psychiatric patients after infancy. This nationwide population-based study in Taiwan aimed to investigate mortality risk in preschool children up to age 5 whose parents have severe mental illness. METHOD: Three nationwide population-based data sets were linked. A total of 3,166 children with one or both parents having schizophrenia or an affective disorder were identified, together with a comparison cohort of 25,328 children matched with the study group in terms of maternal age and year of delivery. Cox proportional hazard regressions were performed to compute hazard ratios, with adjustment for sociodemographic characteristics and maternal medical comorbidities.
RESULTS: During the preschool years, 54 (1.7%) deaths were documented among offspring of parents with severe mental illness and 155 (0.6%) in the comparison cohort. Parental mental illness was independently associated with a risk of death nearly 2.4 times higher (95% CI=1.72-3.28) than in the comparison cohort. The association was even more marked for unnatural causes of death, in which the mortality risk was 8.35 times greater (95% CI=4.04-17.24) in children of affected parents than in the comparison cohort. The proportional mortality rates were as high as 20.4% and 11.1% for accident and homicide, respectively, among offspring exposed to parental mental illness.
CONCLUSIONS: An elevated mortality risk, especially from unnatural causes of death, was identified for offspring of parents with severe mental illness during the preschool years in an Asian society. There is an urgent need for multidisciplinary team approaches and risk management strategies to support psychiatric patients who are having difficulty with the transition to parenthood.