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.

School Health Guidelines to Promote Healthy Eating and Physical Activity

 www.cdc.gov/healthyyouth/npao/strategies.htm

Schools play a critical role in improving the dietary and physical activity behaviors of children and adolescents. Schools can create environments supportive of students’ efforts to eat healthy and be active by implementing policies and practices that support healthy eating and regular physical activity and by providing opportunities for students to learn about and practice these behaviors.

CDC synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in nine guidelines. These guidelines were informed by the Dietary Guidelines for Americans,¹ the Physical Activity Guidelines for Americans,² and the Healthy People 2020 objectives related to healthy eating and physical activity among children, adolescents, and schools.³ The guidelines serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students.

Each of the nine guidelines is accompanied by a set of implementation strategies developed to help schools work towards achieving each guideline. Although the ultimate goal is to implement all nine guidelines included in this document, not every strategy will be appropriate for every school, and some schools, due to resource limitations, might need to implement the guidelines incrementally.

The health of students is linked to their academic success. Both physical activity and healthy eating may help improve academic achievement.^4–7

Healthy eating and regular physical activity play a powerful role in preventing obesity and chronic diseases, including heart disease, cancer, and stroke — the three leading causes of death among adults aged 18 years or older.^8–12

Study of Well-Child Visits Analyzes Content and Satisfaction

September 19, 2011 — Although most well-child visits for children under 3 years of age are of "short duration," parent satisfaction is generally high, according to the results of a cross-sectional national survey in the October 2011 issue of Pediatrics (published onlineSeptember 19).

Among a subset of 1428 parents who participated in the 2000 National Survey of Early Childhood Health (NSECH), one third reported spending 10 minutes or less with the clinician during their well-child visit, 47% reported visits lasting 11 to 20 minutes, and 20% reported visits of 21 minutes or more, reported Neal Halfon, MD, from the Center for Healthier Children, Families and Communities at the University of California, Los Angeles, and colleagues.

"Longer visits are associated with more developmental screening, discussions of more psychosocial risks, and greater parent satisfaction," they write. However, "even with the shortest visits parent-reported satisfaction generally was high."

The NSECH included 2068 parents of children aged 4 to 35 months, of whom 1428 provided details about their well-child visit within the past year.

Participants were asked about the length of the visit, their satisfaction with the visit, and the content of care in terms of anticipatory guidance, psychosocial assessment of risks, developmental assessment, and family-centered care.

Regardless of the length of visit, more than 80% of parents reported receiving anticipatory guidance on immunizations and breastfeeding, with more issues such as sleeping position, feeding issues, and car seats being included in longer visits.

"The pattern indicated that traditional topics that have been part of anticipatory guidance for decades are most likely to be addressed, whereas topics added more recently are less likely to get mentioned when time is short," the authors write.

"Overall, many anticipatory guidance topics were provided more frequently than a developmental assessment (which ranged between 50% and 68% depending on the visit length)," they note.

Ninety-nine percent of parents reported having adequate time with their doctors when the visit was 21 minutes or longer, compared with 76% of parents whose visits lasted 10 minutes or less.

Parental satisfaction remained higher with longer visits even after adjustment for the content of the visit, supporting the notion that "a trusting relationship and good communication between parents and their child’s pediatrician is a key component of optimal well-child care," they suggest.

The authors note that demands on pediatricians performing well-child visits continue to expand as new directives clash with time constraints and lack of reimbursement.

"Efforts to improve preventive services will require strategies that address the time devoted to well-child care," they note.

A focus on parent-identified concerns, the integration of previsit questionnaires, tiered systems that allot more time to higher-risk children, and the division of some care with nonphysician clinicians are among suggested strategies that might enhance care, they write.

"Ultimately, greater reimbursement for preventive and developmental services may best encourage the devotion of time and attention to their provision," they conclude.

The study was supported by the Commonwealth Fund and the Gerber Foundation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 19, 2011.

Efficacy of a School-Based Childhood Obesity Intervention Program in a Rural Southern Community: TEAM Mississippi Project.

Greening L, Harrell KT, Low AK, et al. Obesity (Silver Spring). 2011 Jun;19(6):1213-9. Epub 2011 Jan 13
Abstract
A healthy lifestyle school-based obesity intervention was evaluated in a rural southern community where the rate of obesity ranks as the highest. School-age children (N = 450) ranging from 6 to 10 years of age (M(age) = 8.34) participated in monthly physical activity and nutritional events during a 9-month academic year. The children`s nutritional knowledge, number of different physical activities, fitness level, dietary habits, waist circumference, BMI percentile, and percentage body fat were measured pre- and postintervention. Changes on these measures were compared to students in a school employing the school system`s standard health curriculum. Regression analyses with residualized change scores revealed that the intervention school showed statistically significant improvement in percentage body fat, physical activity, performance on fitness tests, and dietary habits compared to the control school. There was no evidence of differences in outcomes based on gender or ethnicity/race. With rates of obesity and overweight reaching 50% in southern rural communities, intervening early in development may offer the best outcome because of the difficulties with changing lifestyle behaviors later in adulthood. A population-based approach is recommended over a targeted approach to cultivate a culture of healthy lifestyle behaviors when children are developing their health-care habits. Evidence suggests that both boys and girls, and African-American and white children can benefit equally from such interventions.

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB.
Cochrane Database Syst Rev. 2010 Mar 17;3:CD004015
BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.