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1.  Beliefs about the risks of guns in the home: analysis of a national survey 
Injury Prevention  1999;5(4):284-289.
Objectives—While epidemiological evidence suggests homes with guns are more likely to be the site of a suicide or homicide than homes without guns, the public's perception of these risks remains unknown. This study assesses the prevalence of the belief that homes with guns are safer than homes without guns, and factors associated with this belief.
Methods—Telephone interviews were conducted with a random sample of 4138 registered voters in urban areas in the US. Multinomial logistic regression was used to assess correlates of beliefs about the safety of keeping a gun in the home.
Results—Twenty nine per cent of respondents believed keeping a gun in the home makes the home more safe, 40% said less safe, 23% said it depends, and 9% were unsure. The belief that a home is more safe with a gun was associated with being male, young, completing 12 years or fewer of education, having no children living at home, Republican party affiliation, and low levels of trust in the police for protection. Prior exposure to violence and fear of victimization were not associated with the outcome.
Conclusions—Findings may increase understanding about the public's perception of the risk in keeping guns in the home and assist educational efforts to decrease the risk of these injuries.
PMCID: PMC1730555  PMID: 10628918
2.  Identifying Occupational Performance Barriers of Stroke Survivors: Utilization of a Home Assessment 
Physical & occupational therapy in geriatrics  2012;30(2):10.3109/02703181.2012.687441.
Stroke survivors often have impairments that make it difficult for them to function safely in their home environment.
The purpose of this study is to identify occupational performance barriers in the home and describe the subsequent recommendations offered to stroke survivors and their caregivers.
An occupational therapist administered a home safety tool to assess stroke survivors' home environments, determine home safety problems, and provide recommendations.
Among 76 stroke survivors, the greatest problems were indentified in the categories of bathroom, mobility, and communication. Two case studies illustrate the use of the home safety tool with this population.
The home safety tool is helpful in determining the safety needs of stroke survivors living at home. We recommend the use of the home safety tool for occupational therapists assessing the safety of the home environment.
PMCID: PMC3839531  PMID: 24285912
stroke; recovery; home safety evaluation; activities of daily living
3.  Pediatric Cancer CareLink--supporting home management of childhood leukemia. 
We conducted a descriptive evaluation of an Internet-based system designed to support home management of childhood leukemia (Pediatric Cancer CareLink). Twenty-five parents of children with ALL and thirty-four clinicians were interviewed to identify functional requirements and to demonstrate the system's potential to improve the experience and outcomes of children with acute lymphoblastic leukemia (ALL). Parental interviews focused on: medication and side effect management in the home; communication with the health care team; and the use of a computer for ALL home management. Results from these interviews provide strong evidence that parents of children with ALL are struggling to manage the complexity of their children's care in the home. Parents revealed an urgent need for tools that would help them to safely organize the medicines that their children receive while on ALL protocols. Forty percent of parents needed to know more about what to expect during their child's therapy and how to be prepared for it. Clinician interviews focused on the clinical impact and workflow issues associated with such a system. Decision support, prescription refill management, and educational and emotional support functions were considered key components. Clinicians were concerned that such a system would increase their already overburdened workload. Conversely, parents believed that access to such a system would eliminate unnecessary phone calls to the care team. Our findings show that parents would embrace collaborative Internet-based tools that would help with the home management of their child's leukemia.
PMCID: PMC2244563  PMID: 12463833
4.  Home intravenous therapy: Accessibility for Canadian children and youth 
Paediatrics & Child Health  2011;16(2):105-109.
The administration of intravenous (IV) therapy at home is an alternative to hospitalization for treatment of infection and a number of other conditions, and has been demonstrated to be effective and safe, to reduce cost and to improve quality of life. While home IV therapy has many advantages for children, it is not uniformly available and access may be limited by age, geographical location and ability to pay. Physicians caring for children need to be aware of the indications for home IV therapy, its requirements and limitations, as well as whether this option is available for children in their care. Where access is limited, physicians should advocate for home IV therapy for children when it is medically indicated.
PMCID: PMC3043043  PMID: 22294870
Antibiotic; Home intravenous therapy; Paediatric; Parenteral nutrition
5.  Safe discharge: an irrational, unhelpful and unachievable concept 
Emergency Medicine Journal : EMJ  2006;23(10):753-755.
Emergency doctors often decide whether to advise hospital admission or discharge by assessing whether a decision to discharge home is considered safe. This implies that hospital admission may be recommended on the basis of exceeding an arbitrarily defined risk of adverse outcome, rather than weighing the potential benefits, risks and costs of hospital admission. This approach is likely to lead to irrational decision making, unnecessary hospitalisation and unrealistic expectations regarding risk. Instead of using the concept of a safe discharge, we should take a more rational approach to decision making, weighing the benefits, risks and costs of hospitalisation against a default option of discharge home. Hospital admission should be recommended only if the expected benefits outweigh the risks and can be accrued at an acceptable cost. Guidelines should be developed using this approach and used to promote and support rational decision making.
PMCID: PMC2579591  PMID: 16988299
6.  Perceptions of health and risk management among home care workers in Sweden 
Physical Therapy Reviews  2013;18(5):336-343.
Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way.
This study aims to examine home care workers’ perceptions of health, risks, working conditions, and risk management within their organization.
The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides (n = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed.
Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified.
There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.
PMCID: PMC3779860  PMID: 24078781
Health; Risk management; Home care work
7.  Evaluation of a community based childhood injury prevention program. 
Injury Prevention  1997;3(1):14-16.
OBJECTIVES: This pilot study evaluates the effectiveness of a community based childhood injury prevention program on the reduction of home hazards. METHODS: High risk pregnant women, who were enrolled in a home visiting program that augments existing health and human services, received initial home safety assessments. Clients received education about injury prevention practices, in addition to receiving selected home safety supplies. Fourteen questions from the initial assessment tool were repeated upon discharge from the program. Matched analyses were conducted to evaluate differences from initial assessment to discharge. RESULTS: A significantly larger proportion of homes were assessed as safe at discharge, compared with the initial assessment, for the following hazards: children riding unbuckled in all auto travel, Massachusetts Poison Center sticker on the telephone, outlet plugs in all unused electrical outlets, safety latches on cabinets and drawers, and syrup of ipecac in the home. CONCLUSIONS: A community based childhood injury prevention program providing education and safety supplies to clients significantly reduced four home hazards for which safety supplies were provided. Education and promotion of the proper use of child restraint systems in automobiles significantly reduced a fifth hazard, children riding unbuckled in auto travel. This program appears to reduce the prevalence of home hazards and, therefore, to increase home safety.
PMCID: PMC1067757  PMID: 9113841
8.  A randomised controlled trial of general practitioner safety advice for families with children under 5 years 
BMJ : British Medical Journal  1998;316(7144):1576-1579.
Objective: To assess effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on use of safety equipment and safe practices at home.
Design: Randomised, unblinded, controlled trial with initial assessment and six week follow up by telephone survey. Twenty families from intervention and control groups were randomly selected for a home visit to assess validity of responses to second survey.
Setting: A general practice in Nottingham.
Subjects: 98% (165/169) of families with children aged under 5 years registered with the practice.
Interventions: General practitioner safety advice plus, for families receiving means tested state benefits, access to safety equipment at low cost. Control families received usual care.
Main outcome measures: Possession and use of safety equipment and safe practices at home.
Results: Before intervention, the two groups differed only in possession of fireguards. After intervention, significantly more families in intervention group used fireguards (relative risk 1.89, 95% confidence interval 1.18 to 2.94), smoke alarms (1.14, 1.04 to 1.25), socket covers (1.27, 1.10 to 1.48), locks on cupboards for storing cleaning materials (1.38, 1.02 to 1.88), and door slam devices (3.60, 2.17 to 5.97). Also, significantly more families in intervention group showed very safe practice in storage of sharp objects (1.98, 1.38 to 2.83), storage of medicines (1.15, 1.03 to 1.28), window safety (1.30, 1.06 to 1.58), fireplace safety (1.84, 1.34 to 2.54), socket safety (1.77, 1.37 to 2.28), smoke alarm safety (1.11, 1.01 to 1.22), and door slam safety (7.00, 3.15 to 15.6). Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others.
Conclusions: General practitioner advice, coupled with access to low cost equipment for low income families, increased use of safety equipment and other safe practices. These findings are encouraging for provision of injury prevention in primary care.
Key messages We assessed the effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on safe practices at home The intervention increased safe behaviour and use of safety equipment The intervention was equally effective in families receiving means tested benefits as in those not receiving benefits The effectiveness of this intervention should be evaluated over longer periods, in other practices, and when delivered by other members of the primary healthcare team
PMCID: PMC28560  PMID: 9596598
9.  Storage of household firearms: an examination of the attitudes and beliefs of married women with children 
Health Education Research  2007;23(4):592-602.
Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n = 185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon–Mann–Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.
PMCID: PMC2733798  PMID: 17890758
10.  Engagement in safety practices to prevent home injuries in preschool children among white and non-white ethnic minority families 
Injury Prevention  2004;10(6):375-378.
Objective: To examine engagement in home safety practices to prevent injuries in preschool children among white and non-white ethnic minority families.
Design: A self completion postal questionnaire assessed sociodemographic characteristics and engagement in home safety practices.
Setting: Deprived areas in the city of Nottingham, United Kingdom.
Subjects: 3906 caregivers of children aged under 5 years.
Main outcome measures: Use of fireguards, stair gates, smoke alarms, window locks and safe storage of medicines, sharp objects, and cleaning products.
Results: Of the 3906 families, 3805 gave their ethnic origin of which 16.5% classed themselves as from a non-white ethnic minority. The safety practices most commonly adopted by respondents were safe storage of medicines (87.9%) and use of smoke alarms (72.3%). Respondents from non-white ethnic minorities were significantly less likely to adopt all safety practices except they were less likely than whites to store sharp objects unsafely (odds ratio (OR) 0.68, 95% confidence interval (CI) 0.56 to 0.84). Those from non-white ethnic minorities were significantly more likely to indicate that they "did not know they could get" fireguards (adjusted OR 6.01, 95% CI 2.64 to 13.65), stair gates (adjusted OR 4.47, 95% CI 1.53 to 13.05), and cupboard locks (adjusted OR 3.96, 95% CI 2.77 to 5.66) than whites. They were also significantly more likely to say they would need help fitting fireguards (adjusted OR 1.98, 95% CI 1.03 to 3.81), stair gates (adjusted OR 3.61, 95% CI 2.11 to 6.17), and cupboard locks (adjusted OR 1.88, 95% CI 1.39 to 2.54).
Conclusions: Our results support the hypothesis that families from non-white ethnic minorities are less likely to engage in some safety practices and illustrate inequalities in access to information regarding the availability and fitting of safety equipment. Further work is required to examine the association between adoption of safety practices and injury rates in children from non-white ethnic minorities.
PMCID: PMC1730154  PMID: 15583260
11.  Promoting children's home safety. 
Home accidents are the main cause of death and morbidity in early childhood. Working-class children are at greatest risk. A study in an inner city area of the effects of a national television campaign about child accident prevention and of a locally designed health education initiative showed that 55% of families with young children in the study area did not watch any of the television programmes. Only 9% of a group specially encouraged to watch the programmes took any action to make their homes safer. In a comparable group who also received a home visit at which specific advice was given 60% took action to make their homes safer. The families studied were well aware before the television campaign of the importance and preventability of children's accidents. The problems disadvantaged families face are therefore not ones of ignorance or apathy about hazards but practical difficulties in converting their concern into action. Administrative arrangements must be developed for providing health workers--especially health visitors--with detailed local information to pass on to parents.
PMCID: PMC1500158  PMID: 6812798
12.  Teaching home safety and survival skills to latch-key children: a comparison of two manuals and methods. 
I evaluated the influence of two training manuals on latch-key children's acquisition of home safety and survival skills. The widely used, discussion-oriented "Prepared for Today" manual was compared with a behaviorally oriented "Safe at Home" manual. Data were scored by response criteria developed by experts and by parents' and experts' ratings of children's spontaneous answers. With both methods of scoring, three behaviorally trained children demonstrated clear and abrupt increases in skill following training in each of seven trained modules, and these increases largely persisted in real world generalization probes and at 5-month follow-up. Smaller and less stable increases in skill were found in the three discussion-trained children across the seven modules; lower skill levels were also seen in real world generalization probes and at follow-up. Neither group of children demonstrated skill increases in home safety areas that were not explicitly trained. Both training methods produced small decreases in children's self-report of general anxiety and anxiety concerning home safety. Results are discussed in terms of their implications for cost-effective training of latch-key children.
PMCID: PMC1307945  PMID: 6511698
13.  Socioeconomic status and the prevention of child home injuries: a survey of parents of preschool children. 
Injury Prevention  1997;3(1):29-34.
OBJECTIVES: To examine the effect of socioeconomic status on the attitudes parents of preschool children towards child home safety issues and practice of home safety measures. SETTING: A community based study in the Lanarkshire Health Board area, a mixed urban-rural setting in central Scotland. METHODS: A postal survey of two random samples of parents of preschool children (aged 3 years). One sample (A) involved parents living in more affluent areas and the other (B) parents living in less affluent areas. RESULTS: In general, parents in both groups showed similar attitudes towards home safety. The only significant differences to emerge were over parental perceptions of the safety of the neighbourhood in which they lived and over the availability of money to keep their child safe (group B > group A, p < 0.0042). Parents from group B also tended to report similar or safer levels of home safety behaviour to parents from group A. CONCLUSIONS: The findings do not suggest that differences in the injury experience of children from more and less affluent backgrounds are due to differences in parental attitude, knowledge, or practice of home safety measures. Thus, the study does not support the selective targeting of families from less affluent areas with educational interventions. Instead, the findings do support the use of a multi-method approach to home safety, where educational approaches are complemented by environmental modification.
PMCID: PMC1067760  PMID: 9113844
14.  Home Safety and Low-Income Urban Housing Quality 
Pediatrics  2012;130(6):1053-1059.
Living in substandard housing may be one factor that increases the risk of fire and burn injuries in low-income urban environments. The purposes of this study are to (1) describe the frequency and characteristics of substandard housing in urban homes with young children and (2) explore the hypothesis that better housing quality is associated with a greater likelihood of having working smoke alarms and safe hot water temperatures.
A total 246 caregivers of children ages 0 to 7 years were recruited from a pediatric emergency department and a well-child clinic. In-home observations were completed by using 46 items from the Housing and Urban Development’s Housing Quality Standards.
Virtually all homes (99%) failed the housing quality measure. Items with the highest failure rates were those related to heating and cooling; walls, ceilings, and floors; and sanitation and safety domains. One working smoke alarm was observed in 82% of the homes, 42% had 1 on every level, and 62% had safe hot water temperatures. For every increase of 1 item in the number of housing quality items passed, the odds of having any working smoke alarm increased by 10%, the odds of having 1 on every level by 18%, and the odds of having safe hot water temperatures by 8%.
Many children may be at heightened risk for fire and scald burns by virtue of their home environment. Stronger collaboration between housing, health care, and injury prevention professionals is urgently needed to maximize opportunities to improve home safety.
PMCID: PMC3507257  PMID: 23147973
housing quality; child injury; built environment; urban health; smoke alarms; scald burns; environmental health; housing policy
15.  Ethical challenges in home mechanical ventilation: A secondary analysis 
Nursing Ethics  2012;19(2):233-244.
The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family.
PMCID: PMC3573680  PMID: 22183963
autonomy; beneficence; ethical challenges; home mechanical ventilation; justice; non-maleficence
16.  Quantifying respiratory complications post-adenotonsillectomy in patients with normal or inconclusive overnight oximetry 
Children with sleep-disordered breathing (SDB) are at risk of developing post-operative respiratory complications following adenotonsillectomy (T&A). Our goal was to describe and quantify these complications following T&A in children with clinical SDB but with a pre-operative overnight home oximetry score of “normal/inconclusive” (McGill Oximetry Score (MOS) of 1), and to determine whether these children could safely undergo surgery in peripheral hospitals or outpatient surgical centers.
We performed a retrospective chart review of patients 3 years and older who had T&A between 2003 and 2010 at 2 of our institution’s hospitals. To be included in the study, in addition to not having severe comorbidities, children had to have undergone an overnight home oximetry within 12 months of surgery that was normal or inconclusive (MOS of 1). This was defined as fewer than 3 episodes of oxygen desaturation below 90% and stable baseline saturation over 95%. Medical charts were reviewed for major and minor postoperative respiratory complications. The main outcome measure was post-T&A respiratory complications.
Out of 2708 T&A patients, 231 met the inclusion criteria. No patient had a major postoperative respiratory complication requiring re-intubation or admission to the intensive care unit. Five patients (2.16%) had minor respiratory complications but only one required admission to the ward.
An overnight home oximetry that is “normal/inconclusive” (MOS of 1) can be used as a screening tool to identify patients with sleep-disordered breathing who can be safely sent to peripheral hospitals or outpatient surgical centers for T&A.
PMCID: PMC3852483  PMID: 24172173
Adenotonsillectomy; Children; Polysomnography; Sleep-disordered breathing
17.  Telemonitoring of home infusion technology 
The specialized registered nurses working in the technologic homecare team of our organization are highly qualified in technical nursing.
One component of their job is the intravenous administration of medication to patients in their own home by using an infusion pump.
In a hospital setting you can ask a colleague nurse to check the installation of the pump and the dose of medication. In the home situation of a patient this is not possible.
The Inspection for Healthcare in the Netherlands has mentioned this problem in a report about home infusion technology, for the absence of a double check means a higher risk of making mistakes.
This was a motivation to look for a safe solution for this problem by using telemonitoring.
To conceive this method we found an enthusiastic technical installation company (Focus Cura) to develop a portable telemonitoring device which can film and record. The device allows a colleague to receive the recorded pictures at the same time at another location.
After editing a list of requirements made together with the team of specialized nurses, Focus Cura made the first prototype of a portable suitcase with all the equipment. Four different methods of receiving the images have been examined.
The result is a portable suitcase with a camera that makes high quality video images, which are sent by a safe and protected connection to the notebook of a colleague at another location in the region. We have developed a protocol which describes the use of telemonitoring to aid home infusion technology.
Thus, specialized nurses working in an area of about 100 kilometres (62 miles) can reach each other in order of a safe double-check. A simple method which improves the safety of the patient and professional.
PMCID: PMC3031816
telemonitoring; infusion technology; home
18.  Storage of Poisonous Substances and Firearms in Homes with Young Children Visitors and Older Adults 
Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children’s access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only.
Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population.
There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged ≥70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present.
Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors.
PMCID: PMC3694570  PMID: 15626565
19.  Oklahoma Healthy Homes Initiative 
Public Health Reports  2011;126(Suppl 1):27-33.
Compelling scientific evidence suggests that a strong association exists between housing-related hazards and the health and safety of their residents. Health, safety, and environmental hazards (such as asthma and allergy triggers), unintentional injury hazards, lead-based paint hazards, and poor indoor air quality are interrelated with substandard housing conditions. This article describes a Healthy Homes initiative to address these hazards in a coordinated fashion in the home, rather than taking a categorical approach, even in the presence of multiple hazards. It also provides an overview of Oklahoma's Healthy Homes initiative and its pilot project, the Tulsa Safe and Healthy Housing Project, which is currently administered in Tulsa in collaboration with Children First, Oklahoma's Nurse-Family Partnership program. This pilot project seeks to open new areas of research that can lead to a greater understanding of environmental health issues related to substandard housing in the United States, which will eventually make homes safer and healthier.
PMCID: PMC3072900  PMID: 21563709
20.  Primary Prevention of Lead Exposure: The Philadelphia Lead Safe Homes Study 
Public Health Reports  2011;126(Suppl 1):76-88.
Lead exposure in children can lead to neuropsychological impairment. This study tested whether primary prevention interventions in the newborn period prevent elevated blood lead levels (BLLs).
The Philadelphia Lead Safe Homes (LSH) Study offered parental education, home evaluation, and lead remediation to the families of urban newborns. Households were randomized to a standard lead education group or maintenance education group. We conducted home visits at baseline, six months, and 12 months. To compare BLLs, we identified a matched comparison group.
We enrolled and randomized 314 newborns in the intervention component; 110 completed the study. There were few significant differences between the randomized groups. In the combined intervention groups, positive results on visual inspection declined from baseline to 12 months (97.0% to 90.6%, p=0.007). At baseline, 36.9% of homes were above the U.S. Environmental Protection Agency's lead dust standard, compared with 26.9% at 12 months (p=0.032), mainly due to a drop in windowsill dust levels. Both groups showed a significant increase in parental scores on a lead education test. Children in the intervention and matched control groups had similar geometric mean initial BLLs (2.6 vs. 2.7, p=0.477), but a significantly higher percentage of children in the intervention group had an initial blood lead screening compared with those in the matched group (88.9% vs. 84.4%, p=0.032).
A study of primary prevention of lead exposure showed a higher blood lead screening rate for the combined intervention groups and mean BLLs at one year of age not statistically different from the comparison group. Most homes had lead hazards. Lead education significantly increased knowledge.
PMCID: PMC3072906  PMID: 21563715
21.  Teaching self-protection to children using television techniques. 
This study compared the effectiveness of a videotape training program with other methods of teaching children self-protection to prevent child abduction. Subjects were kindergarten and first-grade students. Four experimental conditions were presented: videotape with behavior rehearsal, videotape only, a standard safety program, and no training. Acquisition of self-protective behaviors was measured at posttraining and follow-up by having confederate adults entice the children near their schools and homes. Results revealed that the videotape program with behavior rehearsal was highly effective in teaching children safe responses to potential abductors. The standard safety program was effective with fewer than half of the children. Three fourths of the children who received no training immediately agreed to go with the confederate suspects. The videotape program can be easily used with groups of young children in a classroom setting.
PMCID: PMC1286121  PMID: 3198545
22.  Understanding high traffic injury risks for children in low socioeconomic areas: a qualitative study of parents' views 
Injury Prevention  2007;13(6):394-397.
To gain an in‐depth qualitative understanding of parents' views about their children's exposure to road traffic injury risk in low socioeconomic areas.
Focus groups facilitated by a moderator with content analysis of data.
Focus groups were conducted in 10 low socioeconomic English districts that also have high rates of child pedestrian injury. Research was conducted in community venues within each area.
Parents of children aged 9–14 years living in low socioeconomic areas.
Parents believe that children play in their local streets for the following reasons: they like playing out with friends near home; there are few safe, secure, and well‐maintained public spaces for children; children are excluded from affordable leisure venues because of their costs; insufficient parental responsibility. For children that play in the street, the key sources of risk identified by parents were: illegal riding and driving around estates and on the pavements; the speed and volume of traffic; illegal parking; drivers being poorly informed about where children play; children's risk‐taking behavior.
Intervention programs need to take into account multiple reasons why children in low socioeconomic areas become exposed to hazardous environments thereby increasing their risk of injury. Multi‐agency partnerships involving the community are increasingly needed to implement traditional road safety approaches, such as education, engineering, and enforcement, and provide safe and accessible public space, affordable activities for children, and greater support for parents.
PMCID: PMC2598316  PMID: 18056316
23.  Perceptions of Neighborhood Safety and Asthma among Children and Adolescents in Los Angeles: A Multilevel Analysis 
PLoS ONE  2014;9(1):e87524.
Research examining the impact of neighborhoods on asthma has shown an increased interest in the role of the psychosocial environment. We examined the associations between various measures of neighborhood safety, individual and family characteristics, and asthma outcomes among children in Los Angeles.
Multilevel logistic regression models were used to analyze data on 3,114 children across 65 neighborhoods from Wave 1 of the Los Angeles Family and Neighborhood Survey (2000 to 2002). Primary caregivers reported asthma outcome and all individual covariates; home environmental characteristics were observed by the interviewer.
In fully adjusted models, parents who reported their neighborhood fairly safe or somewhat dangerous had lower odds of reported lifetime asthma compared to those who reported their neighborhood completely safe (OR 0.71; 95% CI 0.52–0.96 and OR 0.60; 95% CI 0.42–0.88 respectively). Conversely, parents who reported they could not trust their neighbors to keep their children safe had a nearly 40% increase in lifetime asthma compared to those who reported they could trust their neighbors to keep their children safe (OR 1.39; 95% CI 1.07–1.81).
The study demonstrates a complex pattern between various measures of neighborhood safety and asthma and suggests that these relationships may operate differently in Los Angeles. As an increasing proportion of children are growing up in newer Western and Southwestern cities, which have different physical layouts and residential segregation patterns compared to Northeast and Midwestern cities, future studies should continue to examine neighborhood psychosocial stressors and asthma in diverse contexts.
PMCID: PMC3900730  PMID: 24466355
24.  Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control 
Malaria Journal  2009;8:292.
Whiles awaiting for the arrival of an effective and affordable malaria vaccine, there is a need to make use of the available control tools to reduce malaria risk, especially in children under five years and pregnant women. Intermittent preventive treatment (IPT) has recently been accepted as an important component of the malaria control strategy. This study explored the potential of a strategy of intermittent preventive treatment for children (IPTC) and timely treatment of malaria-related febrile illness in the home in reducing the parasite prevalence and malaria morbidity in young children in a coastal village in Ghana.
The study combined home-based delivery of IPTC among six to 60 months old and home treatment of suspected febrile malaria illness within 24 hours. All children between six and 60 months of age received intermittent preventive treatment using amodiaquine and artesunate, delivered by community assistants every four months (three times in 12 months). Malaria parasite prevalence surveys were conducted before the first and after the third dose of IPTC.
Parasite prevalence was reduced from 25% to 3% (p < 0.00, Mann-Whitney) one year after the inception of the two interventions. At baseline, 13.8% of the children were febrile (axillary temperature greater than or equal to 37.5 degree Celsius) compared to 2.2% at evaluation (post IPTC3 combined with timely home management of fever) (p < 0.00, Mann-Whitney).
The evaluation result indicates that IPTC given three times in a year combined with timely treatment of febrile malaria illness, impacts significantly on the parasite prevalence. The marked reduction in the parasite prevalence with this strategy points to the potential for reducing malaria-related childhood morbidity and mortality, and this should be explored by control programme managers.
PMCID: PMC2797018  PMID: 20003357
25.  Determining if an older adult can make and execute decisions to live safely at home: a capacity assessment and intervention model 
Determining an older adult’s capacity to live safely and independently in the community presents a serious and complicated challenge to the health care system. Evaluating one’s ability to make and execute decisions regarding safe and independent living incorporates clinical assessments, bioethical considerations, and often legal declarations of capacity. Capacity assessments usually result in life changes for patients and their families, including a caregiver managing some everyday tasks, placement outside of the home, and even legal guardianship. The process of determining capacity and recommending intervention is often inefficient and highly variable in most cases. Physicians are rarely trained to conduct capacity assessments and assessment methods are heterogeneous. An interdisciplinary team of clinicians developed the capacity assessment and intervention (CAI) model at a community outpatient geriatrics clinic to address these critical gaps. This report follows one patient through the entire CAI model, describing processes for a typical case. It then examines two additional case reports that highlight common challenges in capacity assessment. The CAI model uses assessment methods common to geriatrics clinical practice and conducts assessments and interventions in a standardized fashion. Reliance on common, validated measures increases generalizability of the model across geriatrics practice settings and patient populations.
PMCID: PMC2835824  PMID: 19481271
capacity assessment and intervention (CAI) model; safety in independent-living

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