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Objective: To ascertain the activities undertaken by children's centres to prevent unintentional injuries in the under-fives and, in particular, the prevention of falls, poisoning and scalds. Design: A questionnaire was posted to managers of 851 children's centres, using stratified cluster sampling. The questionnaire included questions on injury prevention activities undertaken by the centre, knowledge and attitudes to injury prevention, partnership working, and barriers and facilitators to injury prevention. Setting: England. Results: A response rate of 61% was achieved. Most respondents (98%) agreed that children's centres can be effective in preventing accidents. Over half of the respondents (59%) did not know whether there was an injury prevention group in their area, and 22% did not know whether there was a home safety equipment scheme. Only 12% knew the major cause of injury deaths in children under five. A variety of activities were being undertaken including one to one advice and issuing leaflets. However, for some important topics such as baby walkers and disposal of unwanted medicines, no advice was being provided in some areas. Lack of funding (52%) and lack of capacity (39%) were the most common reasons cited as barriers to injury prevention activities. Conclusion: Injury prevention is an important activity undertaken by children's centres. Given their position in the heart of the community, their potential as an agency to prevent injuries has been highlighted and recommended. Further support and resource will be needed if they are to fully develop their potential in preventing unintentional injuries in the home.

Objective: To examine the provision of practical safety education by Child Safety Education Coalition (CSEC) organizations in England. Design: A postal survey. Setting: Providers of child practical safety education who were also part of CSEC. Methods: In February 2010 all CSEC organizations were sent a self-completion postal questionnaire which aimed to elicit details of safety education activities, priorities, target groups and information about evaluation. Frequencies of responses were calculated. Results: Responses were received from 60 organizations representing a response rate of 65%. They represented private, public and charitable organizations, and provided safety education for children aged 3 to 17 years. Respondents undertook a varied range of activities including talks, theatre work, utility distribution, experiential learning, hospital visits, and sports and leisure activities. The majority ("n" = 43, 72%) ran special events to teach children about safety and most often this occurred at least once a month ("n" = 28, 47%). Respondents provided education addressing the main causes of injury and mortality; road traffic injuries was the topic most often addressed ("n" = 42, 70%). Twenty per cent of respondents ("n" = 12) stated that they did not evaluate their activities and only one-third ("n" = 19, 32%) stated that they produced written reports. Conclusion: Child safety education was delivered using a variety of techniques and was provided by a range of organizations. This highlights the opportunities that exist for teaching children risk competence. Additional support will be needed if evaluation activities are to be robust and fully documented. (Contains 4 figures.)

Little work has examined the utility of home safety behaviours in predicting childhood injury. This study examines the relationship between safety behaviours and child injury using a cohort of 1717 families, with 2357 children aged 0-7 years. Safety behaviours, and sociodemographic and family characteristics were measured using a validated questionnaire, and medically attended injuries were ascertained from medical records. Hospital admission rates were lower amongst children from families with fitted and working smoke alarms [incidence rate ratio (IRR) 0.55, 95% confidence interval (CI) 0.31-0.96], who stored sharp objects safely (IRR 0.44, 95% CI 0.23-0.84) and who had fitted stair gates (IRR 0.57, 95% CI 0.31-1.03). Not having a stair gate and not storing sharp objects safely had high sensitivities and negative predictive values for predicting hospital admission. These findings are unlikely to be explained by reductions in the risk of injuries these items are designed to prevent. Families with a range of safety behaviours may also be "safer" in other ways. Further exploration of factors that may explain lower injury rates in these families is required. Information on safety behaviours may be useful for targeting and monitoring injury prevention activity.

Background:Young children face injury as a potentially life-threatening problem. Injury still has considerable financial, emotional and social effects on families and society as a whole. A variety of interventions are known to prevent child injuries. The literature, however, provides meagre information on what factors enable or inhibit the implementation of these interventions for controlling home injuries in Iran.Methods:Qualitative study was applied using eighteen semi-structured interviews with parents attending urban health centres in Tehran City. The recorded interviews were transcribed verbatim and the data were analysed using thematic analysis.Findings:Factors believed to influence the prevention of home injuries among urban children aged under 5 years are presented as five major themes. These were: the nature of injury and injury prevention, child-related factors, parent-related factors, living environment and society-related factors.Conclusions:The findings highlighted the need for greater support for parents. Half of the parents were struggling with barriers such as money and time. The study has implications for further research and practice to promote child safety at home. [ABSTRACT FROM PUBLISHER]

Introduction: Endometrial hyperplasia is a precancerous lesion of the endometrium, commonly presenting with uterine bleeding. If managed expectantly, it frequently progresses to endometrial carcinoma, rates of which are increasing dramatically worldwide. However, the established treatment for endometrial hyperplasia (progestogens) involves multiple side effects and leaves the risk of recurrence. Metformin is the most commonly used oral hypoglycaemic agent in type 2 diabetes mellitus. It has also been linked to the reversal of endometrial hyperplasia and may therefore contribute to decreasing the prevalence of endometrial carcinoma without the fertility and side effect consequences of current therapies. However, the efficacy and safety of metformin being used for this therapeutic target is unclear and, therefore, this systematic review will aim to determine this. Methods and analysis: We will search the following trials and databases with no language restrictions: Cochrane Gynaecology and Fertility Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; EBSCO Cumulative Index to Nursing and Allied Health Literature; PubMed; Google Scholar; ClinicalTrials.gov; the WHO International Trials Registry Platform portal; OpenGrey and the Latin American and Caribbean Health Sciences Literature (LILACS). We will include randomised controlled trials (RCTs) of use of metformin compared with a placebo or no treatment, conventional medical treatment (eg, progestogens) or any other active intervention. Two review authors will independently assess the trial eligibility, risk of bias and extract appropriate data points. Trial authors will be contacted for additional data. The primary review outcome is the regression of endometrial hyperplasia histology towards normal histology. Secondary outcomes include hysterectomy rate; abnormal uterine bleeding; quality of life scores and adverse reactions to treatments. Ethics and dissemination: Dissemination of the completed review will be through the Cochrane Library as well as through presenting the results at appropriate conferences. [ABSTRACT FROM AUTHOR]

Background: Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4- year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children. Methods: A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme. Discussion: This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is nonstigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

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]

Attention-deficit hyperactivity disorder (ADHD) has a significant impact on children's classroom behaviour, daily functioning and experience of school life. However, the effects of drug treatment for ADHD on learning and academic achievement are not fully understood. This review was undertaken to describe the effects of methylphenidate, dexamfetamine, mixed amfetamine salts and atomoxetine on children's on-task behaviour and their academic performance, and to perform a meta-analysis to quantify these effects. Nine electronic databases were systematically searched for randomized controlled trials comparing drug treatment for ADHD against (i) no drug treatment, (ii) baseline (in crossover trials), or (iii) placebo; reporting outcomes encompassing measures of educational achievement within the classroom environment. Forty-three studies involving a pooled total of 2,110 participants were identified for inclusion. Drug treatment benefited children in the amount of school work that they completed, by up to 15 %, and less consistently improved children's accuracy in specific types of academic assignments, such as arithmetic. Similar improvements were seen in classroom behaviour, with up to 14 % more of children's time spent 'on task'. Methylphenidate, dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children's on-task behaviour and academic work completion. Atomoxetine was examined in two studies, and was found to have no significant effect. These review findings suggest that medication for ADHD has the potential to improve children's learning and academic achievement. [ABSTRACT FROM AUTHOR]

In developed countries, unintentional injury is a leading cause of death and morbidity in childhood, with increased risk for those children living in deprived circumstances. Preschool children are at particular risk of injury in the home. Provision of free safety equipment for families least able to afford it offers a promising counter-measure to home injuries in children under 5 years. This study employed multiple-site case studies to identify barriers and facilitators in the local implementation of a national home safety equipment scheme. Retrospective case studies were conducted in 20 sites in England, all of which had higher than average hospital admission rates for injury to children under five. Methods of data collection included one-to-one interviews, group discussions, site visits and documentary analysis. The findings from cross-case thematic analysis indicated a high level of satisfaction with local schemes among parents and professionals. Partnership working and the flexibility to adapt to local circumstances were identified as key facilitators to scheme delivery. Barriers included the limited project timeframe, lack of support from landlords and organisational factors at both national and local level that impeded implementation. The study highlights the importance of seeking a balance between the expectations of a nationally coordinated public health initiative and the practicalities of implementation within local settings. [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]