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Background: Children with and without speech sound disorders (SSDs) are exposed to different patterns of infant feeding (breast/bottle-feeding) and may or may not engage in non-nutritive sucking (NNS) (pacifier/digit-sucking). Sucking and speech use similar oral musculature and structures, therefore it is possible that early sucking patterns may impact early speech sound development. The objective of this review is to synthesise the current evidence on the influence of feeding and NNS on the speech sound development of healthy full-term children. Summary: Electronic databases (PubMed, NHS CRD, EMBASE, MEDLINE) were searched using terms specific to feeding, NNS and speech sound development. All methodologies were considered. Studies were assessed for inclusion and quality by 2 reviewers. Of 1,031 initial results, 751 records were screened, and 5 primary studies were assessed for eligibility, 4 of which were included in the review. Evidence from the available literature on the relationship between feeding, NNS and speech sound development was inconsistent and inconclusive. An association between NNS duration and SSDs was the most consistent finding, reported by 3 of the 4 studies. Quality appraisal was carried out using the Appraisal Tool for Cross-Sectional Studies (AXIS). The included studies were found to be of moderate quality. Key Messages: This review found there is currently limited evidence on the relationship between feeding, NNS and speech sound development. Exploring this unclear relationship is important because of the overlapping physical mechanisms for feeding, NNS and speech production, and therefore the possibility that feeding and/or sucking behaviours may have the potential to impact on speech sound development. Further high-quality research into specific types of SSD using coherent clinically relevant assessment measures is needed to clarify the nature of the association between feeding, NNS and speech sound development, in order to inform and support families and health care professionals.

Background: Burn injury is one of the leading cause of mortality and morbidity worldwide. In developing countries like Bangladesh, burn is one of the leading causes of illness, disabilities and deaths. More than 365,000 people are injured every year by electrical, thermal and other causes of burn injuries where 27,000 people needed hospital admission and over 5600 people died. Emergency management of burn at the facility level can reduce the severity of burn injuries and improve overall survival. The study has explored the health care providers’ views on gaps and challenges in management of burn injury at the facilities district and sub district health facilities in Bangladesh. Methodology: A qualitative study was conducted during the period in July 2015. In-depth interviews (n = 19) were performed with the doctors and nurses working in the three district government hospitals and seven sub-district (upazila) government health facilities. Thematic analysis was performed on different themes. Results: Health care providers mentioned that the people are coming to the facilities usually, hours after the incidence. Before visiting the facilities, the burn victims mostly seek treatment from the traditional healers or form village doctors (quack) or from the local pharmacy, over the counter. Family waited until they felt that the patient may not survive. It has identified that delaying in decision making and transferring the patient to the health facility are the key challenges identified by the doctors and nurses when they attended any burn patients in their facility. Moreover, use of different traditional infectious agent in burnt areas from their home make the burn surface more damage. While as, deficiency of adequate supplies, logistics and adequate trainings for the health workers in the facility create much more difficulties to treat a burn patient at primary or secondary health care centers. Conclusion: Burn patients are maltreated in the community before coming to the healthcare facility in most of the cases. The community has misperceptions on burn management which delay the proper management in the facility. Readiness of the facility on the other hand is a big challenge. In order to consistent in burn care in Bangladesh, its equally important to build knowledge and awareness among the community on burn prevention and their role. Like this, readiness of the facilities in time will build confidence in community, thus in turns, will save thousands of lives from burn injury in Bangladesh. Keywords: Facility, Burn injury, Management, Bangladesh

Background Unintentional Injuries comprise the fifth leading cause of death in Nepal in 2017, an increase of 23% compared to 1990. In Nepal, there is minimal community-derived evidence of home or occupational injuries. Our aim was to describe the epidemiology of injuries in the Makwanpur district, including the causes and risk factors associated with those injuries. Methods A cross-sectional, household survey was undertaken in three administrative areas of Nepal between April-June, 2019. Data were collected electronically about non-fatal and fatal injuries in the previous three months and five years, respectively. Results 17,593 individuals from 3,327 households were surveyed; 394 people were injured. 136/394 (34.5%) injuries occurred in homes, 109 (27.7%) were work-related. 225 (55.8%) were males, the age range was 0–87 years, 123 (30.7%) were child injuries, (0–17 yrs). The most commonly reported injury was falls (n=173, 43.9%), stumbling and tripping were the most common reasons and 73 (42.2%) occurred at home. More injuries occurred in rural administrative areas than urban areas, especially occupational injuries (occupational: chi-square=22.05, p=0.000; home: chi-square=13.89, p Conclusions Home and occupational fall injuries are common, especially in rural areas. Understanding the context of falls, especially identifying and working with particular occupational groups where they are prevalent, may identify risk factors and help target messages about primary falls prevention and interventions. Learning Outcomes Using hand-held computers and local enumerators for data collection in sample areas resulted in minimal missing data and monitoring of data quality during the collection period.

Burns are common causes of paediatric emergency care attendance; approximately ten per cent result from maltreatment. Following emergency department (ED) attendance with a burn by 232 under five-year-olds, 11 risk factors for maltreatment were collected via health visitor (HV) telephone surveys. Three of these risk factors (domestic violence, social care involvement and developmental impairment) were also available in ED records, and information collected was compared between the two. Non-parametric Fisher's exact tests were applied. Fifty-nine per cent of children lived in families with risk factors for maltreatment. Prominent risk factors known by HVs included: prior injuries (n = 55, 23.7%), carer/parent mental health problems (n = 48, 20.7%), domestic violence (n = 47, 20.3%) and social care involvement (n = 45, 19.4%). A total of 158 cases had complete data for all 11 risk factors: 49 (31.0%) lived in households with one factor, 22 (13.9%) with two factors and 27 (17.1%) with three or more risk factors. In cases where HVs recorded the following risk factors as present, EDs recorded five of 47 (10.6%) for domestic violence, ten of 45 (22.2%) with social care involvement and four of 23 (17.4%) with developmental impairment. Many risk factors that were known to HVs were not identified by EDs staff despite being part of a standardised proforma. Maltreatment risk assessment could be improved if EDs staff had access to HV information. © 2020 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES: • Fifty-nine per cent of preschool children who attended an ED with a burn live in a family with one or more maltreatment risk factors, as identified by HV records.

ObjectiveInjuries are a global health problem. To develop context-specific injury prevention interventions, one needs to understand population perceptions of home and workplace injuries. This study explored a range of views and perceptions about injuries in a variety of settings and identified barriers and facilitators to injury prevention.DesignQualitative study: interviews and focus groups.SettingThree administrative areas: Hetauda submetropolitan city, Thaha municipality and Bakaiya rural municipality in Makwanpur, Nepal.ParticipantsNine focus groups (74 participants) and nine one-to-one interviews were completed; workers from diverse occupations, residents (slum, traditional or modern homes) and local government decision-makers participated in the study between May and August 2019. The interviews and discussions were audio-recorded, transcribed verbatim, translated to English and analysed thematically.ResultsSix themes were developed: unsafe home and workplace environment; inadequate supervision and monitoring; perceptions that injuries are inevitable; safety takes low priority: financial and behavioural considerations; safety education and training; and government-led safety programmes and enforcement. Key barriers to injury prevention were perceived to be lack of knowledge about injury risk and preventive measures both at the community level and at the workplace. Facilitators were community-level educational programmes and health and safety training to employees and employers. Participants stressed the importance of the role of the government in planning future injury prevention programmes in different environments.ConclusionsThis study highlighted that both home and workplace injuries are complex and multifactorial. Lack of knowledge about injury risks and preventive measures, both at the community level and at the workplace, was found to be a common barrier to injury prevention, perceived to be mitigated by educational programmes. Together with previously published epidemiological evidence, the barriers and facilitators identified in this study offer useful basis to inform policy and practice.

BackgroundUnintentional injuries in and around the home are important causes of preventable death and disability among young children globally. In Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries. This study aimed to determine the burden of unintentional home injuries in children MethodsA survey was conducted in 740 households in rural areas of the Makwanpur district during February and March 2015. The primary carer reported home injuries which occurred in the previous 3 months and data collector observation identified the injury hazards. Injury incidence, mechanism and the proportion of households with different hazards were described. Multivariable logistic regression explored associations between the number and type of home hazards and injuries.ResultsInjuries severe enough to need treatment, or resulting in non-participation in usual activities for at least a day, were reported in 242/1042 (23.2%) children ConclusionsA high proportion of young children in rural Nepal sustained injuries severe enough to miss a day of usual activities. Increased frequency of hazards was associated with an increased injury risk.

ObjectiveThis paper describes the epidemiology of home- and work-related injuries, their mechanisms, inequalities and costs associated with these injuries.MethodsA household survey was undertaken in three palikas (administrative areas) of Makwanpur district between April-June, 2019. Data were collected electronically on non-fatal injuries that occurred in the previous three months and fatal injuries that occurred in the previous five years.Findings17,593 individuals were surveyed from 3,327 households. The injury rate was 8.0/1000 population for home injuries and 6.4/1000 for work-related injuries; 61.0% of home injuries were among females and 69.9% of work-related injuries among males. Forty-eight percent of all home injuries were due to falls (28 males (50.9%) and 40 females (46.5%)); burn/scalds were higher among females 15 (10.5%). Cuts and piercings accounted for 40% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12/1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean cost of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n = 74, 64.9%) and work-related (n = 67, 77.9%) injuries were higher in families below the poverty line (ConclusionsHome and occupational fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.What is already known on the subjectLimited epidemiological data are available in Nepal about the location of injury, activity taking place when injury occurred and the costs of injuryThere is limited information about the distribution of injuries by ethnicity and income groups.What this study addsPeople from rural areas experience more injuries than people living in urban or city areasManual workers sustain more work-related injuries than those in other occupationsCertain ethnic groups have higher rates of injuries than other ethnic groupsPeople with lower income experience more injuries than people with higher incomesInjury costs are high in relation to average per capita income.

ObjectiveTo describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries.MethodsA household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years.Findings17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%).ConclusionsHome-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups.

Background: Health mobile applications (apps) have become very popular, including apps specifically designed to support women during the ante- and post-natal periods. However, there is currently limited evidence for the effectiveness of such apps at improving pregnancy and parenting outcomes. This study aims to assess the effectiveness of a pregnancy and parenting app, Baby Buddy, in improving maternal self-efficacy at 3 months post-birth. Methods: Participants were 16 years old or over, first-time mothers, 12–16 weeks gestation, recruited by midwives from five English study sites. The Tool to Measure Parenting Self-Efficacy (TOPSE) (primary outcome) was used to compare mothers at 3 months post-birth who had downloaded the Baby Buddy app with those who had not downloaded the app, controlling for confounding factors. Results: Four hundred and eighty-eight participants provided valid data at baseline (12–16 weeks gestation), 296 participants provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs . 69.6%, P=0.035), more likely to have been introduced to the app by a healthcare professional (P=0.005) and have a lower median score for perceived social support (81 vs . 83, P=0.034) than non-app users. The Baby Buddy app did not elicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth [adjusted odds ratio (OR) 1.12, 95% confidence interval (CI): 0.59 to 2.13, P=0.730]. Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at 3 months post-birth (adjusted OR 1.16, 95% CI: 0.60 to 2.23, P=0.666). There were no statistically significant differences in the TOPSE scores for the in-app data, in terms of passive use of the app between high and low app users (adjusted OR 0.82, 95% CI: 0.21 to 3.12, P=0.766), nor in terms of active use (adjusted OR 0.47, 95% CI: 0.12 to 1.86, P=0.283). Conclusions: This study is one of few, to date, that has investigated the effectiveness of a pregnancy and early parenthood app. No evidence for the effectiveness of the Baby Buddy app was found. New technologies can enhance traditional healthcare services and empower users to take more control over their healthcare but app effectiveness needs to be assessed. Further work is needed to consider: (I) how we can best use this new technology to deliver better health outcomes for health service users and, (II) methodological issues of evaluating digital health interventions.

Introduction Unintentional home injury is an important cause of death and disability among children, especially those living in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs. Methods Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta-analysis was conducted. Results Four studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta-analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) -0.77; 95% CI [-1.36, -0.19]] and burn-related unsafe practices (MD -0.37; 95% CI [-0.66, -0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD -0.5; 95% CI [-0.66, -0.33]) but not for ingestion hazards. Conclusion There is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.

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.

Background Information and communication technologies are used increasingly to facilitate social networks and support women during the perinatal period. This paper presents data on how technology use affects the association between women’s social support and, (i) mental wellbeing and, (ii) self-efficacy in the antenatal period. Methods Data were collected as part of an ongoing study - the BaBBLeS study - exploring the effect of a pregnancy and maternity software application (app) on maternal wellbeing and self-efficacy. Between September 2016 and February 2017, we aimed to recruit first-time pregnant women at 12–16 gestation weeks in five maternity sites across England and asked them to complete questionnaires. Outcomes included maternal mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), and antenatal self-efficacy (antenatal version of the Tool to Measure Parenting Self-Efficacy). Other variables assessed were perceived social support (Multidimensional Scale of Perceived Social Support), general technology use (adapted from Media and Technology Usage and Attitudes Scale). Potential confounders were age, ethnicity, education, socioeconomic deprivation, employment, relationship status and recruitment site. Linear regression models were developed to analyse the relationship between social support and the outcomes. Results Participants (n = 492, median age = 28 years) were predominantly white British (64.6%). Half of them had a degree or higher degree (49.3%), most were married/living with a partner (83.6%) and employed (86.2%). Median (LQ-UQ) overall scores were 81.0 (74.0–84.0) for social support (range 12–84), 5.1 (4.7–5.4) for technology use (range 1–6), 54.0 (48.0–60.0) for mental well-being (range 14–70), and 319.0 (295.5–340) for self-efficacy (range 0–360). Social support was significantly associated with antenatal mental well-being adjusting for confounders [adj R2 = 0.13, p

Background Unintentional injuries in and around the home are an important cause of death and disability among young children globally. However, in Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries Objectives To explore the hazards associated with unintentional home injuries in children Methods A community-based household survey was conducted in 740 households in rural areas of Makwanpur district during February and March 2015. Household respondents reported home injuries in the previous 3 months and researcher observation identified and quantified injury hazards. Injury incidence, mechanism and the proportion of households with different hazards were described. Multivariable logistic regression explored the association between the number and type of home hazards and injuries, adjusted for family and home variables. Findings Injuries severe enough to need treatment or resulting in non-participation in usual activities for at least a day were reported in 242/1042 (23.2%) children Conclusions This study indicated that there is a significant burden of injuries occurring in the home to pre-school children and that hazards increase the risk of injury occurrence. Policy implications Injury prevention initiatives should consider the development and evaluation of interventions to reduce the number of hazards in the home.

IntroductionDevelopments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.PurposeTo assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.MethodsWe will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings’ website.

© 2018 The Author(s). Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.

The aim of this study is to understand barriers and facilitators to the delivery of injury prevention programmes in English children's centres (CCs). Unintentional injury is a major cause of disability and death in children aged 1–4 years; those living in poverty are at greatest risk. CCs are pivotal in English public health strategies to improve outcomes and reduce inequalities for disadvantaged children through health promotion and family support. This study is part of the National Institute for Health Research funded ‘Keeping Children Safe at home’ programme, which aims to develop a better understanding of how to prevent unintentional injuries in pre-school children. Thirty-three interviews with CC staff from 16 CCs across four study sites, Nottingham, Norwich, Newcastle and Bristol, explored practitioners' experience of factors that impact on their implementation of health promotion and injury prevention interventions. Using Framework Analysis, managed by NVivo, key facilitators and barriers were identified across all levels of CCs' operation. Facilitators included knowledge of policies and strategies in injury prevention, partnership working and effective parent engagement. Barriers included paucity of national and local injury data, difficulties reaching disengaged families and funding constraints. The challenge is to learn from those who work in CCs the best ways to harness facilitators and to address barriers to child injury prevention activities, and to provide support, including practical advice, for further development of their essential work in injury prevention.

Introduction: This paper describes a case of pregnant mother who died of burn injury in order to understand the societal factors related to the event. We reviewed the case in the rural community. Initially, the case was reported as a maternal death to maternal and neonatal death review (MNDR) system being conducted in Bangladesh within exiting health system to explore the medical and social causes of maternal and newborn deaths. However, during the verbal autopsy, it was found that the mother died of bun injury. Therefore, we performed detailed case study. Case Presentation: A woman aged 18 years was nine months pregnant in a rural community in Moheskhali upazila of Cox’s Bazar district. During the wintertime, the mother feels cold and goes near to the oven in the yard to be warm. Suddenly, part of her clothing (Anchal of Sari) catches fire; she does not recognized and starts to walk towards her room. A neighbor notices and starts to shout. The woman scars and tries to run. The neighbors come with a bucket of water. By this time, the fire spreads over whole body and cloths. Immediately after the event, she is transferred to a medical college hospital. Conclusions: Doctors tried to do immediate cesarean section; however, they could not save the life of the baby inside. The mother who was severely burnt also died after 10 days. Rural community in Bangladesh still does not have adequate awareness and knowledge about risk of burn. The scarce knowledge of appropriate steps immediately after burn was explored. Moreover, delays in decision-making and transferring the patient to the facility were identified. Specific interventions need to be taken to increase knowledge and awareness in the community, which could save thousands of lives.

BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

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 Children9s 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.

Objective: To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years. Methods: Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, sex, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression. Results: Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63, 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12, 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33, 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30, 2.75; PAF 26%). Conclusions: Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.

We report an ethnographic study of 10 preschool children aged 2-6 years recruited from kindergartens in Hong Kong, 6 of whom were overweight or obese. Each was followed for 12-18 months. We confirmed previously described risk factors and showed how these interacted to produce obesity in some but not all at-risk children. Despite much rhetoric in the literature about holistic care of the preschool child, we were struck by the lack of coordinated professional input to the needs of children at risk of obesity and by the absence of nursing input in particular. We argue that a "whole-systems" nursing role, based in the community and with remit that includes clinical care, education, and policy, is urgently needed, as well as review examples of such roles from other countries.

Childhood obesity is particularly prevalent in areas that have seen rapid economic growth, urbanisation, cultural transition, and commodification of food systems. Structuration theory may illuminate the interaction between population and individual-level causes of obesity. We conducted in-depth ethnographies of six overweight/obese and four non-overweight preschool children in Hong Kong, each followed for 12-18 months. Analysis was informed by Stones' strong structuration theory. Risk factors played out differently for different children as social structures were enacted at the level of family and preschool. The network of caregiving roles and relationships around the overweight/obese child was typically weak and disjointed, and the primary caregiver appeared confused by mixed messages about what is normal, expected and legitimate behaviour. In particular, external social structures created pressure to shift childcare routines from the logic of nurturing to the logic of consumption. Our findings suggest that threats to what Giddens called ontological security in the primary caregiver may underpin the poor parenting, family stress and weak mealtime routines that mediate the relationship between an obesogenic environment and the development of obesity in a particular child. This preliminary study offers a potentially transferable approach for studying emerging epidemics of diseases of modernity in transition societies.

Objective Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age. Design A prospective cohort study, Avon Longitudinal Study of Parents and Children. Setting The former county of Avon, southwest England. Population All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children. Methods Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self-report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children’s health and development. Main outcome measure Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST). Results Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time-points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS ≥ 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11–1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated. Conclusions These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.

Background Injuries accounted for 23% of all deaths in children and adolescents in Nepal during 2010 (n = 3,700). Despite this, there is no national death registration or injury surveillance system. Non-fatal injuries are many times more common than fatal injuries and may leave the injured person with lifelong consequences. Children in low-income settings are exposed to widespread risks of injuries but there is little awareness of how they can be prevented. Community mobilisation has been shown to be effective to reduce maternal and neonatal morbidity. This study aimed to develop a child safety programme and assess the feasibility of delivering the programme through a community mobilisation approach. Methods We developed a culturally appropriate, educational programme for Female Community Health Volunteers that included both primary and secondary prevention materials for unintentional child injuries. We determined the feasibility of evaluating its effectiveness through the mobilisation of women’s groups in rural Nepal. Ten women’s groups across 9 wards in one village development committee area completed the programme during 6 monthly meetings. Parent-reported injuries were collected through a notification system established for this study. Experience of the programme by women’s group participants and leaders was assessed through a structured questionnaire and process measures assessed the delivery and reach of the programme. Results Programme resources were developed for this setting and adapted following feedback from users. Nine FCHVs received first-aid training and shown how to use the facilitation manual and injury prevention resources. The FCHVs convened 10 women’s groups to run over 6 months with 24–29 mothers attending each meeting (290 mothers participated in total). Each group presented their views on child injury risks and proposed prevention activities at local public meetings. Women reported 155 injuries to children under 18 years during 7 months of follow up using the notification system. Conclusions It is feasible to develop and implement a community mobilisation intervention where women’s groups work together with local FCHVs to prevent injuries in children. The intervention was well received by the women’s groups and by community members. The effectiveness and cost effectiveness of the intervention should now be evaluated through an experimental study. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1783-5) contains supplementary material, which is available to authorized users.

Background Childhood unintentional injury represents an important global health problem. Most of these injuries occur at home, and many are preventable. The main aim of this study was to identify key facilitators and barriers for parents in keeping their children safe from unintentional injury within their homes. A further aim was to develop an understanding of parents’ perceptions of what might help them to implement injury prevention activities. Methods Semi-structured interviews were conducted with sixty-four parents with a child aged less than five years at parent’s homes. Interview data was transcribed verbatim, and thematic analysis was undertaken. This was a Multi-centre qualitative study conducted in four study centres in England (Nottingham, Bristol, Norwich and Newcastle). Results Barriers to injury prevention included parents’ not anticipating injury risks nor the consequences of some risk-taking behaviours, a perception that some injuries were an inevitable part of child development, interrupted supervision due to distractions, maternal fatigue and the presence of older siblings, difficulties in adapting homes, unreliability and cost of safety equipment and provision of safety information later than needed in relation to child age and development. Facilitators for injury prevention included parental supervision and teaching children about injury risks. This included parents’ allowing children to learn about injury risks through controlled risk taking, using “safety rules” and supervising children to ensure that safety rules were adhered to. Adapting the home by installing safety equipment or removing hazards were also key facilitators. Some parents felt that learning about injury events through other parents’ experiences may help parents anticipate injury risks. Conclusions There are a range of barriers to, and facilitators for parents undertaking injury prevention that would be addressable during the design of home safety interventions. Addressing these in future studies may increase the effectiveness of interventions.

Failure to retain participants in randomised controlled trials and longitudinal studies can cause significant methodological problems. We report the recruitment and retention strategies of a randomised controlled trial to promote fire-related injury prevention in families with pre-school children attending children’s centres in disadvantaged areas in England. Thirty-six children’s centres were cluster randomised into one of three arms of a 12-month fire-related injury prevention trial. Two arms delivered safety interventions and there was one control arm. Retention rates compared the numbers of participants responding to the 12-month questionnaire to the number recruited to the trial. Multivariable random effects logistic regression was used to explore factors independently associated with participant retention. The trial exceeded its required sample size through the use of multiple recruitment strategies. All children’s centres remained in the study, despite increased reorganisation. Parent retention was 68% at 12 months, ranging from 65% to 70% across trial arms and from 62% to 74% across trial sites. There was no significant difference in the rates of retention between trial arms (p = 0.58) or between trial sites (p = 0.16). Retention was significantly lower amongst mothers aged 16–25 years than older mothers [adjusted odds ratio (AOR) 0.57, 95% CI 0.41, 0.78], those living in non-owner occupied accommodation than in owner occupied accommodation (AOR 0.53, 95% CI 0.38, 0.73) and those living in more disadvantaged areas (most versus least disadvantaged quintiles AOR 0.50, 95% CI 0.30, 0.82). Studies recruiting disadvantaged populations should measure and report attrition by socioeconomic factors to enable determination of the extent of attrition bias and estimation of its potential impact on findings. Where differential attrition is anticipated, consideration should be given to over-sampling during recruitment and targeted and more intensive strategies of participant retention in these sub-groups. In transient populations collection of multiple sources of contact information at recruitment and throughout the study may aid retention. Clinicaltrials.gov identifier: NCT01452191 ; Date of registration: 10 October 2011, ISRCTN65067450 .

The argument for evidence-based nursing practice informed by research has placed nursing research capacity-building firmly on the agenda. Despite the recognition of the need for sustainable sources of funding, the emphasis has remained on NHS R&D undertaken by doctor, supported by other professions such as nurses. Indeed, it is common for nurses to be employed in the role of research assistant or data collector, under the supervision of a doctor. The titles ‘Research Nurse’ and ‘Nurse Researcher’ are used interchangeably and this paper highlights the distinction between the two, the requirements of their posts, reasons why nurses may become involved in research and the difficulties that this may entail. We draw attention to the expectations of the research training that first-level nurses receive, the assumption that it results in them being research competent, and the implications for the status of nursing research. Investment in research capacity-building needs to be reflected in the organisation and infrastructure of academic departments and NHS trusts. Joint, long-term educator/practitioner/researcher appointees are required to facilitate the nurseorientated research necessary to inform the increasing demands on practice. If the practice of nursing, midwifery and health visiting is to be underpinned by a scientific evidence-base specific to its own needs, it is necessary to foster an environment conducive to reflection on practice and cultivation of ideas.

A woman's psychological state during pregnancy has been shown in previous research to be predictive of her adaptation to maternal functioning. Two hypotheses were examined: (a) women who have a negative attitude to pregnancy and motherhood have children who exhibit slower development at 2 years, compared with children of women who have more positive attitudes; (b) women with poor psychological health antenatally have children who exhibit slower development at 2 years, compared with children of women who have good psychological health antenatally. Three aspects of child development were assessed: cognitive, motor and behaviour, as measured using the Bayley Scales of Infant Development. This prospective, longitudinal study recruited primiparous women in the last trimester of pregnancy, registered at seven health centres in socially deprived areas of Bristol City (N = 436). Baseline data were collected antenatally, and postnatally at 6 weeks, 1 year and 2 years. Developmental assessments were administered at...

Background. Patient expectation for a prescription is a recognized influence on GPs' prescribing, particularly in relation to the prescribing of antibiotics. Nurses are now able to supply antibiotics under a Patient Group Direction (PGD) in NHS walk-in centres and may experience similar pressures in this new role. Objectives. Our aim was to compare walk-in centre nurses' and GPs' perceptions of the influence of patient expectation on their supply of an antibiotic to patients with an acute respiratory tract infection presenting with a sore throat or cough. Methods. Between June and December 2001, all patients presenting with a sore throat or cough at six walk-in centres and six nearby general practices were eligible to participate in the study. After the health professional-patient consultation, the health professional and the patient each completed a questionnaire. Results. There were 472 health professional (181 GPs and 291 walk-in centres) and 160 (34%, 160 out of 472) patient questionnaires returned. GPs were more likely to report that the patient expected an antibiotic than nurses (72% of 181 versus 13% of 291, P < 0.001). GPs were also less likely to report that an antibiotic was indicated than nurses (88% of 136 versus 97% of 194, P < 0.001). There was a trend for doctors to prescribe more frequently than nurses, in 74% of 180 patients versus 66% of 291 patients (P = 0.06). GPs were likely to report that the patient expected an antibiotic when the patient reported wanting a prescription (60% of 68, P = 0.05) and to report that the patient expected an antibiotic if the patient thought an antibiotic would be beneficial (62% of 68, P = 0.001). There was a much weaker relationship between nurse perceptions of patient expectation for an antibiotic and, either patient desire for a prescription or the patient's affirmative belief that an antibiotic would be beneficial. Conclusions. Nurses may be compensating for a lack of security in their new role as antibiotic suppliers by not acknowledging the influence of patient expectation on their decision making. The acknowledgement of the influence of patient expectation might be beneficial to nurses' development as suppliers of medicines by giving them greater understanding of the consultation process and in the need to discuss patient expectations explicitly in the consultation. © Oxford University Press 2004, all rights reserved.

Background To improve the translation of public health evidence into practice, there is a need to increase practitioner involvement in initiative development, to place greater emphasis on contextual knowledge, and to address intervention processes and outcomes. Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited. With this knowledge the Keeping Children Safe programme developed an "Injury Prevention Briefing (IPB)" using a 7 step process to combine scientific evidence with practitioner contextual knowledge. The IPB was designed specifically for children’s centres (CCs) to support delivery of key fire safety messages to parents. This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB, in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked. Methods Interviews were conducted with key staff at 24 CCs participating in the two intervention arms: 1) IPB supplemented by initial training and regular facilitation; 2) IPB sent by post with no facilitation. Framework Analysis was applied to these interview data to explore intervention adherence including; exposure or dose; quality of delivery; participant responsiveness; programme differentiation; and staff experience of IPB implementation. This included barriers, facilitators and suggested improvements. Results 83% of CCs regarded the IPB as a simple, accessible tool which raised awareness, and stimulated discussion and behaviour change. 15 CCs suggested minor modifications to format and content. Four levels of implementation were identified according to content, frequency, duration and coverage. Most CCs (75%) achieved ‘extended’ or ‘essential’ IPB implementation. Three universal factors affected all CCs: organisational change and resourcing; working with hard to engage groups; additional demands of participating in a research study. Six specific factors were associated with the implementation level achieved: staff engagement and training; staff continuity; adaptability and flexibility; other agency support; conflicting priorities; facilitation. CCs achieving high implementation levels increased from 58% (no facilitation) to 92% with facilitation. Conclusion Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation, particularly when supplemented by ongoing training and facilitation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1256) contains supplementary material, which is available to authorized users.

Objective To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies. Methods The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses. Results In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value

BACKGROUND: Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. OBJECTIVES: To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. DESIGN: Feasibility multicentre, cluster, randomised, unblinded trial. SETTING: Eight children's centres in Bristol and Nottingham, UK. PARTICIPANTS: Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. INTERVENTIONS: The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. MAIN OUTCOME MEASURES: Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. RESULTS: An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. CONCLUSIONS: This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03605270. SOURCE OF FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information. Language: en

Background:- The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0–14 years; these injuries have the steepest social gradient of all injuries in the UK. Children’s centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children’s centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention. Methods/Design:- Pragmatic, multicentre cluster randomised controlled trial, with a nested qualitative study, in four study centres in England. Children’s centres in the most disadvantaged areas will be eligible to participate and will be randomised to one of three treatment arms comprising: IPB with facilitation package; IPB with no facilitation package; usual care (control). The primary outcome measure will be the proportion of families who have a fire escape plan at follow-up. Eleven children’s centres per arm are required to detect an absolute difference in the percentage of families with a fire escape plan of 20% in either of the two intervention arms compared with the control arm, with 80% power and a 5% significance level (2-sided), an intraclass correlation coefficient of 0.05 and assuming outcomes are assessed on 20 families per children’s centre. Secondary outcomes include the assessment of the cost-effectiveness of the intervention, other fire safety behaviours and factors associated with degree of implementation of the IPB. Discussion:- This will be the first trial to develop and evaluate a fire prevention intervention for use in children’s centres in the UK. Its findings will be generalisable to children’s centres in the most disadvantaged areas of the UK and may also be generalisable to similar interventions to prevent other types of injury. Trial registration:- http://NCT01452191 webcite (date of registration: 13/10/2011).

Background Unintentional injury is the leading cause of preventable death in children in the UK, and 0–4year-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 groupbased 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.

Background: Injuries sustained in the home are a significant contributor to the burden of death and disabilities among young children especially those living in Low and Middle Income Countries (LMICs). The objective of this review was to identify and evaluate the effectiveness of environmental change interventions to reduce child injuries and injury hazards in the home in LMICs. Methods: Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies of environmental change interventions designed to reduce child injuries and home hazards and published up to 1 April 2014. Where possible, meta-analysis was conducted using RevMan 5. Results: In total four studies were included in the review. Only one study (CBA) reported child injury and three studies (RCTs) home hazards. In the CBA study, child resistant containers were found effective to reduce the incidence of paraffin ingestion by 47% during the intervention period and by 50% after the intervention. Data from two RCTs pooled in a meta-analysis found that a multifactorial intervention (home inspection, safety education and safety device) significantly reduced the post intervention mean scores in the intervention group for poisoning hazards (Mean Difference (MD) -0.77; 95% CI -1.36, -0.19) and burn related unsafe practices (MD -0.37; 95% CI -0.66, -0.09) but not for fall, electrical and paraffin burn hazards. The intervention (home inspection and safety education, not safety device) used in a single RCT significantly reduced the post-intervention mean scores in the intervention group for fall hazards (MD -0.5; 95% CI -0.66, -0.33) but not for ingestion hazards. Conclusions: There is limited evidence to determine if environmental change interventions reduce child injuries but some evidence suggested that they may reduce home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries.

Background Children’s centres were established across England to improve health outcomes for children. Injury prevention is one of the many roles centres have in protecting and promoting children’s health. The centres have the potential to make significant contributions to home safety for children under five. The aim of this study was 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. Methods A questionnaire was posted to managers of 851 children’s centres, selected by 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. Results A response rate of 61% was achieved. Most respondents (98%) agreed that children’s centres can be effective in preventing accidents. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 22% did not know if 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. Conclusions 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.

Background Injuries are among the leading causes of death and hospitalisation of children worldwide; 90% of all injuries are unintentional. In 2010, over 900 children aged 1–4 years died from injuries in Nepal; the extent of non-fatal injuries is unknown. Most of the injuries to younger children occur at home, and associated with lack of supervision. Community mobilisation may be a feasible approach for preventing child injuries in rural Nepal. We describe community mobilisation for developing a community-creche for 1–3 year old children to increase supervision and promote early childhood development. Methods We worked with one women’s group in Makwanpur and facilitated group discussion; a visit to an established creche system in Bangladesh; did debriefing and orientation, and community involvement sessions. The women’s group formed a committee to develop and manage the creche; nominating 2 volunteers who were responsible for identifying eligible children and running the creche. Published minimum standards for early child development centres (ECDC) by the government of Nepal were applied. Results In February 2015, a creche was established in Hatiya (Makwanpur) under the ownership of local women’s group; and registered with local authority. A qualified ECD trainer trained the volunteers and mothers on stages of childhood development. A total of 17 children aged 1–3 years were enrolled and attended the creche for 3 to 4 hours daily. Parents observed positive changes in children attending creche. They also felt their children were in secure place when they were at work. The local municipality provided financial support to the creche. A local government ECD centre agreed to intake the graduates from the creche. Conclusion It is feasible, acceptable and potentially sustainable to establish creches for young children in Nepal with full ownership of local women’s group. There is very high potential for the partnership with local government which can also provide resources.

Background Non-fatal injuries are many times more common than fatal injuries and may lead to lifelong consequences in children. Lack of child injury surveillance system hinders evidence generation in a low-income setting. Children in rural Nepal are exposed to widespread injury risks and families may have little awareness of how they can be prevented. Community mobilisation may be an effective approach. This study aimed to develop an educational package on child injury prevention and assess the feasibility of delivering it with the involvement of women’s groups. Methods An educational package was developed for Female Community Health Volunteers (FCHVs) that included both primary and secondary prevention materials for unintentional child injuries and was adapted from those developed by CIPRB (Bangladesh). Ten women’s groups across 9 wards in one village development committee (VDC) area were actively engaged in 6 monthly meetings. The sessions were led by FCHV and lasted for 1–2 hours where rigorous discussions were held using the educational materials provided. Structured checklists were used to obtain feedback and to assess the delivery and reach of the programme. Results First-aid training, meeting faciliation guide, parents’ booklet and educational wall posters were the major outputs of this project. Nine FCHVs received first-aid training and kits. FCHVs convened 10 women’s groups to run over 6 months with 25 to 30 mothers attending each session. Each group presented their views on child injury risks and proposed prevention activities at local public meetings. Community members appreciated the project and developed their own interventions to tackle local injury hazards. Conclusions It is feasible to develop and implement a community mobilisation intervention where women’s groups work with FCHVs to prevent injuries in children. The intervention was well received by the women’s groups and by community members.

Background The UK has high mortality rates for fire-related deaths in children aged 0–14 years with steep social gradients. Interventions to promote fire safety practices can be effective in reducing the risk of fire-related injury. We therefore developed an evidence-based fire safety intervention comprising an Injury Prevention Briefing (IPB), training and facilitation for use in children’s centres. Methods A cluster randomised controlled trial, with integrated qualitative study, was conducted across four study sites in England involving children’s centres in disadvantaged areas; participants were staff and families attending those centres. Centres were stratified by study site and randomised within strata to one of three arms: IPB plus facilitation (IPB+), IPB only, usual care. IPB+ centres received initial training and facilitation at months 1, 3, and 8. Data collected comprised baseline and 12 months parent- and staff-completed questionnaires, home safety activity logs and staff interviews. The primary outcome was the proportion of families with a home fire-escape plan. Treatment arms were compared by using multilevel models to account for clustering by centre. Results 1112 parents at 36 CCs participated. There was no significant effect of the intervention on family possession of fire-escape plans (AOR IPB only vs. usual care: 0.93, 95% CI: 0.58, 1.49; AOR IPB+ vs. usual care 1.41, 95% CI: 0.91, 2.20). However, significantly more families in the intervention arms achieved more fire-escape planning behaviours (AOR IPB only vs. usual care: 2.56, 95% CI: 01.38, 4.76; AOR IPB+ vs. usual care 1.78, 95% CI: 1.01, 3.15). Conclusions Our study demonstrated that children’s centres can deliver an injury prevention intervention to families in disadvantaged communities and achieve changes in home safety behaviours.

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.

Title. The transition to parenthood: what does it mean for fathers? Aim. This paper is a report of a study to explore the needs of first-time fathers in relation to the care, support and education provided by healthcare professionals during the antenatal period, particularly in relation to preparing them for the transition to fatherhood. Background. Pregnancy and transition to parenthood are major developmental periods within families throughout the world. Previous research suggests that fathers in many different countries feel unprepared for parenthood. Methods. Purposive sampling was used to recruit 20 partners of primiparous women from two healthcare provider organizations in South-West England between December 2005 and July 2006. Recruitment took place at about 28 weeks gestation. Semi-structured interviews were undertaken at home in the last trimester of pregnancy and 3–4 months postpartum. Content analysis of the interview data was undertaken. Findings. Several common themes emerged from both the ante- and postnatal data, including lack of support mechanisms, involvement in antenatal provision and the need for more information given in the antenatal period on parenting, baby care and relationships. Conclusions. Adequately preparing new fathers for parenthood in advance of the birth of their baby is important, and healthcare professionals can contribute to this by involving and supporting new fathers. Further study is needed to explore the role of fathers in antenatal education and the types of interventions that are effective in improving their early experiences of parenthood. The study needs to be repeated with fathers from black and ethnic minority groups.

Background Pregnancy and the transition to parenthood are major adjustment periods within a family. Existing studies have asked parents, retrospectively, about their experience of antenatal education, mainly focusing on women. We sought to address this gap by asking first-time mothers and their partners about how they could be better supported during the antenatal period, particularly in relation to the transition to parenthood and parenting skills. Methods Purposive sampling was used to recruit 24 nulliparous women with a range of ages from two healthcare organisations in South-West England, 20 of whom had partners. Recruitment took place antenatally at around 28 weeks gestation. Semi-structured interviews were undertaken at home in the last trimester of pregnancy and between 3–4 months postpartum. Content analysis of the interview data was undertaken. Results Several common themes emerged from both the ante- and postnatal data, including support mechanisms, information and antenatal education, breastfeeding, practical baby-care and relationship changes. Knowledge about the transition to parenthood was poor. Women generally felt well supported, especially by female relatives and, for those who attended them, postnatal groups. This was in contrast to the men who often only had health professionals and work colleagues to turn to. The men felt very involved with their partners' pregnancy but excluded from antenatal appointments, antenatal classes and by the literature that was available. Parents had been unaware of, and surprised at, the changes in the relationship with their partners. They would have liked more information on elements of parenting and baby care, relationship changes and partners' perspectives prior to becoming parents. Conclusion Many studies and policy documents have highlighted the paucity of parents' preparation for parenthood. This study has indicated the need for an improvement in parents' preparation for parenthood, the importance of including fathers in antenatal education and that inadequate preparation remains a concern to both women and their partners. This paper identifies several avenues for action and further research to improve both new parents' experience of antenatal education and their preparation for parenthood.

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.

Population ageing, escalating costs in pensions, health-care and long-term care have prompted a new policy agenda for active ageing and quality of life in old age across the European Union and other developed countries. In England, the National Service Framework for Older People (NSF OP) explicitly demands for the first time that the NHS and local authorities, in partnership, agree programmes to promote health ageing and to prevent disease in older people. These programmes are expected to improve access for older people to mainstream health promotion services and also to develop multiagency initiatives to promote health, independence and well-being in old age. This paper describes the evaluation of one interagency project team established to test out mechanisms for addressing health promotion for older people through primary care. A mixed methodology was used to understand the processes of service development, the impact of the team's intervention, and the primary and secondary outcomes for older people. The project demonstrated that multi-agency partnerships have the potential to improve the quality of the lives of older people deemed 'at risk' by their general practitioners, particularly through income generation but also in the identification of medical problems such as unrecognised hypertension, hearing loss and visual loss. It also offered some key learning points for other multi-agency groups developing similar services.

Until recently antibiotics were only available on prescription. Nurses in NHS Walk-in Centres (WiCs) now supply and administer antibiotics in accordance with patient group directions (PGDs). The aim of this study was to investigate the process of antibiotic supply from WiCs. Antibiotic PGDs from ten WiCs were selected and medical notes of 50 patients who received an antibiotic at these WiCs were examined to determine compliance with PGD specifications. No consistency of approach in format and content of PGDs was found. PGDs from six WiCs complied with 15/20 or fewer PGD requirements. In the examination of patients’ records, 65% of all relevant PGD requirements were explicitly recorded. The breadth and variability of PGDs demonstrates local needs and priorities; however, low compliance levels with PGD requirements provide cause for concern. This article discusses the legality of PGDs, equity in both service provision and advice offered, compliance of medical notes with PGD requirements, implications for patients and WiC nurses, and training implications. Incomplete documentation makes it impossible to verify the quality of care provided across and within WiCs. It also suggests that uncertainty remains around the supply of medicines under PGDs.

Aims: To assess outcomes in families who received the First Parent Health Visitor Scheme (FPHVS), in comparison with families who received conventional ("generic") health visiting. Methods: Retrospective data on 2113 families were collected during 1986–92 as part of National Health Service (NHS) service provision. Prospective data were collected during 1993–98 on 459 mothers and their children, with outcomes assessed at one year (93% follow up) and two years (80% follow up). Results: There were no differences between the groups of mothers in self esteem, locus of control, or depression rates. The women who received the FPHVS were more likely to have changed partners, but they also had a wider support network than comparison women, and consulted their general practitioner (GP) less often. Breast feeding rates were higher in the FPHVS mothers, who also gave their infants more fruit juice drinks than the comparison group. No differences were apparent in developmental outcome using the Bayley Scales at 1 and 2 years of age. Both height and weight Z scores at 2 years of age were lower in the FPHVS children than the comparison children. Receipt of the FPHVS was associated with increased use of electric socket covers and lower accident rates in the second year of life. No differences were seen in immunisation rates, uptake of child health surveillance, or use of hospital services. A higher proportion of families who received the FPHVS were registered on the local child protection register compared with comparison families. Conclusion: Clustering effects dominated the analysis, but overall this evaluation could not show a clear advantage for the FPHVS over conventional health visiting.