An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines.

OBJECTIVES: Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD). METHODS: This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury. RESULTS: The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%). CONCLUSIONS: Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

Health education intervention promoting infant safe sleep in paediatric primary care: randomised controlled trial.

BACKGROUND: Few randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance delivered at well child visits (WCVs). This protocol paper describes the design of the Safe Start Study, which aims to evaluate the impact of safe sleep interventions on parents' knowledge, beliefs and behaviours related to creating and maintaining a safe sleep environment for their infants. METHODS: Safe Start is a three-group RCT comparing a safe sleep health education intervention delivered as part of the 2-week WCV, an attention-matched control group that receives a scald burn prevention intervention, and a standard of care group. A baseline survey is completed at the 2-week WCV; follow-up surveys and observations are completed in the home at 2-4 weeks and 2-3 months. Participants include mother-baby dyads attending a large urban paediatric primary care practice and their paediatricians. Primary outcomes are self-reported behaviours (baby sleeps alone, on back, in crib and in a smoke-free environment), observations of the sleep environment, paediatricians' anticipatory guidance counselling about safe sleep and participants' reported exposure to an existing city-wide safe sleep campaign. DISCUSSION: Providing a theory-driven and evidenced-based safe sleep intervention is both a research and a clinical practice priority. This study will advance the application of educational and environmental interventions in the primary care setting to improve the safety of infant sleep environments in high-risk families. TRIAL REGISTRATION NUMBER: NCT03070639; Pre-results.

Lessons from sustainability of Play Streets in the United States.

Communities around the world lack safe places for children to play and be physically active. One solution to this issue is Play Streets, which involves the temporary closure of streets for several hours to create a safe space for active play and physical activity. While the benefits of these programs are greater when they are recurring over many years, there is a dearth of literature regarding how to successfully sustain Play Streets. To understand how Play Streets can be sustained in the long term, we conducted semi-structured interviews with 24 Play Streets organizers representing 22 Play Streets programs across the United States. Four recurring sustainability challenges were highlighted from the thematic analysis: 1) securing and sustaining funding, 2) managing community and city resistance to street closures, 3) navigating government bureaucracy, and 4) retaining interest amongst organizers and volunteers. With each challenge, we describe how Play Streets organizers navigated those challenges, with a goal of generating recommendations for those wishing to sustain Play Streets programs in the long term.

Applying the Haddon Matrix to evaluate sexual assault interventions on college campuses.

Objective: A Haddon Matrix analysis was used to systematically review literature evaluating college campus sexual assault prevention programs to identify research gaps and intervention opportunities. Methods: Articles included were published from January 1, 2001 to December 31, 2017; indexed in PubMed, PsycInfo, or Scopus; involving English-speaking undergraduate students in the US; with experimental or quasi-experimental design. Results: All 31 eligible studies evaluated educational programing; all relied on self-report measures; and three-quarters had follow-up periods ≤ 6 months. Significant positive effects were reported by 6 of 10 studies that measured bystander behavior, 6 of 10 that educated potential victims and assessed victimization, and one of four that educated potential perpetrators and measured perpetration. Conclusion: The Haddon Matrix analysis identified the need for interventions that address perpetrators and the post-assault period, as well as studies of the impact of enforcing existing policies and new environmental and situational approaches to sexual assault prevention.

Defining appropriate stages of change for intimate partner violence survivors.

Recent research suggests that the transtheoretical model of behavior change is a promising approach for interventions addressing women's experiences of intimate partner violence. This study explores the distribution of abused women across the stages of change for (a) staying safe from intimate partner violence and (b) leaving an abusive relationship. It explores the relationship between stage assignment and other indicators of a woman's stage (i.e., safety behaviors and desire for services). Quantitative surveys were conducted with 96 low-income, urban abused women recruited from six health care clinics. The findings call into question the appropriateness of using a staging algorithm that uses one "global" question about keeping safe and suggest that staging questions focused on a single action stage (e.g., leaving) are also problematic. In conclusion, additional work remains to be done to develop and validate quantitative measures of stages of change for survivors of intimate partner violence and to design, implement, and evaluated stage-based, tailored intimate partner violence interventions.

Outcomes of a brief coping skills group intervention for adults with severe postconcussion symptoms.

AIM: The aim of this study was to evaluate a brief psychologically informed coping skills group intervention for adults with severe prolonged symptoms following mild traumatic brain injury (mTBI). METHODOLOGY & RESULTS: Patients attended an education session about mTBI; 22 patients completed an additional coping skills group intervention, 16 declined/stopped the intervention early and 19 were not offered the intervention. At follow-up, patients who completed the intervention reported a similar degree of symptom improvement and disability as those who did not complete the intervention. The majority of patients who completed the intervention were satisfied with it and perceived it to be credible. CONCLUSION: The coping skills intervention was not associated with measurable clinical benefit. Recommendations for improving psychological interventions for mTBI are discussed.

Transforming City Streets To Promote Physical Activity And Health Equity.

Most US cities lack built environments that support physical activity, which is a key determinant of health. Making permanent changes to the physical environment to promote physical activity is not always feasible. Play Streets is a place-based intervention that is typically organized by local governments or community organizations and involves temporarily closing streets to create safe places and free opportunities for physical activity. In this descriptive study we examined 162 of Chicago's PlayStreets, held in the summer of 2018, to assess the volume and type of physical activity among youth participants and the variety of services provided to residents. We analyzed implementation data and forms completed after PlayStreets, and we conducted systematic observations at a purposeful sample of PlayStreets. We found that PlayStreets provides opportunities for youth physical activity in areas where opportunities do not otherwise always exist. PlayStreets also provides an avenue for residents to access community resources. This research on Chicago's experience with PlayStreets showed how one city is temporarily turning streets into places for youth physical activity to advance health equity. Local policies that facilitate temporarily closing streets and that provide resources to support opportunities for physical activity and access to community resources can advance health equity in cities nationwide.

Content of Infant Safe Sleep Counseling and Maternal Reported Practices in an Urban Clinic.

OBJECTIVE: Sudden Infant Death Syndrome is a leading cause of mortality in infants, and pediatric providers can influence caregiver infant safe sleep practices. We described the content of safe sleep counseling by pediatric providers and examined pediatric provider and caregiver factors that may be related to the delivery of safe sleep counseling. METHODS: A sample of mothers and providers enrolled in the Safe Start Study, a randomized controlled trial assessing a safe sleep intervention, were audio-recorded during the 2-week well child visits (WCV) at a large urban pediatric practice in Baltimore, Maryland from October 2015 to April 2017. Provider counseling content related to infant sleep was transcribed and coded based on American Academy of Pediatrics (AAP) policy statement Grade A recommendations. Maternal reported infant sleep practices were defined by items on an interviewer administered survey. Multivariate logistic regression analyses were used to examine the relation between maternal reported infant sleep practices and provider counseling. RESULTS: Most, 92%, of WCVs included at least 1 safe sleep topic, but there was inconsistency in content delivered based on AAP recommendations. Yet, only 12% of WCVs included all 4 components of ABC counseling. Maternal report of infant sleeping with a person or an object in sleep space was associated with decreased odds of receiving counseling on alone no person, no objects (adjusted odds ratio: 0.34, 95% confidence interval: 0.13, 0.90). CONCLUSIONS: Pediatric provider counseling on safe sleep is inconsistent across AAP recommendations demonstrating a need for enhanced provider education and a more standardized approach to assess infant sleep practices.

HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States.

This article reviews 35 U.S. studies on the intersection of HIV and adult intimate partner violence (IPV). Most studies describe rates of IPV among women at risk or living with HIV/AIDS and identify correlates, using multiple types of convenience samples (e.g., women in methadone treatment, women in shelters or clinics), cross-sectional designs, and self-reported risk behaviors. HIV-positive women appear to experience any IPV at rates comparable to HIV-negative women from the same underlying populations; however, their abuse seems to be more frequent and more severe. The authors found only four relevant interventions and none addressed sexually transmitted HIV and partner violence risk reduction simultaneously. There is a critical need for research on (a) causal pathways and cumulative effects of the syndemic issues of violence, HIV, and substance abuse and (b) interventions that target IPV victims at risk for HIV, as well as HIV-positive women who may be experiencing IPV.

Osteoconduction in keratin-hydroxyapatite composite bone-graft substitutes.

Reconstituted keratin-hydroxyapatite (K-HA) composites have shown potential as nonload-bearing bone graft substitute material. This in vivo study investigated the bone regeneration response of keratin plus 40% HA composite materials in comparison to collagen counterparts and an unfilled defect site. The implantation site was a noncritical size defect created in the long bones (tibia) of sheep, with observations made at 1, 2, 4, 6, 8, and 12 weeks postimplantation. Porous K-HA materials displayed an excellent biocompatibility similar to collagen counterparts; however, the rate of bone regeneration at K-HA implantation sites was markedly slower than that of the collagen or unfilled defect sites. While collagen materials were undetectable by 4 weeks implantation, K-HA composite remnants were present at 12 weeks. However, there is evidence that K-HA implants participated in the natural remodelling process of bone, with bone regeneration occurring via a creeping substitution mechanism. Observations imply that the rate of bone ingrowth into the K-HA defect site was matched with the rate of K-HA resorption. These results suggest that K-HA materials may offer significant benefits as nonload-bearing bone graft substitutes where it is desirable that the degradation of the scaffolding material be well matched with the rate of bone regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2034-2044, 2017.

A new approach to improve TMJ morphological information from plain film radiographs.

The hard tissues of the temporomandibular joint (TMJ) can be assessed through radiographic imaging to provide information to assist in diagnosis and treatment. However, the quality of information gathered from such imaging is often less than desired due to the small size of the TMJ, the widely varying fossa and condylar morphology, and the surrounding dense osseous structures. These make a clear and undistorted radiographic image of the hard tissue of the joint technically difficult. It is postulated that, if the degree of inaccuracy of a given radiograph is known quantitatively and taken into account, the clinician will be able to make a better informed qualitative assessment of TMJ morphology. The aim of this study is: 1. to improve the qualitative information that can be acquired from routine clinical plain film radiographs of the TMJ; 2. to use quantitative data to test the novel Neural Network (NN) model; and 3. to statistically show the discrepancies between routine radiographic images and the actual joint. Linear measurements of excised TMJs and their radiographic images were used to train a multilayer perceptron (MP) type NN model to predict joint dimensions more accurately. Such a neural network, developed using a statistical software package such as SPSS (SPSS, Inc. Chicago, IL), functions as a computer software program and predicts joint dimensions with increased accuracy when radiographic measurements are entered into the program. The NN model described here predicts the actual linear distances of the TMJ more closely than radiographic measurements and is more reliable in assessing the TMJ morphology.

Keratin-hydroxyapatite composites: biocompatibility, osseointegration, and physical properties in an ovine model.

Reconstituted keratin has shown promise as an orthopaedic biomaterial. This in vivo study investigates the biological response of composite materials prepared from reconstituted keratin containing a high content of hydroxyapatite (HA) (40 wt % HA), implanted for up to 18 weeks in the long bones of sheep. Keratin-HA composites were compared with a commercially available polylactic acid (PLA) HA composite (BIO RCI HA®, Smith and Nephew). Porous keratin-HA materials displayed excellent biocompatibility and osseointegration, with full integration into bone by 12 weeks. Dense keratin-HA materials also showed excellent biocompatibility, with a more limited osseointegration, involving the penetration of new bone into the periphery of the implant after eight weeks. In contrast, the PLA-HA implant did not integrate with surrounding tissue. Microindentation showed that porous keratin-HA implants were initially soft, but became stiffer as new bone penetrated the implant from four weeks onwards. In contrast, although the initial rigidity of dense keratin-HA composites was maintained for at least two weeks, the implant material weakened after four weeks. The PLA-HA implant maintained its physical properties throughout the course of the trial. This study demonstrates the increased osseointegration/osteoconduction capacity of keratin-HA composites and provides further evidence supporting the suitability of keratin-based materials, such as bone graft substitutes and soft tissue fixation devices.

Bone-like matrix formation on magnesium and magnesium alloys.

Mg metal and its alloys have promise as a biocompatible, degradable biomaterials. This work evaluates the potential of in vitro cell culture work with osteoblast-like cells on Mg based materials, and investigates cell differentiation and growth on Mg alloyed with various non-toxic or low-toxicity elements. Mg based substrates support the adhesion, differentiation and growth of stromal cells towards an osteoblast-like phenotype with the subsequent production of a bone like matrix under in vitro conditions. No significant difference in the final tissue layer is observed on pure Mg, an AZ21 alloy or a 0.5 wt% Ca alloy. Only a 0.8 wt% Ca alloy which shows complete structural disintegration shows minimal cell growth. Due to association of non-soluble degradation products formed when Mg is incubated in physiological-like fluid, mass changes typically used to report Mg degradation are not viable estimates of degradation. Methods quantifying the time dependent change in the mechanical integrity of samples as a function of incubation time are required for a proper assessment of Mg degradation. We conclude that in vitro cell culture of bone cells on Mg substrates is expected to be a viable screening technique to assess the relative biological activity of Mg-based materials.

Child pedestrians: the role of parental beliefs and practices in promoting safe walking in urban neighborhoods.

The purpose of this study was to describe parents' child pedestrian safety practices, knowledge, risk perceptions, and beliefs. We surveyed 732 parents from four elementary schools in urban neighborhoods that differed in income, and child pedestrian injury risks. Findings indicated that most parents taught their children street safety. Few (16%) knew basic pedestrian safety facts; 46% believed children younger than 10 years could safely cross streets alone; 50% believed a child pedestrian crash was likely. Parents in lower income neighborhoods reported the highest rates of unpleasant walking environments and concerns about drug dealers, crime, violence, and trash. We conclude that education should focus on children's risk, developmental capabilities, and supervision needs. Promoting physical activity in urban neighborhoods, especially lower income ones, must address concerns about the physical and social environment.