Keeping children safe at home: protocol for a matched case-control study of modifiable risk factors for poisoning.

BACKGROUND: Childhood unintentional and suspected poisonings are a serious public health problem. Evidence from systematic reviews demonstrates that home safety education in combination with safety equipment provision increases the safe storage of medicines and other products. There is lack of evidence that poisoning prevention practices reduce poisoning rates. OBJECTIVES: To estimate ORs for medically attended poisonings in children aged 0-4 years for items of safety equipment, home hazards and parental safety practices aimed at preventing poisoning, and to explore differential effects by child and family factors. DESIGN: Multicentre case-control study in UK hospitals with validation of parent-reported exposures using home observations. Cases are aged 0-4 years with a medically attended poisoning occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression; unmatched analyses will use unconditional logistic regression to adjust for confounding variables. The study requires 266 poisoning cases and 1064 matched controls to detect an OR of 0.64 for safe storage of medicinal products and of 0.65 for non-medicinal products, with 80% power, a 5% significance level and a correlation between exposures in cases and controls of 0.1. MAIN OUTCOME MEASURES: Unintentional childhood poisoning. DISCUSSION: This will be the largest study to date exploring modifiable risk factors for poisoning in young children. Findings will inform: policy makers developing poison prevention strategies, practitioners delivering poison prevention interventions, parents to reduce the risk of poisoning in their homes.

Validation of a home safety questionnaire used in a series of case-control studies.

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

Keeping children safe at home: protocol for three matched case-control studies of modifiable risk factors for falls.

BACKGROUND: Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. OBJECTIVES: To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. DESIGN: Three multicentre case-control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0-4 years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. MAIN OUTCOME MEASURES: Falls on stairs, on one level and from furniture. DISCUSSION: As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children.

Older people with complex long-term health conditions. Their views on the community matron service: a qualitative study.

BACKGROUND: The Department of Health in the UK has suggested that older people with complex health problems may benefit from a case-management approach to meet their needs. The NHS has since invested heavily in community matrons as one method of tackling managed care. Matrons are highly trained nurses, able to diagnose, prescribe and manage patients with long-term conditions within primary care. Early evidence suggests that the matron approach does not achieve the government targets of reducing unplanned hospital admissions. AIM: To explore the experiences and attitudes of older people who have a community matron so that we may gain an understanding of the successes and failures of this form of case management. DESIGN OF STUDY: Qualitative study using one-to-one interviews with patients and carers. Setting Nottingham and surrounding rural areas during 2006-2007. METHOD: A purposive sample of patients recruited from community matron caseloads. In-depth semi-structured interviews were audiotaped and transcribed. Analysis for emergent themes used a template approach and was validated by discussion with lay advisors and community matrons and by separate analysis of a sample of interviews by an independent researcher. RESULTS: Twenty-four participants were recruited. They often valued their matron as a personal friend as well as a professional. Many suggested that matrons improved their global health, reduced the workload of general practitioners, kept them out of residential care, reduced the need for social and psychological care, and supported their carers. Some were unclear why they had been selected for the matron service and knew of others they felt would benefit more than them. CONCLUSIONS: Matrons seem to be generally highly valued on a professional and personal level, almost filling the role of family doctor vacated by changing practices in modern primary care. Participants suggested several reasons why matrons could be economically justified, which need further investigation. The methods of case selection for these services also need to be questioned.