Use of the modified Delphi technique to identify and rate home injury hazard risks and prevention methods for young children.

OBJECTIVE: For children aged 1-5 years, the authors used the Delphi method to determine (1) the most important injury hazards in each area of the home; (2) the most important injury prevention behaviors; and (3) feasible and efficacious safety devices and behaviors to reduce injury risks. DESIGN: The authors used a modified Delphi method to prioritize home injury hazards for children 1-5 years of age. The Delphi method is an indirect, anonymous, iterative process aimed at achieving consensus among experts; in this study, the authors queried key informants electronically. Thirty four key informants, primarily from the United States, participated in at least one of the three rounds of questionnaires. Responses were submitted by email or fax. Participants identified, rated, and ranked home injury hazards and prevention methods. RESULTS: The overall response rate for each survey ranged from 82% to 97%. Initially, 330 unique hazards and prevention behaviors/devices were identified in seven areas of the home. The 126 home injury hazards were rated based on frequency, severity, and preventability of injury; and the 204 behaviors and devices were rated by efficacy and feasibility. These experts rated firearms and pools as the most significant hazards, and smoke alarms and safe water temperature as the most important preventions. CONCLUSIONS: The modified Delphi method of consensus was useful to prioritize home injury hazards and prevention methods for children under the age of 6 years.

Validating self reported home safety practices in a culturally diverse non-inner city population.

OBJECTIVE: To determine the validity of face to face, self reported responses to questions about the presence of safety devices and use of safety practices in the home aimed at preventing unintended injuries to preschool aged children. METHODS: The authors invited families with children enrolling in a medium sized Midwestern US community Head Start program to participate in a randomized study of home safety practices. Participation involved consenting parents (n = 452) completing an initial questionnaire during Head Start enrollment or in their home. Project staff conducted home inspections to confirm parental responses to 16 questions. Only inspections conducted within 34 days of questionnaire completion (n = 259) were included in the validation study. Parents were told that the home visit would assess the need for safety devices, but were not informed of the validation aspect of the study. RESULTS: Sensitivities were generally high for all 16 safety practices, whereas negative predictive value and specificity varied considerably. Positive predictive value was also high for most practices, and did not vary by ethnicity. Answers provided by parents in their home were different and more reliable than those provided by parents interviewed at school (p = 0.001). CONCLUSIONS: Use of safety devices and practices by parents of preschool aged children reported in a face to face interview are generally reliable. Reliability increases if the interview is conducted in the home. Parents may also be more willing to report potential problems if they perceive they may receive corrective assistance.

Child restraint systems: an update for physicians.

During the past decade, many advances have been made in motor vehicle safety restraint systems, and these advancements have brought changes in the recommendations for child passenger safety. In spite of these advances, a high morbidity and mortality rate continues to be attributed to improper or absent child restraint use. Child transportation safety is a complex issue. Lack of public awareness and incomplete laws contribute to the confusion. The solution involves professional and public education, further technological advances, and advocacy for improved legislation and regulation. Physicians have a unique opportunity to incorporate advice about proper restraint use into their daily practice; however, that requires a clear understanding of the current recommendations. Both the age and weight of the child determine the appropriate child restraint system. Understanding, practicing, and promoting these recommendations will save lives. This article reviews the current recommendations for proper child restraint while traveling in a motor vehicle.

Community-based injury prevention programs: toward a safer Wisconsin.

Community-based injury prevention programs are an important approach to the reduction of the burden of injury in all age groups. These programs may focus on education and behavioral change, increasing access to safer products, creating a safer environment, and passing and enforcing legislation. This article reviews some of the community-based injury prevention programs in Wisconsin that focus on the prevention of home- and transportation-related injuries. Community participation in the design and implementation of these programs will increase the likelihood of adopting safer behaviors on a community level. We are hopeful that physicians and other health care providers will be actively involved in community-based injury prevention activities in their locale.

Parents' knowledge of neonatal screening and response to false-positive cystic fibrosis testing.

Neonatal screening for cystic fibrosis (CF) has become feasible through analyzing dried blood specimens for immunoreactive trypsinogen (IRT), but the benefits and risks of such a screening program remain to be delineated. This study, a survey of the parents of 104 Wisconsin infants with false-positive IRT tests, showed parents had knowledge deficits about neonatal screening in general, misconceptions about test results, and high levels of anxiety. Parenting behaviors were reportedly unchanged during the usual 3-day waiting period between the news of the abnormal screening test and the diagnostic sweat test. Most, but not all, parents were relieved by negative sweat test results subsequent to the abnormal IRT test. Factors associated with continued parental concern included having less than a high school education and/or having an infant with low Apgar scores. Additionally, those contacted by telephone were more likely to have misinformation and lingering concerns about the presence of CF in their child.