***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To identify predictors of unintentional injury to school-age children seen in pediatric primary care . METHODS Members of a managed health care system ( 295 children ages 5 - 11 years and their mothers ) participated . We used Time 1 measures of child , maternal , and family functioning and health care utilization to predict rates of unintentional child injury for the following year . Multiple regression analyses were performed to identify variables contributing to prospect i ve injury rates . RESULTS The final regression model included eight Time 1 variables and accounted for 21 % of the variance in Time 2 injury rates . Significant predictors of increased injury liability were younger child age , more children at home , child behavior problems , child social competence , three indices of reduced child health , and maternal anxiety . CONCLUSIONS We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury Abstract The accident risk to the children of a r and om sample of 458 women living in a former Inner London borough was associated with both a working-class status and the presence of psychiatric disturbance ( usually depression ) in the mother . The time of onset of the psychiatric disorder in these women and in another sample of women treated for depression by psychiatrists and general practitioners indicates that the mother 's psychiatric disorder greatly increases the risk of accidents to children The objective of this study was to evaluate the efficacy of a home-based intervention targeted to parents with intellectual disability to promote child health and home safety in the preschool years . A total of 63 parents were recruited for the study with 45 parents ( 40 mothers and 5 fathers ) from 40 families completing the project . The research design permitted comparison between the intervention and three alternative conditions with all parents receiving the intervention in an alternating sequence over the life of the project . The intervention consisted of 10 weekly lessons carried out in the parent 's home focusing on child health and home safety . The program was adapted to suit the Australian context from the UCLA Parent -- Child Health and Wellness Project ( Tymchuk , Groen , & Dolyniuk , 2000 ) . Outcome measures assessed parental health and safety behaviours . St and ard measures included parental health , intelligence and literacy . The intervention improved parents ' ability to recognize home dangers , to identify pre caution s to deal with these dangers and result ed in a significant increase in the number of safety pre caution s parents implemented in their homes with all gains being maintained at 3 months post-intervention . Parents ' health behaviours including improved underst and ing of health and symptoms of illness , knowledge of and skills needed to manage life-threatening emergencies , knowledge about visiting the doctor , knowing when to call , what information to provide and what questions to ask , and how to use medicines safely significantly increased . Again , all gains were maintained 3 months post-intervention . The intervention was effective regardless of parental health , literacy skills , and IQ . This form of home-based intervention promotes a healthy and safe environment which is a prerequisite to continuing parental custody Objective . To evaluate the extent to which a program of home visitation ( Early Start ) , targeted at families who are facing stress and difficulty , had beneficial consequences for child health , preschool education , service utilization , parenting , child abuse and neglect , and behavioral adjustment . Methods . The study used a r and omized , controlled trial design in which 220 families who were participating in the Early Start program were contrasted with a control series of 223 families who were not participating in the program .  Families were enrolled in the program after population screening that was conducted by community health nurses . Families were enrolled in the program for up to 36 months . Outcomes were assessed at 6 , 12 , 24 , and 36 months after trial entry . Results . Families in the Early Start series received a mean of 24 months of service . Comparisons between the Early Start and control series over the 36-month follow-up period revealed that families in the Early Start program showed significant benefits in the areas of improved utilization of child health services , reduced rates of hospital attendance for injury/poisoning , increased preschool education , increased positive and nonpunitive parenting , reduced rates of severe parent/child assaults , and reduced rates of early problem behaviors . Effect sizes ( Cohen 's “ d ” ) were found to be in the small to moderate range , with d ranging from .03 to .31 ( median : .22 ) . Conclusions . The Early Start program was associated with small to moderate benefits in a wide range of areas relating to child health , preschool education , parenting , child abuse , and early behavioral adjustment . Comparisons with other studies are made , and threats to validity are considered BACKGROUND Healthy Steps ( HS ) was design ed to address , prospect ively , behavioral and developmental support needs of young families in pediatric clinical care setting s.  PrePare ( PP ) initiates these services prenatally , whereas HS begins services in the postnatal period . Both interventions have universal and risk-directed components . Intervention effects in the first 3 months after birth are reported here . METHODS A quasi-experimental design was used to allocate 439 participants to intervention or usual care conditions . Within the intervention group , enrollees were r and omly assigned to receive HS or PP+HS services . Early outcomes were assessed by telephone survey at 1 week and 3 months postpartum . RESULTS Mothers in either intervention condition were less likely to report depressive symptoms and more likely to describe themselves as pleased in their role as parents . Intervention families were more likely to continue breastfeeding and more likely to read to their 3-month-old . Knowledge of infant development and recognition of appropriate discipline was greater among intervention recipients . Satisfaction with pediatric care was higher among intervention recipients and the rate of health plan disenrollment was 75 % lower at 3 months among those enrolled in the prenatal intervention . No other outcome difference emerged between HS and PP+HS enrollees . CONCLUSIONS Receipt of either intervention was associated with positive effects on health , safety , and developmentally appropriate parenting , as assessed in early infancy . There were positive effects on health plan disenrollment . No additional benefit could be ascribed to prenatal institution of services . A combination of universal and risk-based support for new parents is recommended , rather than the provision of risk-based services alone OBJECTIVE --To see whether non-professional volunteer community mothers  could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year . DESIGN --R and omised controlled trial . SETTING --A regional health authority in Dublin . SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin ; 30 experienced mothers from the same community recruited as community mothers . INTERVENTIONS --All the first time mothers received st and ard support from the public health nurse . In addition , those in the intervention group received the services of a community mother , who was scheduled to visit monthly during the first year of the child 's life . RESULTS --232 ( 89 % ) first time mothers completed the study --127 in the intervention group , 105 controls . At the end of the study children in the intervention group were more likely to have received all of their primary immunisations , to be read to , and to be read to daily , played more cognitive games ; and were exposed to more nursery rhymes . They were less likely to begin cows ' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein , non-animal protein , wholefoods , vegetables , fruit , and milk . Mothers in the intervention group also had a better diet than controls . At the end of the study they were less likely to be tired , feel miserable , and want to stay indoors ; had more positive feelings ; and were less likely to display negative feelings . CONCLUSION --Non-professionals can deliver a health promotion programme on child development effectively . Whether they can do so as effectively as professionals requires further study OBJECTIVES Two factors were considered as predictors of children 's risk for unintentional injury : ( a ) children 's temperamentally difficult behavior patterns and ( b )  parenting .  Along with hypotheses to replicate previous univariate effects , it was hypothesized that active , involved parents with sufficient time re sources might reduce injury risk among temperamentally at-risk children . METHODS Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds . Study 2 replicated Study 1 using a prospect i ve design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age . RESULTS In Study 1 , male gender , child hyperactivity , and family poverty predicted injury in a univariate manner . In Study 2 , male gender and lack of positive parenting predicted injury in a univariate manner . Interaction effects also emerged : in Study 1 the interaction between child hyperactivity and parental time re sources protected children from injury , and in Study 2 the interaction between child 's difficult temperament and positive parenting protected children from injury . CONCLUSIONS Children at increased risk for injury , i.e. , those with hyperactive and difficult behavior patterns , might be protected in the environment of positive parenting . Theoretically , results suggest that research ers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior . From an applied perspective , results have implication s for the design of injury prevention campaigns : Parents who spend positive time with temperamentally difficult children might protect them from injury 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 . Prospect i ve 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 Abstract Objective : To assess the effectiveness of safety advice at child health surveillance consultations , provision of low cost safety equipment to families receiving means tested state benefits , home safety checks , and first aid training on frequency and severity of unintentional injuries in children at home . Design : Cluster r and omised controlled trial . Setting : 36 general practice s in Nottingham . Subjects : All children aged 3 - 12 months registered with participating practice s. Interventions : A package of safety advice at child health surveillance consultations at 6 - 9 , 12 - 15 , and 18 - 24 months;provision of low cost safety equipment to families on means tested state benefits ; and home safety checks and first aid training by health visitors . Outcome measures : Primary outcomes measures were frequency and severity of medically attended injuries . Secondary outcome measures were self reported safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk of injury and risk of hazards assessed by postal question naire at baseline and follow up at 25 months . Results : At baseline , both groups had similar risk factors for injury , sociodemographic characteristics , safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk . No significant difference was found in frequency of at least one medically attended injury ( odds ratio 0.97 , 95 % confidence interval 0.72 to1.30 ) , at least one attendance at an accident and emergency department for injury ( , 0.76 to 1.37 ) , at least one primary care attendance for injury ( 0.75 , 0.48 to 1.17 ) , or at least one hospital admission for injury ( 0.69 , 0.42 to 1.12 ) . No significant difference in the secondary outcome measures was found between the intervention and control groups . Conclusions : The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home , and larger trials are required to assess the effect on more severe injuries The behavior of 10,394 British children was related prospect ively to their injury history between ages 5 and 10 years , obtained from parents . Aggressive and overactive  behaviors  at age 5 years were measured by subscales of the Rutter Child Behavior Question naire completed by the parents . Multivariate techniques were used to assess the association between behavior and injuries while controlling for social , demographic , and psychological characteristics . Boys ' behavior at age 5 years was more strongly predictive of injuries in the subsequent five years than was girls ' behavior . The odds of experiencing injuries result ing in hospitalization in boys with high aggression scores was 2.4 times that of boys with low aggression scores . The identification of high-risk children provides the foundation for underst and ing the behavioral mechanisms that contribute to injuries and for developing preventive strategies tailored to the needs of these children Physicians are often faced with conflicting recommendations from therapeutic studies . An evaluation form is proposed to facilitate the evaluation of the quality of therapeutic studies  and the result ing treatment or management recommendations in any area of medicine . Twelve major topics for evaluation include sample size determination , r and omization , selection of control group(s ) 
    Output:
    
Parenting interventions , most commonly provided within the home , using multi-faceted interventions appear to be effective in reducing unintentional child injury .