***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 access an underserved , mobile segment of a monolingual Spanish speaking population and to improve maternal self efficacy for home safety behaviors using a culturally appropriate intervention . Design : A pre- and post-test experimental design tested differences in maternal childhood injury health beliefs ( MCIHB ) and controllable safety hazards ( CHS ) . Participants were r and omly assigned to experimental and control groups . Baseline data assessed demographic and study variables comparability . The intervention included counseling , assessment of maternal safety practice s , and provision of safety items . Setting : A non-urban area in Texas where low income , largely migrant Hispanics represent the majority of residents . Participants : Eighty two mothers of 1–4 year old children . Results : The 95 % retention rate of an itinerant , hard to reach population suggests that minority participants may be receptive to culturally appropriate home visits . The intervention group demonstrated improved self efficacy for home safety behaviors ( F ( 2 , 77 ) = 7.50 , p = 0.01 ) . Mothers with stronger self efficacy and fewer perceived barriers had fewer accessible in-home hazards . Observed home hazard predictors were : ( a ) never being married ; ( b ) poor home repair , ( c ) lower self efficacy for safety behaviors ; and ( d ) control group status . Conclusions : Safety items coupled with a home visit tailored to child age and maternal culture was an effective intervention in a hard to reach population . This study contributes to design ing research for a monolingual population with limited local language proficiency and community residency . Injuries represent a major source of health disparities in these neglected population OBJECTIVE To improve health outcomes of children  , the US Maternal and Child Health Bureau has recommended more effective organization of preventive services within primary care practice s and more coordination between practice s and community-based agencies . However , applying these recommendations in communities is challenging because they require both more complex systems of care delivery within organizations and more complex interactions between them . To improve the way that preventive health care services are organized and delivered in 1 community , we design ed , implemented , and assessed the impact of a health care system-level approach , which involved addressing multiple care delivery processes , at multiple levels in the community , the practice , and the family . Our objective was to improve the processes of preventive services delivery to all children in a defined geographic community , with particular attention to health outcomes for low-income mothers and infants . DESIGN Observational intervention study in 1 North Carolina county ( population 182 000 ) involving low- income pregnant mothers and their infants , primary care practice s , and departments of health and mental health . An interrupted time-series design was used to assess rates of preventive services in office practice s before and after the intervention , and a historical cohort design was used to compare maternal and child health outcomes for women enrolled in an intensive home visiting program with women who sought prenatal care during the 9 months before the program 's initiation . Outcomes were assessed when the infants reached 12 months of age . INTERVENTIONS Our primary objective was to achieve changes in the process of care delivery at the level of the clinical interaction between care providers and patients that would lead to improved health and developmental outcomes for families . We selected interventions that were directed toward major risk factors ( eg , poverty , ineffective care systems for preventive care in office practice s ) and for which there was existing evidence of efficacy . The interventions involved community- , practice - , and family-level strategies to improve processes of care delivery  to families and children . The objectives of the community-level intervention were : 1 ) to achieve policy level changes that would result in changes in re sources available at the level of clinical care , 2 ) to engage multiple practice organizations in the intervention to achieve an effect on most , if not all , families in the community , and 3 ) to enhance communication between , among , and within public and private practice organizations to improve coordination and avoid duplication of services . The objective of the practice -level interventions was to overcome specific barriers in the process of care delivery so that preventive services could be effectively delivered . To assist the health department in implementing the family-level intervention , we provided assistance in hiring and training staff and ongoing consultation on staff supervision , including the use of structured protocol s for care delivery , and regular feedback data about implementation of the program . Interventions with primary care practice s focused on the design of the delivery system within the office and the use of teamwork and data in an " office systems " approach to improving clinical preventive care . All practice s ( N = 8) that enrolled at least 5 infants/month received help in assessing performance and developing systems ( eg , preventive services flow sheets ) for preventive services delivery . Family-level interventions addressed the process of care delivery to high-risk pregnant women ( < 100 % poverty ) and their infants . Mothers were recruited for the home visiting intervention when they first sought prenatal care at the community health center , the county 's largest provider of prenatal care to underserved women . The home visiting intervention involved teams of nurses and educators and involved 2 to 4 visits per month through the infant 's first year of life to provide parental education on fetal and infant health and development , enhance parents ' informal support systems , and link parents with needed health and human services . We included training in injury prevention and discipline , and home visitors assisted mothers in obtaining care from one of the primary care offices . RESULTS There were high levels of participation , changes in the organization of the delivery system , and improvements in preventive health outcomes . Agencies cooperated in joint contracting , staff training , and defining program eligibility . All 8 eligible practice s agreed to participate and 7/8 implemented at least 1 new office system element . Of eligible women , 89 % agreed to participate , and outcome data were available on 80 % ( 180/225 ) . After adjusting for differences in baseline characteristics , intervention group women were significantly more likely than comparison group women to use contraceptives ( 69 % vs 47 % ) , not smoke tobacco ( 27 % vs 54 % ) and have a safe and stimulating home environment for their children . Intervention group children were more likely to have had an appropriate number of well-child care visits ( 57 % vs 37 % ) and less likely to be injured ( 2 % vs 7 % ) . Intervention mothers also received Aid to Families with Dependent Children for fewer months after the birth of their child ( 7.7 months vs 11.3 months ) . CONCLUSIONS We observed a number of positive effects at all 3 levels of intervention . Policy-level changes at the state and community led to lasting changes in the organization and financing of care , which enabled changes in clinical services to take place . These changes have now been exp and ed beyond this community to other communities in the state . We were also able to engage multiple practice organizations , reduce duplication , and improve the coordination of care . Changes in the process of preventive services delivery were noted in participating practice s. Finally , the outcomes of the family-level intervention  were comparable in direction and magnitude to the outcomes of previous r and omized trials of the intervention . All the changes were achieved over a relatively brief 3-year study period , and many have been sustained since the project was completed . Tiered , interrelated interventions directed at an entire population of mothers and children hold promise to improve the effectiveness and outcomes of health care for families and children Aims To assess the cost-effectiveness of installing thermostatic mixer valves ( TMVs ) in reducing risks of  bath water scalds  and estimate the costs of avoiding bath water scalds . Methods The evaluation was undertaken from the perspective of the UK public sector , and conducted in conjunction with a r and omised control trial of TMVs installed in social housing in Glasgow . Installation costs were borne by the social housing organisation , while support material s were provided by the UK NHS . Effectiveness was represented by the number of families with at-risk bath water temperatures pre- and post-installation , and the number of bath scalds avoided as a result of installation . Differences in the number of families with at-risk temperatures between groups were derived from the RCT . Cost-effectiveness was assessed and a series of one-way sensitivity analyses were conducted . Results Unit costs associated with installation were calculated to be £ 13.68 , while costs associated with treating bath water scalds ranged from £ 25 226 to £ 71 902 . The cost of an avoided bath water scald ranged from net savings to public purse of £ 1887 to £ 75 520 and at baseline produced a net saving of £ 3 229 008 ; that is , £ 1.41 saved for every £ 1 spent . Conclusion It is very likely that installing TMVs as st and ard in social housing in new buildings and major refurbishments accompanied by educational information represents value for money . Trial registration number IS RCT N:21179067 BACKGROUND . Innovations to improve the delivery of pediatric preventive care are needed . METHODS . We enrolled children , 0 to 11 years of age , into a factorial , r and omized , controlled trial of a  tailored , evidence -based , Web site ( MyHealthyChild )  that provided information on prevention topics before a scheduled well-child visit . There were 2 components of the intervention , namely , parental Web content and provider notification . Parental Web content provided information to parents about prevention topics ; provider notification communicated to physicians topics that were of interest to parents . We assigned 887 children r and omly to 4 groups ( usual care , content only , content and notification , or notification only ) . Outcomes were determined with telephone follow-up surveys conducted 2 to 4 weeks after the visit . Poisson regression analysis was used to determine the independent effects of each intervention on the number of topics discussed and the number of preventive practice s implemented . RESULTS . Parents in the notification/content group and in the notification-only group reported discussing more MyHealthyChild topics with their provider . Parents in the notification/content group and in the content-only group reported implementing more MyHealthyChild topic suggestions ( such as use of a safety device ) . CONCLUSIONS . A Web-based intervention can activate parents to discuss prevention topics with their child 's provider . Delivery of tailored content can promote preventive practice OBJECTIVE To determine whether educational baby books are an effective method for increasing  low-income , first-time mothers ' safety practice s during their child 's first 18 months . METHODS Primiparous women ( n = 167 ) were r and omly assigned to 1 of 3 groups : an educational book group , a noneducational book group , or a no-book group . Home visits and interviews measured safety practice s when women were in their third trimester of pregnancy ( baseline ) and when their children were 2 , 4 , 6 , 9 , 12 , and 18 months of age . RESULTS Women in the educational book group had fewer risks in their homes and exercised more safety practice s than the no-book group ( - 20 % risk reduction ; effect size = -.30 ) . When the safety practice s involved little time or expense ( eg , putting away sharp objects ) , the educational book group was significantly more likely to engage in these behaviors than the no-book group ( 40 % higher practice s ; effect size = 0.19 ) or noneducational book group ( 27 % higher practice s ; effect size = 0.13 ) . However , no differences were found between groups for behaviors that required high effort in time , money , or hassle ( eg , installing latches on cabinets ) . CONCLUSIONS Educational baby books appear to be an easy and low-cost way to increase the safety practice s of new mothers , especially if the practice s involve little to no time , money , or hassle OBJECTIVE To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices . DESIGN A nested , prospect i ve , r and omized controlled trial . SETTING Indoor environment of housing units . PARTICIPANTS Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study . Among 8878 prenatal patients , 1263 ( 14.2 % ) were eligible , 413 ( 32.7 % ) agreed to participate , and 355 were r and omly assigned to the intervention ( n = 181 ) or control ( n = 174 ) groups . INTERVENTION Installation of multiple passive measures ( eg , stair gates , cabinet locks , and smoke detectors ) to reduce exposure to injury hazards . Injury hazards were assessed at home visits by teams of trained research assistants using a vali date d survey . MAIN OUTCOME MEASURE Modifiable and medically attended injury ( ie , telephone calls , office visits , and emergency visits for injury ) . RESULTS The mean age of children at intervention was 6.3 months . Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years ( P < .004 ) . There was no difference in the rate for all medically attended injuries in intervention children compared with controls : 14.3 injuries ( 95 % confidence interval [ CI ] , 9.7 - 21.1 injuries ) vs 20.8 injuries ( 95 % CI , 14.4 - 29.9 injuries ) per 100 child-years ( P = .17 ) ; but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls : 2.3 injuries ( 95 % CI , 1.0 - 5.5 injuries ) vs 7.7 injuries ( 95 % CI , 4.2 - 14.2 injuries ) per 100 child-years ( P = .03 ) . CONCLUSION An intervention to reduce exposure to hazards in homes led to a 70 % reduction in the rate of modifiable medically attended injury . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00129324 Objective : To evaluate Safe Kids Week 2001—a national public awareness campaign on scald and burn prevention — run by Safe Kids Canada . Design : R and om digit dial telephone survey . Setting : Canada . Subjects : 
    Output:
    
There is little evidence that interventions are effective in reducing the incidence of scalds in children .
More evidence was found that inventions are effective in promoting safe hot tap water temperature , especially when home safety education , home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided .
No consistent evidence was found for the effectiveness of interventions on the safe h and ling of hot food or drinks nor improving kitchen safety practice s. CONCLUSION Education , home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds .