***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: BACKGROUND The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern . This article reports on the influence of a home visitation programme ( HVP ) on household hazards associated with unintentional childhood injuries in a South African low-income setting . METHODS A r and omised controlled trial ( n=211 households ) was conducted in a South African informal settlement . Community members were recruited and trained as paraprofessional visitors . Four intervention visits were conducted over 3 months , focusing on child development , and the prevention of burn , poison , and fall injuries . The HVP , a multi-component intervention , included educational inputs , provision of safety devices , and an implicit enforcement strategy . The intervention effect ( IE ) was measured with a st and ardised risk assessment index that compared post-intervention scores for intervention and control households . RESULTS A significant reduction was observed in the hazards associated with electrical and paraffin appliances , as well as in hazards related to poisoning . Non-significant changes were observed for burn safety household practice s and fall injury hazards . CONCLUSIONS This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting OBJECTIVE to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall . DESIGN r and omized controlled trial . SETTING a large teaching hospital . SUBJECTS 348 consecutive patients aged 65 or over attending the Accident and Emergency Department with a fall . INTERVENTIONS we r and omized patients to falls nurse intervention or usual care . Within 4 weeks , the intervention group received a home assessment to address easily modifiable risk factors for falls . This included assessment s of medication , ECG , blood pressure , cognition , visual acuity , hearing , vestibular dysfunction , balance , mobility , feet and footwear . All patients were given advice and education about general safety in the home . MAIN OUTCOME MEASURES Further falls , functional ability , re-attendance at the Accident and Emergency Department and admission to hospital . RESULTS at 6 months post-Index fall , 36 patients in the intervention group and 39 patients in the control group had had 89 and 145 falls respectively . Although the intervention group had less falls , this was not significant ( P>0.05 ) . Similarly , the intervention group had fewer fall-related admissions and bed days ( 8 and 69 respectively ) than the control group ( 10 and 233 respectively ) . The intervention group scored significantly higher in indicators of function ( P<0.05 ) and mobility within the community ( P<0.02 ) . CONCLUSIONS although the differences were not significant , patients in the intervention group had fewer falls , less hospital attendances and spent less time in hospital . Moreover , patients in the intervention group were more functionally independent at 6 months post-Index fall STUDY OBJECTIVE In the causative mechanism of falls among older community dwellers , slips and trips have been found to be significant precursors . The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips , trips and falls among the well , older community . DESIGN Four groups with approximately equal numbers of participants were r and omly allocated to interventions . The prevention strategies included education and awareness raising of falls risk factors , exercise sessions to improve strength and balance , home safety advice to modify environmental hazards , and medical assessment to optimise health . The interventions combined the strategies in an add on approach . The first intervention group receiving the information session only was regarded as the control . The outcome of interest was the occurrence of a slip , trip or fall , monitored prospect ively using a daily calendar diary . PARTICIPANTS AND SETTING Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate . National Seniors clubs provide a forum for active , community dwelling Australians aged 50 and over to participate in policy , personal development and recreation . MAIN RESULTS Using Cox 's proportional hazards regression model , adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 ( 95 % CI 0.17 , 0.73 ) to 0.48 ( 0.25 , 0.91 ) for slips ; 0.29 ( 0.16 , 0.51 ) to 0.45 ( 0.27 , 0.74 ) for trips ; and 0.60 ( 0.36 , 1.01 ) to 0.82 ( 0.51 , 1.31 ) for falls . While calendar monitoring recorded outcome , it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical non-intervened group . At one year after intervention , reductions in the probability of slips , trips and falls ( 61(95%CI 54 , 66)% ; 56 ( 49 , 63)% ; 29 ( 22 , 36)% respectively ) were demonstrated . CONCLUSIONS This study makes an important contribution to the priority community health issue of falls prevention by showing that effective , sustainable , low cost programmes can be introduced through community-based organisations to reduce the incidence of slips , trips and falls in well , older people OBJECTIVES To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents . DESIGN Cluster , r and omized , controlled trial . SETTING Fourteen r and omly selected residential care homes in Auckl and , New Zeal and . PARTICIPANTS All older residents ( n=628 , 95 % participation rate ) . INTERVENTION Residential care staff , using existing re sources , implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool , high-risk logo , and strategies to address identified risks . MEASUREMENTS Number of residents sustaining a fall , falls , and injurious-falls incidence rates . RESULTS During 12 months of follow-up , 103 ( 43 % ) residents in the control group and 173 ( 56 % ) residents in the intervention group fell ( P<.018 ) . There was a significantly higher incidence rate of falls in intervention homes than in control homes ( incident rate ratio=1.34 , 95 % confidence interval=1.06 - 1.72 ) during the intervention period after adjusting for dependency level ( type of home ) , baseline fall rate , and clustering . There was no difference in the injurious fall incidence rate or incidence of serious injuries . CONCLUSION This fall-prevention intervention did not reduce falls or injury from falls . Low-intensity intervention may be worse than usual care BACKGROUND Falls in elderly people are a common presenting complaint to accident and emergency departments . Current practice commonly focuses on the injury , with little systematic assessment of the underlying cause , functional consequences , and possibilities for future prevention . We undertook a r and omised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls . METHODS Eligible patients were aged 65 years and older , lived in the community , and presented to an accident and emergency department with a fall . Patients assigned to the intervention group ( n=184 ) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated ; those assigned to the control group ( n=213 ) received usual care only . The analyses were by intention to treat . Follow-up data were collected every 4 months for 1 year . FINDINGS At 12-month follow-up , 77 % of both groups remained in the study . The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group ( p=0.0002 ) . The risk of falling was significantly reduced in the intervention group ( odds ratio 0.39 [ 95 % CI 0.23 - 0.66 ] ) as was the risk of recurrent falls ( 0.33 [ 0.16 - 0.68 ] ) . In addition , the odds of admission to hospital were lower in the intervention group ( 0.61 [ 0.35 - 1.05 ] ) whereas the decline in Barthel score with time was greater in the control group ( p<0.00001 ) . INTERPRETATION The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment 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 The EBN users ’ guide in the previous issue of Evidence -Based Nursing outlined the primary and secondary questions for evaluating studies of healthcare interventions . One of the primary questions for assessing the validity of a study ’s findings is whether the assignment of patients to treatments was r and omised and whether r and omisation was concealed . One of the secondary questions is whether patients , clinicians , outcome assessors , and data analysts were unaware of ( blinded to or masked from ) patient allocation . Beginning with the October 1999 issue of Evidence -Based Nursing , allocation concealment and blinding have been given more attention . The “ design ” section of abstract s of r and omised trials now includes a statement of whether r and omisation was concealed from those responsible for entering patients into trials , and who was blinded to treatment allocation during the trials . These additional specifications provide readers with more information to judge the internal validity of trials . In this editorial , the background and rationale for these decisions are addressed Background Pre-discharge home visits aim to maximise independence in the community . These visits involve assessment of a person in their own home prior to discharge from hospital , typically by an occupational therapist . The therapist may provide equipment , adapt the home environment and /or provide education . The aims of this study were to investigate the feasibility of a r and omised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation . Methods Ten patients participating in an inpatient rehabilitation program were r and omly assigned to receive either a pre-discharge home visit ( intervention ) , or st and ard practice in-hospital assessment and education ( control ) , both conducted by an occupational therapist . The pre-discharge home visit involved assessment of the older person 's function and environment , and education , and took an average of 1.5 hours . The hospital-based interview took an average of 40 minutes . Outcome data were collected by a blinded assessor at 0 , 2 , 4 , 8 and 12 weeks . Outcomes included performance of activities of daily living , reintegration to community living , quality of life , readmission and fall rates . Results Recruitment of 10 participants was slow and took three months . Observed performance of functional abilities did not differ between groups due to the small sample size . Difference in activities of daily living participation , as recorded by the Nottingham Extended Activities of Daily Living scale , was statistically significant but wide confidence intervals and low statistical power limit interpretation of results . Conclusion Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible , but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting BACKGROUND In 2001 , 486 deaths and 17,300 injuries occurred in domestic fires in the UK . Domestic fires represent a significant cost to the UK economy , with the value of property loss alone estimated at pounds 375 million in 1999 . In 2001 in the US , there were 383 500 home fires , result ing in 3110 deaths , 15,200 injuries and dollar 5.5 billion in direct property damage . METHODS A cluster RCT was conducted to determine whether a smoke alarm give-away program , directed to an inner-city UK population , is effective and cost-effective in reducing the risk of fire-related deaths/injuries . Forty areas were r and omized to the give-away or control group . The number of injuries/deaths and the number of fires in each ward were collected prospect ively . Cost-effectiveness analysis was undertaken to relate the number of deaths/injuries to re source use ( damage , fire service , healthcare and give-away costs ) . Analytical methods were used which reflected the characteristics of the trial data including the cluster design of the trial and a large number of zero costs and effects . RESULTS The mean cost for a household in a give-away ward , including the cost of the 
    Output:
    
There is insufficient evidence to determine whether interventions focused on modifying environmental home hazards reduce injuries .