***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: In a quasi-experimental study , hospital-treated traffic accident injuries were recorded prospect ively for 7 1/2 years in the two Norwegian cities , Harstad and Trondheim . In Harstad the recorded data were used actively in analysis , planning , and implementation of a community-based injury prevention program . Trondheim was the nonequivalent control city . The intervention was divided into three periods , each of 30 months duration . Preventive efforts were implemented to some extent in period 1 , increasingly in period 2 and period 3 . Traffic safety was promoted in an extensive community program based on the Ottawa charter for health promotion . A 26.6 % overall reduction of traffic injury rates was found in Harstad from period 1 to period 3 ( p < 0.01 ) , whereas a corresponding significant increase was found in the comparison city . Analysis of data from other sources were not conclusive in supporting the Trondheim data as showing the national trend . Alternative explanations for the injury rate reduction in Harstad were assessed by means of other available relevant data . The exact mechanisms that brought about the reduction of injury rates were hard to eluci date because so many intervention elements were implemented at the same time . It is concluded that at least some of the reduction was due to behavioural and structural changes brought about by health promotion . Important factors for the effect of and participation in the prevention program were local relevance and continuous feedback of accident injury data Parents of 171 children coming to the Yale-New Haven Hospital Primary Care Center for their 6-month checkup were r and omized into an intervention group ( n = 85 ) and a  control  group ( n = 86 ) . Parents in the intervention group received a three-part individualized course in child safety that required active parental participation . Parts 1 , 2 , and 3 were given at the 6-month , 9-month , and 12-month well-child visits , respectively . Parents in the control group received routine safety education as provided at well-child visits . The educational phase of the study was completed by 129 families , 65 in the intervention group and 64 in the control group .  Safety knowledge , number of hazards in the home , and reported accidents were assessed by a " blinded " community health worker approximately 1 month after the 12-month well-child visit . A total of 109 home visits were made , 55 for the intervention group and 54 for the control group . Parental safety knowledge was assessed based upon pictorial hazard recognition . Of 13 possible hazards , the mean number of hazards recognized by the intervention group parents was 9.4 ( n = 55 ) v 8.4 ( n = 50 ) by the control group parents ( t = 2.1 , P less than .05 , two-tailed ) . A hazard score was determined for each family based on nine possible hazards observed at the home visit . The mean hazard score for the intervention group was 2.4 ( n = 55 v 3.0 ( n = 54 ) for the control group ( t = 2.4 , P less than .02 , two-tailed ) . Parentally reported accidents and accidents reported in hospital records were similar for both groups . Results of this study suggest that age-appropriate safety education that is repetitive and individualized and that requires active parental participation results in an increase in parental knowledge and an improvement in certain safety practice OBJECTIVE To determine the effectiveness of a safety education program , Safety City , that is design ed to teach kindergarten and first grade children how to cross the street , call 911 in an emergency , and avoid strangers . PARTICIPANTS / SETTING Kindergarten students at 10 urban elementary schools . DESIGN Each school was r and omized to either the intervention or control group . An evaluation tool was administered to all participants as a pretest . The Safety City program was then presented to the intervention schools . Afterward , the same evaluation tool was used as a post-test . The posttest was administered to the intervention group 6 months after the Safety City program was presented . The control group took the posttest 6 months after the pretest . MAIN OUTCOME MEASURE Change in individual test scores . RESULTS One hundred eighty-one children completed the pretest and posttest evaluations . There was no statistical difference in the change between pretest and posttest scores of children who participated in the Safety City program and those in the control group ( crossing the street , P = .29 ; calling 911 , P = .41 ; stranger avoidance , P = .57 ) . CONCLUSIONS Exposure to the Safety City program did not achieve the desired changes in safety knowledge among participants . This is most likely owing to the fact that Safety City attempts to convey a large amount of relatively complex information to young children in a brief period . We conclude that programs such as Safety City are not sufficient to teach children these behaviors . This report also emphasizes the importance of building an evaluation component into educational programs Summary . Trends in road casualty figures among children in recent years are evaluated and interpretations suggested . The experiment reported here shows that the educator 's conception of the function of the kerb drill , i.e. , to detect traffic , is not reflected in its function as perceived by many young children , who in the experimental setting behave as though they regarded the performance of the kerb drill as in itself sufficient to ward off the dangers of the road . The experiment also demonstrates that the notions of directionality which the kerb drill presupposes are not those of 5–6-year-old children , who often regard ‘ left ’ and ‘ right ’ as parts of the environment rather than relations to the person . The ‘ static ’ conception of directionality becomes more frequent after exposure to a propag and a film in which the kerb drill exemplars perform facing their audience OBJECTIVE To test the feasibility of a hospital-based injury recording for accident analysis and outcome evaluation of bicyclist and pedestrian injury prevention . DESIGN Prospect i ve injury recording lasting 7 1/2 years , using a quasi-experimental design . SETTING The population of Harstad ( 22,000 ) . INTERVENTION Injury data were evaluated in an injury prevention group and used in planning a community-based intervention . Promotion of bicyclist helmet use and pedestrian safe behaviour was implemented by activating public and voluntary organizations and media . A traffic safety pamphlet containing local traffic injury data was distributed . Changes were made in the physical traffic environment . MAIN OUTCOME MEASURES Injury rates for bicyclists and pedestrians . RESULTS In 275 bicyclists  upper extremity and head injuries were predominant 70 % were below 16 years . In 137 pedestrians  lower extremity injury was most frequent and children below 10 years had the highest injury rates . Significant injury rate reductions were observed after intervention for child bicyclists and pedestrians . CONCLUSION A hospital-based injury recording is feasible for bicyclists and pedestrian accident analysis , planning injury prevention , and outcome evaluation of the programme . This study indicates that a significant injury rate reduction in children may have been the result of the intervention HYPOTHESIS Young children can learn safety behavior in the public school system . These children will modify family seat belt use . SETTING DESIGN : This is a prospect i ve cohort analytic study conducted in a 50,000 square mile regionalized trauma center referral area . METHODS A school-based injury prevention program targeting kindergarten through second- grade ( K-2 ) students addressed four aspects of traffic safety : seat belt use , pedestrian and bicycle safety , school bus safety , and unsafe rides . After inservice instruction , teachers taught the program over a 10-week period . A simultaneous community traffic safety program was conducted through the media .  Family seat belt use  was monitored by blinded observation at six study schools and one control school . Income level of schools was characterized as low or high , based on student use of federal lunch subsidies . School program implementation was defined as good or poor , based on adherence to teaching protocol . RESULTS A total of 68,650 K-2 students have completed this traffic safety program during 1990 to 1994 . During the study year ( 1992 to 1993 ) , 25,900 students completed the program taught by 1,400 teachers in 95 schools . A total of 5,936 observations of seat belt use were made in seven schools . Income stratification delineated a subset of these schools in which seat belt use increased by 86 % ( p = 0.01 ) . Half of the schools failed to follow protocol , and no change in seat belt use was observed . CONCLUSIONS ( 1 ) School K-2 safety education improves family seat belt use , ( 2 ) low income schools should be targeted , and ( 3 ) strict adherence to the teaching protocol is essential Using a simulation game design ed to teach children to obey certain traffic safety rules , an experimental study was conducted with 136 five-year-old children in four Quebec schools . Within each classroom , subjects were r and omly divided into four groups : three intervention groups and one control group . Each of the experimental groups was subjected to a different intervention with outcome measured using three instruments related to attitudes , behavior , and transfer of learning of pedestrian traffic safety . Results suggest that simulation games including role-playing/group dynamics and modeling/training can change attitudes and modify behavior in the area of pedestrian traffic safety in children of this age BACKGROUND Programmes design ed to teach children about road safety have often failed to assess their effectiveness in terms of either an increase in  children 's knowledge or an improvement in children 's behaviour . AIM The two studies reported here sought to address both issues , by focusing on the abilities of Primary 1 children ( 5 years old ) . SAMPLE A total of 120 Primary 1 children within the age range 4 - 5 years old participated in this study , drawn from three different primary schools within an educational district of Scotl and . METHODS In the first study the effects of three different road safety interventions were tested , all of which employed commercially marketed products : 1 ) a three-dimensional model of the traffic environment ; 2 ) a road safety board game ; and 3 ) illustrated posters and flip-chart material s. In the second study the transfer of knowledge to children 's behaviour in a real-life traffic environment was tested , using a sub sample of 47 children who had taken part in the first study . RESULTS Results from the first study showed , surprisingly , that all three interventions were effective in increasing children 's knowledge about safe and dangerous locations at which to cross the street , and that this knowledge was retained for a period of six months . Study 2 , however , showed that increased knowledge did not result in improved traffic behaviour . Children who had received training performed no better than children in a control group . CONCLUSION These findings highlight the need to distinguish between children 's road safety knowledge and their behaviour , particularly for teachers and parents , who may mistakenly believe that children who know more will be safer on the road Abstract Pedestrian-skills training procedures were compared using 30 mentally retarded institutionalized adults . Ten subjects were r and omly assigned to a no-treatment control group and ten subjects were assigned to each of two modes of pedestrian-skills training . The training methods included a form of individualized classroom training consisting of the practice of correct behavior using movable figures on a scale model of an intersection , vs independence training which emphasized self-evaluation of performance , social reinforcement , sign recognition and the utilization of a mock-up of an intersection on the hospital grounds . Data were taken on sign recognition , verbal and performance based responses to classroom training of pedestrian skills , performance of skills at an intersection on the hospital grounds , and performance of pedestrian skills in the community . Independence training proved to be significantly more effective than no treatment or classroom training . In addition , classroom training proved to be significantly more effective than no treatment at all A r and omized pretest and posttest comparative design was used to evaluate the outcome of implementing Think First for Kids ( TFFK )  , an injury prevention program for children grade s 1 , 2 , and 3 , among intervention and controls schools . The study showed that children often lack basic knowledge regarding safety and do not recognize behaviors considered high risk for injury . By using multivariate analysis , the intervention children had a significantly greater increase in knowledge about the brain and spinal cord and safe behaviors to prevent traumatic injury , and a decrease in self-reported , high-risk behaviors ( p < .001 ) when compared with control subjects , adjusting for the covariates gender , socioeconomic status , and race/ethnicity . African American and Hispanic children , although displaying the lowest test scores at baseline , had the largest absolute improvement in posttest scores . The TFKK prevention program addresses the leading causes of trauma among children including sports , motor vehicle crashes , falls , drowning , and pedestrian injuries Methods of confidence interval construction are provided for summary measures of treatment effect arising from design s r and omizing clusters to one of two treatment groups . Three basic design s are considered for the case of continuous and dichotomous variables : completely r and omized , pair-matched and stratified 
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Some of these trials showed evidence of behavioural change following pedestrian safety education but it is difficult to predict what effect this might have on pedestrian injury risk .
REVIEW ER 'S CONCLUSIONS Pedestrian safety education can result in improvement in children 's knowledge and can change observed road crossing behaviour but whether this reduces the risk of pedestrian motor vehicle collision and injury occurrence is unknown .