***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 assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers ' behaviors and practice s related to home safety . METHODS We conducted a r and omized , clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home . After completing a structured home safety question naire via face-to-face interview , caregivers were r and omly assigned to receive either comprehensive home safety education and free safety devices or focused , injury-specific ED discharge instructions . Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety question naire . The pretest and posttest question naires were scored such that the accrual of points correlated with reporting of safer practice s. Scores were then normalized to a 100-point scale . The overall safety score reflected performance on the entire question naire , and the 8 category safety scores reflected performance in single areas of home injury prevention ( fire , burn , poison , near-drowning , aspiration , cuts/piercings , falls , and safety device use ) . The main outcome was degree of improvement in safety practice s as assessed by improvement in safety scores . RESULTS The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group ( 73.3 % + /- 8.4 % vs 66.8 % + /-11.1 ) and significant improvements in poison , cut/piercing , and burns category scores .  Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices . CONCLUSIONS This educational and device disbursement intervention was effective in improving the home safety practice s of caregivers of young children . Moreover , the ED was used effectively to disseminate home injury prevention information In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : to evaluate the effectiveness of a school-based injury prevention program . Design : Cluster r and omised controlled trial . Setting : 20 primary schools in Nottingham , UK . Participants : 459 children aged 7 to 10 years . Intervention : The “ Risk Watch ” program delivered by teachers , aim ed at improving bike and pedestrian , falls , poisoning and fire and burns safety . Main outcome measures : Safety knowledge , observed safety skills and self-reported safety behaviour . Results : At follow-up , intervention group children correctly answered more fire and burn prevention knowledge questions than control group children ( difference between means 7.0 % ( 95 % CI 1.5 % to12.6 % ) ) . Children in intervention group schools were more likely to know the correct actions to take if clothes catch fire and the correct way to wear a cycle helmet ( difference between school means 35.3 % ( 95 % CI 22.7 % to 47.9 % ) and 6.3 % ( 95 % CI 1.4 % to 11.1 % ) respectively ) . They were also more likely to know the correct actions to take in a house fire and on finding tablets ( OR 2.80 ( 95 % CI 1.08 to 7.22 ) and OR 3.50 ( 95 % CI 1.18 to 10.38 ) respectively ) and correctly demonstrated more safety skills than control group children ( difference between means 11.9 % ( 95 % CI 1.4 % to 22.5 % ) ) . There was little evidence to suggest the first year of the program impacted on self-reported safety behaviours . Conclusions : The Risk Watch program delivered by teachers in primary schools increased some aspects of children ’s safety knowledge and skills and primary schools should consider delivering this program . Longer term , larger scale evaluations are required to examine retention of knowledge and skills and impact on safety behaviours and child injury rates In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if a body of evidence is associated with a high risk of publication bias . Even when individual studies included in best- evidence summaries have a low risk of bias , publication bias can result in substantial overestimates of effect . Authors should suspect publication bias when available evidence comes from a number of small studies , most of which have been commercially funded . A number of approaches based on examination of the pattern of data are available to help assess publication bias . The most popular of these is the funnel plot ; all , however , have substantial limitations . Publication bias is likely frequent , and caution in the face of early results , particularly with small sample size and number of events , is warranted Background Toddler-aged children are vulnerable to unintentional injuries , especially those in low-income families . Objective To examine the effectiveness of an intervention grounded in social cognitive theory ( SCT ) on the reduction of home safety problems among low-income families with toddlers . Methods 277 low-income mother – toddler dyads were r and omised into a safety promotion intervention ( n=91 ) or an attention-control group ( n=186 ) . Mothers in the safety promotion intervention group received an eight-session , group-delivered safety intervention targeting fire prevention , fall prevention , poison control and car seat use , through health education , goal - setting and social support . Data collectors observed participants ' homes and completed a  nine-item checklist of home safety problems  at study enrolment ( baseline ) , 6 and 12 months after baseline . A total score was summed , with high scores indicating more problems . Linear mixed models compared the changes over time in home safety problems between intervention and control groups . Results The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up ( between-group difference in change over time β=−0.54 , 95 % CI −0.05 to −1.03 , p=0.035 ) , with no significant differences at the 6-month follow-up . Conclusions A safety promotion intervention built on principles of SCT has the potential to promote toddlers ' home safety environment . Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinical ly important improvement in home safety practice s. Trial registration number NCT02615158 ; post- results This study offers evidence that computer-based instruction is a feasible and effective alternative training method for long-term care staff . Participants were 289 nursing facility staff r and omly divided into two treatment groups . One group completed instructor-led ( IL ) fire safety training and the other completed computer-based ( CB ) training adapted from the IL version . Both the CB and IL groups significantly increased their scores from pre- to posttest . Differences between the two groups were not significant The objective of this study was to determine the impact of a community based fire prevention intervention directed only to parents on the fire safety knowledge and behavior in elementary school children . This was a prospect i ve , quasi-r and omized controlled study in which third and fourth grade students from two elementary schools in an urban , poor , minority community completed knowledge/behavior surveys at baseline and following completion of the intervention . The intervention group received an in-home visit from fire department personnel who installed free lithium smoke detectors and provided a fire escape plan . After accounting for a small difference in baseline summary scores of knowledge and behavior between the control and intervention groups , this study found a modest improvement in fire safety behavior among children whose families received a fire prevention intervention reflecting a change in household fire safety practice s. However , there was no significant change in fire safety knowledge Background Fires and burns are a leading cause of unintentional injury death in the USA . Although it has been anecdotally reported that vacant dwellings are at a higher risk for fire , the association between vacancy and fire risk at the individual household level has not been empirically measured . Methods In this cross-sectional study ,  geocoded residential vacant properties ( VP ) and fire events are analysed in Baltimore City at the census tract level and the individual household level . Results On average , a 10 % increase in the proportion of vacancies in a census tract was associated with a 9.9 % increase in fires ( 95 % CI : 5 % to 15 % ) . R and om-effects Poisson models , controlling for housing and neighbourhood conditions , found contagion effects . The risk of fire in an occupied dwelling increased by 8 % ( 95 % CI : 1 % to 10 % ) for every vacant structure within 10 m , and the risk of fire decreased by half ( 95 % CI : 45 % to 62 % ) for every km between an occupied dwelling and vacant building . Close proximity to VP was associated with trash fires within dwellings ( p=0.039 ) and structure fires ( p=0.012 ) . Conclusions We believe that this is the first study to demonstrate increased risk posed by nearby VP at the household level , confirming earlier ecological analyses of the role of VP as strong correlates of home fires . Measurement of this risk can motivate property owners , policy makers and insurers to invest in risk reduction measures that include building maintenance and trash removal OBJECTIVE Fire is a leading cause of unintentional injury and , although young children are at particularly increased risk , there are very few evidence -based re sources available to teach them fire safety knowledge and behaviors . Using a pre-post r and omized design , the current study evaluated the effectiveness of a computer game ( The Great Escape ) for teaching fire safety information to young children ( 3.5 - 6 years ) . METHOD Using behavioral enactment procedures , children 's  knowledge and behaviors related to fire safety were compared to a control group of children before and after receiving the intervention . RESULTS The results indicated significant improvements in knowledge and fire safety behaviors in the intervention group but not the control . CONCLUSION Using computer games can be an effective way to promote young children 's  underst and ing of safety and how to react in different hazardous situations Background Although proven measures for reducing injury due to motor vehicle collision and residential fires exist , the number of families properly and consistently using child passenger restraints and smoke alarms remains low . This paper describes the design of the Safety In Seconds ( SIS ) 2.0 study , which aims to evaluate the impact of a smartphone app on parents ' use of child restraints and smoke alarms . Methods SIS is a multisite r and omised controlled trial . Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service . Parents are r and omised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app . A baseline and two follow-up surveys at 3 months and 6 months are conducted . Primary outcomes are : ( 1 ) having the correct child restraint for the child 's age and size ; ( 2 ) restraining the child in the back seat of the car ; ( 3 ) buckling the child up for every ride ; ( 4 ) having the restraint inspected by a child passenger safety technician ; ( 5 ) having a working smoke alarm on every level of the home ; ( 6 ) having hard-wired or lithium battery smoke alarms ; ( 7 ) having and ( 8) practising a fire escape plan . Discussion Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority . This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use . Trial registration number NCT02345941 ; Pre- results 
    Output:
    
The limited evidence supports the use of HFS interventions to improve HFS knowledge and behaviour in children , families with children and adults