***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: Sixty percent to 70 % of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections . The purpose of this injury prevention research study was to evaluate a desktop virtual reality ( VR ) program that was design ed to educate and train children to safely cross intersections . Specifically , the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior . Following focus groups with a number of key experts , a virtual city with eight interactive intersections was developed . Ninety-five children participated in a community trial from two schools ( urban and suburban ) . Approximately half were assigned to a control group who received an unrelated VR program , and half received the pedestrian safety VR intervention .  Children were identified by group and grade by colored tags on their backpacks , and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions . There was a significant change in performance after three trials with the VR intervention . Children learned safe street crossing within the virtual environment . Learning , identified as improved street-crossing behavior , transferred to real world behavior in the suburban school children but not in the urban school . The results are discussed in relation to possibilities for future VR interventions for injury prevention 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 Background : Neurologically impaired persons seem to benefit from driving-training programs , but there is no convincing evidence to support this notion . The authors therefore investigated the effect of simulator-based training on driving after stroke . Methods : Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were r and omly allocated to either an experimental ( simulator-based training ) or control ( driving-related cognitive tasks ) group . Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training . Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered . Results : Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training . There were no significant differences between both groups in improvements from pre- to post-training except in the “ road sign recognition test ” in which the experimental subjects improved more . Significant improvements in the three-class decision ( “ fit to drive , ” “ temporarily unfit to drive , ” and “ unfit to drive ” ) were found in favor of the experimental group post-training . Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training . Significantly more experimental subjects ( 73 % ) than control subjects ( 42 % ) passed the follow-up official predriving assessment and were legally allowed to resume driving . Conclusions : Simulator-based driving training improved driving ability , especially for well educated and less disabled stroke patients . However , the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training Background Injuries at home are a major cause of death , disability , and loss of quality of life  among young children . Despite current safety education , required safety behavior of parents is often lacking . To prevent various childhood disorders , the application of Web-based tools has increased the effectiveness of health promotion efforts . Therefore , an intervention with Web-based , tailored , safety advice combined with personal counseling ( E-Health4Uth home safety ) was developed and applied . Objective To evaluate the effect of E-Health4Uth home safety on parents ’  safety behaviors with regard to the prevention of falls , poisoning , drowning , and burns . Methods A r and omized controlled trial was conducted ( 2009 - 2011 ) among parents visiting well-baby clinics in the Netherl and s. Parents were r and omly assigned to the intervention group ( E-Health4Uth home safety intervention ) or to the control condition consisting of usual care .  Parents in the intervention condition completed a Web-based safety behavior assessment question naire ; the result ing tailored safety advice was discussed with their child health care professional at a well-baby visit ( age approximately 11 months ) . Parents in the control condition received counseling using generic safety information leaflets at this well-baby visit .  Parents ’ child safety behaviors were derived from self-report question naires at baseline ( age 7 months ) and at follow-up ( age 17 months ) . Each specific safety behavior was classified as safe/unsafe and a total risk score was calculated . Logistic and linear regression analyses were used to reveal differences in safety behavior between the intervention and the control condition at follow-up . Results A total of 1292 parents ( response rate 44.79 % ) were analyzed . At follow-up , parents in the intervention condition ( n=643 ) showed significantly less unsafe behavior compared to parents in the control condition ( n=649 ) : top of staircase ( 23.91 % vs 32.19 % ; OR 0.65 , 95 % CI 0.50 - 0.85 ) ; bottom of staircase ( 63.53 % vs 71.94 % ; OR 0.69 , 95 % CI 0.53 - 0.88 ) ; top and bottom of staircase ( 68.94 % vs 78.28 % ; OR 0.62 , 95 % CI 0.48 - 0.81 ) ; storage of cleaning products ( 30.33 % vs 39.91 % ; OR 0.67 , 95 % CI 0.53 - 0.85 ) ; bathing of the child ( 23.46 % vs 32.25 % ; OR 0.65 , 95 % CI 0.51 - 0.84 ) ; drinking hot fluids ( 34.84 % vs 41.73 % ; OR 0.76 , 95 % CI 0.61 - 0.96 ) ; using rear hotplates ( 79.34 % vs 85.27 % ; OR 0.67 , 95 % CI 0.50 - 0.90 ) ; and the total risk score in which a higher score indicates more unsafe behavior ( mean 13.63 , SD 6.12 vs mean 15.34 , SD 6.07 ; beta –1.59 , 95 % CI –2.26 to –0.93 ) . There were no significant differences for other specific behaviors between the two study conditions . Conclusions Compared to generic written material s , the E-Health4Uth home safety intervention seems more effective in promoting parents ’ safety behavior for safe staircases , storage of cleaning products , bathing , drinking hot fluids , and cooking . This study supports the application of Web-based , tailored , safety advice for the prevention of unintentional injuries in the youth health care setting . Trial Registration Nederl and s Trial Register : NTR1836 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=1836 ( Archived by WebCite at http://www.webcitation.org/6MPIGQxpx ) Objective This study aim ed to evaluate the impact of a computer kiosk intervention on parents ’  self-reported safety knowledge as well as observed child safety seat , smoke alarm use , and safe poison storage and to compare self-reported versus observed behaviors . Methods A r and omized controlled trial with 720 parents of young children ( 4 months to 5 years ) was conducted in the pediatric emergency department of a level 1 pediatric trauma center . Enrolled parents received tailored safety information ( intervention ) or generic information ( control ) from a computer kiosk after completing a safety assessment . Parents were telephoned 4 to 6 months after the intervention to assess self-reported safety knowledge and behaviors ; in-home observations were made 1 week after the telephone interview for a subset of 100 r and omly selected participants . Positive and negative predictive values were compared between the intervention and control groups . Results The intervention group had significantly higher smoke alarm ( 82 % vs 78 % ) and poison storage ( 83 % vs 78 % ) knowledge scores . The intervention group was more likely to report correct child safety seat use ( odds ratio , 1.36 ; 95 % confidence interval , 1.05–1.77 ; P = 0.02 ) . Observed safety behaviors were lower than self-reported use for both groups . No differences were found between groups for positive or negative predictive values . Conclusions These results add to the limited literature on the impact of computer tailoring home safety information . Knowledge gains were evident 4 months after intervention . Discrepancies between observed and self-reported behavior are concerning because the quality of a tailored intervention depends on the accuracy of participant self-reporting . Improved measures should be developed to encourage accurate reporting of safety behaviors Background Injuries in or around the home are the most important cause of death among children aged 0 - 4 years old . It is also a major source of morbidity and loss of quality of life . In order to reduce the number of injuries , the Consumer Safety Institute introduced the use of Safety Information Leaflets in the Netherl and s to provide safety education to parents of children aged 0 - 4 years . Despite current safety education , necessary safety behaviours are still not taken by a large number of parents , causing unnecessary risk of injury among young children . In an earlier study an E-health module with internet-based , tailored safety information was developed and applied . It concerns an advice for parents on safety behaviours in their homes regarding their child . The aim of this study is to evaluate the effect of this safety information combined with personal counselling on parents ' child safety behaviours . Methods / Design Parents who are eligible for the regular well-child visit with their child at child age 5 - 8 months are invited to participate in this study . Participating parents are r and omized into one of two groups : 1 ) internet-based , tailored safety information combined with personal counselling ( intervention group ) , or 2 ) personal counselling using the Safety Information Leaflets of the Consumer Safety Institute in the Netherl and s for children aged 12 to 24 months ( control group ) . All parents receive safety information on safety topics regarding the prevention of falling , poisoning , drowning and burning . Parents of the intervention group will access the internet-based , tailored safety information module when their child is approximately 10 months old . After completion of the assessment questions , the program compiles a tailored safety advice . The parents are asked to devise and inscribe a personal implementation intention . During the next well-child visit , the Child Health Clinic professional will discuss this tailored safety information and the implementation intention with the parents . The control group will receive usual care , i.e. the provision of Safety Information Leaflets during their well-child visit at the child 's age of 11 months . Discussion It is hypothesized that the intervention , internet-based , tailored safety information combined with personal counselling results in more parents ' child safety behaviours . Trial registration Current Controlled Trials Background Nonadherence and medication errors are common among patients with complex drug regimens . Apps for smartphones and tablets are effective for improving adherence , but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology . Objective The objective of this study was to design , implement , and evaluate a medication self-management app ( called ALICE ) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use . Methods A single-blind r and omized controlled trial was conducted with a control and an experimental group ( N=99 ) in Spain in 2013 . The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals .  ALICE was design ed for And roid and iOS to allow for the personalization of prescriptions and medical advice , showing images of each of the medications ( the packaging and the medication itself ) together with alerts and multiple reminders for each alert . The r and omly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months . Pre and post measures included rate of missed doses and medication errors reported by patients , scores from the 4-item Morisky Medication Adherence Scale ( MMAS-4 ) , level of independence , self-perceived health status , and biochemical test results . In the experimental group , data were collected on their previous experience with information and communication technologies , their rating of ALICE , and their perception of the level of independence they had achieved . The intergroup intervention effects were calculated by univariate linear models and ANOVA , with the pre to post intervention differences as the dependent variables . Results Data were obtained from 99 patients ( 48 and 51 in the control and experimental groups , respectively ) . Patients in the experimental group obtained better MMAS-4 scores ( P<.001 ) and reported fewer missed doses of medication ( P=.02 ) . ALICE only helped to significantly reduce medication 
    Output:
    
Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours .
Kiosk programmes showed evidence of modest knowledge and behaviour gains .
Both programmes using mobile technology improved behaviours .
Virtual-reality programmes consistently improved behaviours , but there were little gains in knowledge .
Conclusions There is much potential for computer-based programmes to be used for injury-prevention behaviour change .
The review ed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours