Psicología para Invertir en FOREX

Chapters 10-11 provide guidance for improving the adoption of home safety measures.

Chapter 10 describes the epidemiology of home injuries; and summarizes the available evidence on prevention strategies that address the groups most at risk for four of the leading causes of home injury -- infant sleep-related deaths, house fires and burns, poisonings, and falls. Effective prevention strategies have been identified to reduce injury or mitigate risk behaviors. The evidence is summarized by the strength of the evidence for selected prevention strategies for each of these injury causes. Strong evidence was found to support recommendations for burn prevention, pediatric and older adult falls, and pediatric poisoning

Chapter 12

196

prevention. Strong evidence indicates that next steps for these evidence-based recommendations is the dissemination of these recommended strategies to the target populations. Table 1 presents a summary of the evidence. Recommendations for the prevention of adult poisoning and infant safe sleep were limited to recommended and promising categories indicating that further evaluative work is needed to determine the effectiveness of these recommendations.

Table 1. Prevention strategies for home injuries by type of injury, outcomes studied, and level of

evidence

Prevention strategies Outcomes studieda

(%)

Level of Evidence Safe sleep

National Back to Sleep Campaign Injury Promising Crib distribution program Behavior Recommended

practice Parent/caregiver education Behavior Promising

Poisoning Behavior Promising

Fires and burns

Working smoke alarms Injury Strong

Smoke alarm installation and education programs Behavior Strong Residential sprinkler technology Injury Strong Sprinkler mandates for new home construction Behavior Promising Reduced ignition propensity cigarettes Injury Promising Fire escape planning interventions Behavior Strong Interventions for safe storage of matches Behavior Recommended

practice Child-resistant cigarette lighters Injury Promising Interventions for safe hot water temperature Behavior Strong Interventions for keeping hot drinks and foods out of

reach

Behavior Recommended practice Falls (children)

Mandated redesign of baby walkers Injury Promising Reduction of baby walker possession and use Behavior Strong Stair gate education and distribution Behavior Strong Window guard mandates Injury Strong Falls (older adults)

Medication review Falls Strong

Strength and balance exercise programs Falls Strong

Home modification Falls Strong

Yearly vision screening Falls Promising Multicomponent interventions Falls Strong Poisoning (children)

Safe storage of medication away from children Behavior Strong Child-resistant and sublethal dose packaging Injury Strong Poison control centers Injury Strong

General Discussion

Prevention strategies Outcomes studieda

(%) Level of Evidence Poisoning (adults)

Safe storage, use, and disposal of opioid pain relievers Behavior Recommended Control of supply and dispensing of opioid pain

relievers

Injury Promising Carbon monoxide alarms Behavior Recommended Chapter 10;Table 4 Gielen AC, McDonald EM, Shields WC. Unintentional Home Injuries across the Life Span: Problems and Solutions. The Annual Review of Public Health. 2015; 36:2.1-2.23 The Healthy Housing community, which has historically addressed lead poisoning and asthma in homes of affected children, is a new audience for injury prevention outreach. The CHASE Tool was developed and validated as a tool for use by this community. (Chapter 11) The CHASE tool which contains 14 injury subdomains, and 25 injury measures have been developed and validated to assist housing programs working in homes of children to identify and mediate injury risks. The majority of households had safe water temperature 56%, working smoke alarms on every level 62%, and CO alarms 70%. The overall passed percent of subdomains passed was 57% for the total group. Individual item pass rates varied greatly between CHASE items from a low of 0% having medication locked and 11% having window guards to highs of 90% having proper exits and 80% being free of furniture crowding. These results are important because they add to the literature demonstrating the need for injury prevention to be addressed as part of the healthy homes initiative. [34,35]The comparison between groups, which was done via an adjusted paired regression analysis, demonstrated that case status significantly predicted the CHASE sub-domain such that those who were in the injured group were significantly less likely to pass (b=-3.315, p=.025). This finding demonstrated that the CHASE Inspection tool could distinguish between injured and non-injured children. The current interest in public health circles in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Collaborating with our environmental health and healthy housing colleagues is one important approach to reducing home injuries. Their access to homes and their ability to influence housing policy can play significant roles in reducing home injuries. Sharing the science of injury prevention [36] with the wide array of professionals who create home environments and interact with people in their homes (e.g., architects, home builders, home visiting programs, fire and EMS providers) could be a useful approach. The broad dissemination of the CHASE tool has the potential to decrease injury risk in homes served by the programs which previously were not addressed.

The strategies explored in chapters 10 and 11 provide guidance for clinical providers, injury preventions researchers, and the Healthy Housing Community to reduce injuries in the home. The guidance provided in these chapters has the potential to reduce home injuries if properly utilized and disseminated to specific

Chapter 12

198

identified target audiences. Chapter 10 and 11 additionally provide insight into areas which are in need of additional evaluative work to determine the effectiveness of the recommended strategies before they can be deemed to be supported by strong evidence.