A longitudinal study of boys' and girls' injury-risk behaviors and parent supervision during infancy.

In most developed nations worldwide, unintentional injury is the leading cause of death for youth 1 through 18 years. Infants are a particularly vulnerable group because motor development enables increased access to hazards, yet they are poorly equipped to assess danger. The current study compared when infants possessed low versus high motor development skills and examined the frequency and type of injury-risk behaviors and parent supervision patterns, as well as modeling how supervision influences injury-risk behaviors across motor development stages and if it does so differentially for boys and girls. Applying a participant-event monitoring method, parents were trained in completing injury-risk behavior diary forms, which they did once the child could move from their seated location on the floor in some way and continued until a month after the child could walk independently. Results revealed few differences between boys and girls in risk behaviors. The overall rate of risk behaviors was greater at high than low motor development stages and there was stability in the rate of individual infant injury-risk behaviors across motor development stages. The same general types of risk behaviors occurred over motor development stages, though about 88% of risk behaviors per se were novel and unfamiliar to parents. Parents supervised boys and girls similarly. However, model testing indicated that greater supervision increased the rate of risk behaviors longitudinally for boys but not girls. Implications for preventing injuries to boys and girls during infancy are discussed.

A longitudinal study of parents' expectations about infants' emerging behaviors and their safety strategies to moderate injury risk.

RATIONALE: Unintentional injuries are the leading cause of preventable deaths for children under 19 years of age. Infancy has been identified as a high-risk stage for injury. Throughout infancy, infants acquire increasing motor competencies but have limited capabilities to appraise danger. This longitudinal multi-method study examined parents' expectations about their infant's emerging behaviors and their in-home safety practices when their infants were at two stages of motor development: pre-mobile (i.e. sitting independently) and mobile (i.e. walking independently). METHODS: At each motor development stage, parents completed an interview and rating scales to report on their infants' current and anticipated (3 months later) behavioral competencies, as well as their own safety practices and anticipated changes in these. RESULTS AND IMPLICATIONS: Findings revealed that parents engaged in poorer supervision (reduced proximity, decreased attention) when infants were mobile than pre-mobile, while at the same time doing less to constrain their infants' movements around the room when mobile than pre-mobile. At both stages of motor development, parents reported expecting increased unpredictability in how their infants would behave in the upcoming months, due primarily to motor development (pre-mobile infants) or cognitive curiosity (mobile infants). In response, they planned to change their safety practices by decreasing supervision and increasing teaching about safety, despite the young ages of the children. Implications for injury risk to infants and prevention initiatives focusing on parents are discussed.

Understanding Infants' In-Home Injuries: Context and Correlates.

RATIONALE: Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning. METHODS: In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants' home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant's and parent's behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries. RESULTS: Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent. CONCLUSION: Implications of these results for injury prevention messaging are discussed.

Validation of a measure of injury-risk behaviors in the first 2 years of life: Infant/Toddler-Injury Behavior Questionnaire (IT-IBQ).

Unintentional injuries are the leading cause of death for young children and many result from them doing injury-risk behaviors in the home. There are a number of questionnaire measures of injury-risk behaviors for children 2 years and older, but none that apply during infancy. The current study addressed this gap. Parents completed the new Infant/Toddler-Injury Behavior Questionnaire when infants were pre-mobile (sitting independently) and mobile (walking independently), with diary measures of injuries and risk behaviors taken continuously throughout this period. Validated questionnaire measures of chaos and routines in the home were also completed. The IT-IBQ showed positive associations with injuries, risk behaviors, and degree of chaos in the home, and was negatively associated with family routines. The results provide evidence for criterion validity and suggest that the new measure holds promise as one that can aid in identifying infants who are likely to engage in injury-risk behaviors.

In Their Own Words: Perspectives on Nonsuicidal Self-Injury Disorder Among Those With Lived Experience.

Nonsuicidal self-injury (NSSI) is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition warranting further study. Although potential advantages and disadvantages regarding this prospect have been documented, no study has examined the perspectives of those who self-injure. The goal of the current study was to give voice to these views. Seventy-six participants with an NSSI history completed quantitative and qualitative measures assessing perspectives about NSSI being included as a DSM disorder. Findings revealed mixed views overall. Thematic analysis of open-ended responses highlighted several unique advantages (i.e., enhanced understanding of NSSI, validation of the NSSI experience, facilitation of NSSI treatment, encouragement of NSSI help-seeking, reduction of NSSI stigma) and disadvantages (i.e., exacerbation of NSSI stigma, diminishment of underlying concerns). These findings speak to the need to consider the perceptions of those with lived NSSI experience; future directions and implications are discussed.

Peer-to-Peer Feedback: A Novel Approach to Nursing Quality, Collaboration, and Peer Review.

This article describes how an acute care organization in Texas, a peer review mandated state, created a nonpunitive peer feedback structure and process for nursing staff. Strategies were targeted to improve patient outcomes. A peer feedback committee designed, implemented, and evaluated the feedback model to coexist with the state-required formal peer review committee structure. Peer feedback provided opportunities to advance skill development, enhance quality improvement, improve patient outcomes, and support a culture of safety within the healthcare environment.

Hot embossing for micropatterned cell substrates.

This paper reports the development of a technique for preparing microtextured polymer substrates for cell growth and studies the response of osteoblast cells grown on these surfaces. The surfaces were manufactured with hot embossing, where a silicon micromachined printing master was pressed into a thermoplastic polymer substrate at elevated temperature, forming a regular microgroove pattern in the polymer. The grooves were approximately 5 microm deep, 4 microm wide, and had a periodicity of 34 microm. The polymer substrate was polyimide, which can be spincast and printed in its uncured form, and is mechanically rigid and chemically nonreactive after full cure. Osteoblast cells were grown on the textured polymer substrate and their responses to grooved and smooth surfaces were observed with fluorescence microscopy. Alignment and aspect ratio were analyzed for the cell body, cell nucleus, and focal adhesions. Cell membrane body, cell nucleus, and focal adhesions all strongly aligned with the microgrooves, while only the cell body shape changed on the microgrooved surface. This novel substrate preparation technique offers the opportunity for low-cost and rapid manufacture of microtextured surfaces that can be used to control cell shape and alignment.