Social and economic factors associated with child unintentional injury mortality in high-income countries.

INTRODUCTION: Recognising the connection between country-level social determinants of health, and child unintentional injury mortality can contribute to better resource allocation for child safety. This cross-sectional country-level study aims to investigate such a link where the role of income inequality (Gini Index) is examined alongside education expenditure, current health expenditure and gross national income (GNI) per capita. METHODS: A total of 49 high-income countries were studied, using the WHO Global Health Estimates 2016, the World Bank's World Development Indicators for education and GNI per capita, and the standardised world income inequality database to compile estimates of child unintentional injury mortality rates and selected socioeconomic characteristics. RESULTS: A wide range of childhood mortality rates from unintentional injury was observed (1.3-10.0 deaths per 100 000 children). Such risk is strongly associated with income inequality (0.50), GNI per capita (-0.35) and education expenditure (-0.01) (mediated by income inequality). No association was found to current health expenditure. The results explain 52% of the variance in child unintentional injury mortality. CONCLUSIONS: In countries with higher overall economic activity and lower-income inequality, child mortality from unintentional injuries is lower. Allocation of education expenditure is one contributor to reducing income inequality; other factors need further exploration.

Taking responsibility for sexual health curricula content: A national study of Israeli nursing faculty.

BACKGROUND: Little is known about sexual health education for nursing practice that nursing students receive in their undergraduate curricula. OBJECTIVES: This study examined nursing curricula for sexual health content and the context in which it was taught. Faculty's professional background, attitudes, perceived barriers, and facilitators were examined. METHODS: A mixed-methods national cross-sectional study was conducted. All Israel's nursing school directors were approached (n = 27) with a 51.8 % response rate. RESULTS: All participants (100 %) reported positive attitudes (M = 4.5, SD = 0.51) toward integrating sexual health content into nursing practice curricula; however, the general perception of most nursing schools (79.6 %) was that nursing students received insufficient preparation to deal with patient sexual concerns. Sexual health assessment was integrated into academic curricula only in two nursing schools (n = 2), with no school including clinical competencies for sexual health in their clinical practice (0 %). According to the results of the qualitative analysis, education, including faculty education and student curriculum, and comfort were identified as facilitators for the inclusion of sexual health content into nursing curricula. In contrast, discomfort, education, and cultural issues were described as barriers. CONCLUSION: Comprehensive sexual health education is mandatory content for nursing practice. The lack of sexual health content in the nursing curricula may limit the student's ability to assess the patient's sexual health in professional practice. Therefore, regulatory organizations in nursing education need to include this competency as a mandatory component of nursing education content.

Mothers' Knowledge of Infants' Fever Management: A National Prospective Study.

OBJECTIVES: The aim of this study was to describe mothers' knowledge of infant fever management after birth and six months later and its association with sociodemographic characteristics, perceived support, sources of consultation and health education; and to assess determinants of change in mother's knowledge from birth to six months. METHODS: Mothers (n = 2804) answered a self-reporting questionnaire after giving birth in maternity wards in six hospitals in Israel; six months later follow- up interviews were conducted by telephone. RESULTS: The mothers' knowledge level of infant fever management was low after birth (mean = 50.5, range 0-100, SD = 16.1), and rose to a moderate level six months later (mean = 65.2, SD = 15.0). Mothers having their first born, with lower household income or education were less knowledgeable about infant fever management after birth. However, these mothers showed the largest improvement after six months. Mothers' perceived support or sources of consultation and health education (partner, family, friends, nurses, and physicians) were not associated with their knowledge at either time. Moreover, mothers stated self-learning from internet and other media as often as receiving health education by health professionals. CONCLUSIONS FOR PRACTICE: Public health policy for health professionals in hospitals and community clinics is essential to promote clinical interventions promoting mothers' knowledge of infant fever management. Efforts should focus at first time mothers, those with non-academic education, and those with a moderate or low household income. Public health policy enhancing communication with mothers regarding fever management in hospitals and community health settings, as well as accessible means of self-learning is warranted.

Self-reported elevated pain levels: A coping strategy used by women undergoing medical abortion procedures.

PURPOSE: Epidural analgesia alleviates pain during normal labour but women who undergo medical abortion procedures using epidural analgesia continue to express high pain levels. To understand this we assessed if patients undergoing medical abortions, treated with epidural analgesia, use their pain for psychological benefits. METHODS: This study comprised 105 patients over 13 weeks of gestational age diagnosed with foetal abnormalities after selecting a medical abortion procedure using epidural analgesia. Three questionnaires were handed-out: 1) 'Need for Affect', assessed the motivation to react to emotions; 2) 'Pain-Levels' 3) PANA- 'Positive Affect' (PA), 'Negative Affect' (NA) assessed emotions pre-abortion and post-abortion. RESULTS: Patients with a strong Need for Affect and high Pain-Levels expressed a stronger PA post-abortion (b = .69, se = .11, ß = .68, p < .001, 95%CI [.48,.90]). Patients with a strong NA pre-abortion and high Pain-Levels expressed a higher NA post-abortion (b = .48, se = .11, ß = .53, p < .001, 95%CI [.26, .70]). CONCLUSION: Patients with a strong Need for Affect who express a strong PA pre-abortion intensify their pain to fulfill their Need for Affect, which then helps recovery. Patients with a strong NA pre-abortion and high Pain-Levels indicate a less favourable outcome.

Age, Ethnicity, and Socioeconomic Factors Impacting Infant and Toddler Fall-Related Trauma.

OBJECTIVE: To characterize trauma-related falls in infants and toddlers aged 0 to 3 years over a 4-year period and develop a risk stratification model of causes of fall injuries. METHODS: Data on falls of 0 to 3 year olds from 2009 to 2012 were identified from a Jerusalem tertiary hospital trauma registry (N = 422) and the National Trauma Registry of Israel (N = 4,131). RESULTS: Almost half of falls occurred during the first year of life, and 57% of the children were Jewish. The majority of the children lived in low socioeconomic environments, both in the Jewish (59.2%) and Arab (97.6%) samples. Most (74%) of the falls resulted in head injury. A classification and regression tree analysis indicated that falls from furniture were the leading cause of injury in 0 to 12 month olds (estimated probability of 37.9%), whereas slipping is the leading cause in 13 to 36 month olds (estimated probability of 38.4%). Age and ethnicity emerged as the leading predictors of the nature of a fall; Injury Severity Score and the child's sex were secondary. Compared with the national data, Jerusalem children had a higher incidence of falls from buildings (9.3%; 2.4%), a higher moderate-severe Injury Severity Score (>16), a higher incidence of traumatic brain injury, and a longer hospital length of stay (P < 0.001). CONCLUSIONS: The leading determinants of fall injuries in children below the age of 3 years are age, ethnicity, and low socioeconomic status. Future outreach community interventions should target these risk groups and be tailored to their defining characteristics.

Do parental decision-making patterns predict compliance with use of child booster seats?

Booster seat use for 4-9 year olds remains the lowest of all age groups in many countries. The objective of this study is to examine whether parents' decision-making patterns, as measured by the Melbourne Decision Making Questionnaire, relate to car booster seat use. Israeli parents of 4-7 years old children (n = 398) answered a questionnaire about car safety and decision-making habits. Ninety per cent of parents reported having a booster seat; 70.5% reported consistent booster seat use in general and on short drives during the last month (booster seat use compliance index). Greater compliance index was positively related to a vigilant decision-making pattern, passenger compliance with rear seat belts and families with fewer children. Lower booster seat use compliance index was associated with buck-passing decision-making pattern. Health professionals and policy-makers should take into account parents' habitual decision-making patterns when designing interventions for car booster seat compliance.

An ecological model to factors associated with booster seat use: A population based study.

Belt-positioning booster seat use (BPB) is an effective technology to prevent severe child injury in cases of car crash. However, in many countries, age-appropriate car restraint use for children aged 4-7 years old remains the lowest among all age groups. The aim of this study was to identify the main determinants of BPB use through a comprehensive approach. An ecological model was used to analyze individual, parent-child relationships, and neighborhood characteristics. Parents of children enrolled in the first and second grades completed a self-reported questionnaire (n=745). The data were subjected to multilevel modeling. The first level examined individual and parent-child relationship variables; in addition the second level tested between neighborhood variance. According to parental self- reports, 56.6% of their children had used a BPB on each car trip during the previous month. The results indicated that the determinants positively related to BPB use were individual and parental; namely, the number of children in the family, the parents' car seat belt use, parental knowledge of children's car safety principles, and a highly authoritative parenting style. Children's temperaments and parental supervision were not associated with BPB use. At the neighborhood level, a small difference was found between neighborhoods for BPB users compared to non-users.