Time to prioritise safe walking.

This study draws on information from two recently published documents on pedestrian safety and global status of road safety to draw attention to the need to prioritize safe walking in planning and policy at local, national and international levels. The study shows that each year, more than 270 000 pedestrians lose their lives on the world's roads. The study argues that this situation need not persist because proven pedestrian safety interventions exist but do not attract the merit they deserve in many locations. The study further shows that the key risk factors for pedestrian road traffic injury such as vehicle speed, alcohol use by drivers and pedestrians, lack of infrastructure facilities for pedestrians and inadequate visibility of pedestrians are fairly well documented. The study concludes that pedestrian collisions, like all road traffic crashes, should not be accepted as inevitable because they are, in fact, both predictable and preventable. While stressing that reduction or elimination of risks faced by pedestrians is an important and achievable policy goal, the study emphasizes the importance of a comprehensive, holistic approach that includes engineering, enforcement and education measures.

Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial.

OBJECTIVE: To assess the effects of providing daycare facilities for young children on the health and welfare of disadvantaged families. DESIGN: Randomised controlled trial. Eligible children from the application list to a daycare facility were randomly allocated to receive a daycare place or not. SETTING: Early Years daycare centre in Borough of Hackney, London. PARTICIPANTS: 120 mothers and 143 eligible children (aged between 6 months and 3.5 years). INTERVENTION: A place at the centre, which provided high quality day care. Control families used other child care that they secured for themselves. MAIN OUTCOME MEASURES: Maternal paid employment, household income, child health and development. RESULTS: At 18 months' follow up, 67% of intervention group mothers and 60% of control group mothers were in paid employment (adjusted risk ratio 1.23 (95% confidence interval 0.99 to 1.52)), but were no more likely to have a weekly household income of above pound 200 (risk ratio 0.88 (0.70 to 1.09)). Intervention group children had more otitis media with effusion (risk ratio 1.74 (1.02 to 2.96)) and used more health services (1.58 (1.05 to 2.38)), but both estimates were imprecise. CONCLUSION: The provision of child day care may have increased maternal employment, but it did not seem to increase household income. The results suggest that providing day care may be insufficient as a strategy to reduce poverty. The study shows how random allocation can be used to ration and evaluate interventions where demand exceeds supply.