Safe communities for children: insight from a pilot program for preventing unintentional injuries.

This study presents insights in safety promotion of community-based intervention programs, in preventing unintentional injury among children. We modeled and used an evaluation tool to estimate the effectiveness of a community-based injury prevention program. The intervention program consisted of a five-year multidisciplinary, multi-strategic childhood safety promotion and injury prevention protocol. The purpose of the program was to set up safety awareness in ten low-income communities in Israel. This study describes the process, impact and outcome of the intervention program and includes the difficulties faced during the evaluation process, documenting the insights gained from this pilot program. The findings suggest that evaluating the program was a positive and important undertaking. Evaluating the success of the outcome in the earlier program, however, did not confirm its effectiveness. It appears there were hindrances to the progress and implementation of the program. This study gave insights into these obstacles and how we should correct them.

[Emergency Department (ED) administrative data--what can we learn from this data about pediatric injury? Is there a need for a designated injury surveillance system?].

BACKGROUND: Data on injury characteristics can help direct prevention activities. AIMS: To explore the potential use of Emergency Department (ED) data as a source of information regarding child injury in Israel. To examine the need for a designated injury surveillance system in Israel. METHODS: Data on ED visits by children (0-17 years] between the years 2005-2007, for reasons other than illness were extracted from the administrative data system of a pediatric hospital in Israel. Data was analyzed using SPSS. RESULTS: The study included 36,603 children, 62% males. Mean age was 7 (s.d. 5) years. Hospitalization was the outcome for 2333 children (6.5%). The reason for the visit was "other accident" for half of the patients: 15,652 kids (43%) due to falls and 2111 children (6%) were involved in road crashes. Patient complaints included 636 children (2%) that had swallowed an object, 113 of them (18%) were hospitalized. Bruises were the most frequent complaint. Half of the children complained of bruises, 10,277 were bruised as a result of a fall, 1,473 (7.5% of bruised population) were bruised as a result of a road accident. Cuts were the second most frequent complaint (8,773 children, 24%) with only 2% hospitalized. One half of the patients with cuts were aged 0-4 years. Only 231 kids had suffered poisoning, of them, 193 children (84%) infants and toddlers below the age of 4 years and 16% were hospitalized. CONCLUSION: Findings suggest that administrative data can be used to observe pediatric injury patterns. Several new data fields in the existing system could fill information gaps on the external cause of injury. Making this data available to injury prevention professionals should be considered a priority.

[The rationale for promotion of bicycle helmet legislation for children up to 18 years].

BACKGROUND: Each year, many children suffer from injuries caused by bicycles, scooters, skateboards, and roller skates accidents. Head injury is the most common cause of death and serious disability in bicycle-related crashes. In various studies the use of bicycle helmets has been proven to be the most effective measure in preventing head injury: the use of bicycle helmets reduced the risk of head and brain injury by 85-88%. Legislation that mandates the use of helmets has been shown to effectively increase helmet use and, therefore, significantly decrease head injuries among riders. COST-BENEFIT: Legislation requiring helmets will save $44.2 million (direct benefit) to society over a 5-year period, and save approximately 57 lives, 2,544 hospitalizations, and 13,355 emergency room visits. BICYCLE-RELATED DEATHS AND INJURIES IN ISRAEL: Data from trauma registry of 10 hospitals of the Israeli Center for Trauma and Emergency Medicine research indicate that 649 children ages 17 years and under were injured in a bicycle-related accidents (58-serious, 77-medium injury). Bicycle-related injuries accounted for approximately 33% of motor vehicle accidents among children ages 17 years and under. LEGISLATION: Many countries have legislation requiring helmets for riders. In Israel, there is no law requiring helmets. On a telephone survey, conducted by 'Beterem', a high support rate for a law requiring bicycle helmets (89%) was found among parents to children up to 15 years of age. Based on the evidence of the effectiveness of helmets as a means for reducing head injuries in cyclists, and the importance of a law to this effect, the medical community in Israel should act to promote the legislation requiring helmets for children on bicycles, scooters, skateboards, roller skates, and rollerblades.

Epidemiology of pediatric bite/sting injuries. One-year study of a pediatric emergency department in Israel.

Animal bite/sting injuries are a known source of morbidity with a significantly higher incidence among children who are most often bitten in the face, head, and neck. The objective of this study was to provide a better understanding of bite/sting injuries treated at the pediatric emergency department in order to guide preventive efforts. The sociodemographic, epidemiological, and clinical data on all bite/sting injuries treated in one representative pediatric emergency department in Israel over a 1-year period were retrieved and analyzed. Two hundred of the 9,309 pediatric trauma cases treated in the emergency department were bite/sting injuries (2.1%). Non-Jewish patients were under-represented in this subgroup. The majority of patients were males (61.5%). Age distribution from 0-12 years was fairly even, except for an unexplained peak at 8 years. Dogs inflicted 56%, cats 11%, and hornets 9.5% of the injuries. Limbs were affected in 64% and the head and neck in 27%. Specialists, mostly plastic surgeons, were consulted in 42 cases (21%). The incidence rate for hospitalization (7%) was similar to that seen in other types of injuries. Children with scorpion or hornet stings and young age were more likely to be hospitalized. Preventive and educational aspects are discussed.

Parental knowledge on car safety for children: an Israeli survey.

The objective of this study was to assess the level of parental car safety knowledge and actual behavior regarding their children under the age of 15 years. This study forms part of the National Center for Child Safety and Health in Israel (Beterem) program to examine awareness on child safety. Seven hundred and five Jewish families with at least one child at home younger than 15 years (a total of 1,345 children) were used as a randomized sample of the Jewish population. A telephone survey was conducted by professional interviewers using a questionnaire developed by injury prevention specialists consisting of seven knowledge questions and a diagram that described the usual seating positions and restraining method of the family members in the family car. Concerning knowledge about injury prevention, the rate of incorrect answers was high, 64% in regard to the proper car seats for age and 84% in regard to the age for booster seats. Sixty five percent of parents did not know what a booster seat was and 54% did not know that the proper place for children was in the back seat. The average of incorrect answers was 4.86 out of 7 (SD=1.45) correlated with low socioeconomic status. Concerning care safety behavior 60% percent of babies and 38% of toddlers were not restrained properly. This study should alert planners and policy makers to the need of implementation of educational prevention programs for the Israeli public of parents concerning car safety for children in order to reduce childhood injury.

Childhood injury prevention: intervention in the Bedouin city of Rahat.

For several years, the National Center for Children's Health and Safety (Beterem) has worked on many levels to promote safety and prevent injury of the children in Israel. As part of intervention programs in 20 communities around Israel, this paper describes a 1-year, multidisciplinary, multistrategic childhood safety promotion and injury prevention project. The project took place in the Bedouin city of Rahat in the Southern part of Israel, the Negev, conducted by a local safety coordinator. This specific intervention study took place from March 2003 to March 2004. The main goal was to identify hazards and dangerous obstacles in public places in Rahat, then remove or repair the obstacles found, in order to secure a safe public environment for children. "Obstacle" was defined as any barrier that could endanger the safety of a child. Ten examples are used to illustrate this applied research project, and 80% of the problems were solved within the project period (time to solve between 1 week to 3 months, depending on various factors). We recommend the involvement of a safety coordinator from the community to focus on safety hazards for children, the use of a documentation diary to log the time frame, and also the use of pictures to illustrate the hazards and the changes, or to use as arguments in the lobbying process.

Child injury in Israel: emergency room visits to a children's medical center.

The object of this study was to provide data for policy making and prevention program planning in Israel. The study examined all visits to the Department of Emergency Medicine at the Schneider Children's Medical Center in 1996 (41,279 visits in total). Approximately 22.6% of the emergency room patients were admitted following injury. Most (97%) were unintentional injury. Approximately 42% of the patients were less than 4 years old and about 20% were 2 years old. In all age groups, the rate of boys was double. Approximately 92% were Jews. Despite this low rate of non-Jewish patients, however, they constituted 20% of later hospitalizations. The main injuries recorded were bruises and wounds from blunt objects, falls, motor vehicle-related accidents, and sport injuries. The most commonly injured body parts were the head and upper and lower limbs. In 82%, medical treatment was reported and 7% were hospitalized. In examining injuries over the year, there were no significant differences between the different months, but there were clusters of injuries around various holidays--bicycle and skateboard accidents at Rosh Hashanah, Yom Kippur, and Succoth; pedestrian accidents around Lag BaOmer; burns on Purim, Hannukkah, and Passover; and accidental poisoning around Passover. The findings gave an indication of the nature of the injured population groups. These data could be useful for prevention strategy, both on the level of physical injury as well as on the level of the times of the year, when the risk was higher. The data collected very strongly raise the urgent need for establishing a national surveillance system, which would allow tracking injury-related data with respect to young people throughout the country.

Youth injury in Israel: an appeal for change.

Unintentional injury in children and adolescents have raised public health concerns in recent years, because it is the leading cause of death, a physical burden for the injured person, an emotional and social burden for the families together with an economic burden for society. The National Center for Children's Safety and Health in Israel was established in 1995 at the Schneider Children's Medical Center in order to focus on prevention of childhood and adolescent injury and safety. Over these years data has been collected from the Central Bureau of Statistics, the Ministry of Health, the National Trauma Register, Police and the National Poison Center in order to look for trends and develop strategies for intervention. These efforts, together with the active prevention programs that have been established, resulted in a national report (1) presented to the Minister of Health and other policy makers in 2003. The current situation of youth injuries in Israel, which over the years have not shown any improvement, necessitates a new agenda with a focus on prevention and collaboration between various ministries and agencies in order to implement it. The report alone cannot have an impact upon youth safety, but we hope that it will provide an impetus for developing youth safety strategies and programs based on data. We also believe there is a need for long-term monitoring and follow-up of youth injury trends in Israel.