Child Injury Prevention Research Articles

Pediatric Trauma - A Silent Epidemic.

Trauma is the leading cause of preventable deaths in children all over the world. In the majority of cases, children are innocent victims of road traffic accidents. They suffer from both short-term and long-term impacts of trauma. Deaths from road traffic accidents can be prevented by adopting simple road safety measures and the use of protective equipment. Worldwide programs have been initiated to curb this ever-rising menace; however, the success of these programs depends on their outreach and acceptance among the population in general. Golden hours in trauma management is the initial hour post-trauma, the success of resuscitation depends on the appropriate management of pediatric trauma victims in hospitals dedicated to the management of pediatric trauma victims. The current review highlights the epidemiology, pattern of injury, road safety measures, and global health initiatives for the prevention of accident-related injury in children. The shortcomings of this review are as follows- Firstly pediatric trauma is an exhaustive topic, it is impossible to cover all aspects of pediatric trauma. Thus, the review might have missed some important aspects of pediatric trauma. Secondly, the concept of a pediatric trauma registry is nonexistent in almost all developing countries; hence a true picture of pediatric trauma epidemiology and injury patterns is missing. Thirdly not much work has been done on pediatric trauma in developing countries leading to insufficient data from these countries.

Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)

Abstract Background The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions. Methods A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents. Results A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%). Conclusions The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.

1.N. Scientific session: Child injuries monitoring and reporting: Challenges and technological developments

Abstract Globally, more than 1,600 children and adolescents below the age of 19-years die every day from preventable injuries. Road traffic injuries, drowning and self-harm represent leading causes of death and injury among children and adolescents (WHO 2021; WHO Regional Office for Europe, 2021; Unicef, 2021). Most unintentional injuries in early childhood occur at home and children from less advantaged backgrounds are exposed to more hazardous home environments due to overcrowding or unsafe structures over which parents often have limited control (WHO, 2020). According to the IDB data analysis approximately 15% of home injuries could have been prevented by improved product safety and parental education. The COVID-19 pandemic and the conflict in Ukraine have created a complex and challenging situation for children and adolescents in the region, increasing their vulnerability and compromising their well-being. To efficiently prevent child injuries, one must account for a complex interplay between human factors as well as physical and socio-cultural environments. Multiple determinants of child injury cannot be addressed by the health sector alone, this is why a whole-of-government and a whole-of-society approaches are required. Schools have a crucial role to play for promoting the well-being of children and serve as a platform to increase access to health services. However, EU countries are still missing intersectoral collaboration and strong information systems to enable efficient response to the problem. Data on child injuries are still inconsistently collected in Europe due to substantial differences in coding systems, variation between injury mechanisms, different general policies pertaining to the admission of patients, and legal policies on reporting requirements. EU-wide networks such as the Eurosafe study (IDB network) collecting information on child injuries, are scarce. Likewise, access to healthcare services and support systems are unevenly distributed, particularly in underserved communities. Building country capacity in collecting, analysing and increasing the use of child injury data for decision making at global, regional, and national levels, is critical. Adequate epidemiological data on the burden of child injuries are necessary to allow governments prioritize areas for intervention and maximize the impact of their resources. Utilizing evidence-based tools and procedures and promoting intersectoral collaboration is vital. The workshop aims to discuss trends and inequalities of injury burden and present efficient measures and latest developments in monitoring and reporting child injuries across EU countries. The workshop will further discuss the methodological challenges in collecting and analysing data on child injuries. Evidence-informed tools for sharing health information and improved measurements of injury burden that are feasible and usable in both research and clinical contexts will be presented and success stories will be presented. Key messages • There is an EU-wide need for epidemiological data on the burden of child injuries. • Validated tools, well-designed injury data management systems and standard data collection procedures are missing.

Parental non-compliance to childhood safety practices: A cross-sectional study.

Background & objectives To assess the pattern of non-compliance to childhood safety practices among parents of children between one and five yr of age and to determine the reasons behind the same. Methods A descriptive, cross-sectional study was conducted on 120 children between one and five yr of age through a questionnaire-based interview of the primary carer. Poor compliance was defined as compliance to <85 per cent of the recommended practices. Results Of the total 48 injuries, 32 were serious (66.6%). Falls and burns/scalds were the two common types of injuries. Nearly three-fourths (72.5%) of families showed overall poor compliance. Poorest compliance was observed towards four safety practices namely, helmet wearing, restricting number of pillion riders to two on a two-wheeler, seatbelt wearing in a car and avoiding food items with a high risk of choking in children <3 yr. Parental perception of 'unnecessary' and 'lack of knowledge' were the main reasons behind non-compliance. Interpretation & conclusions Low compliance among families occurred with respect to safety on motor vehicles and avoidance of choking hazards. Change of parental perception and improved awareness is necessary for the prevention of unintentional childhood injuries.

Development of an Internet-based Product-related Child Injury Textual Data Platform (IPCITDP) in China.

Internet-based media stories provide valuable information for emerging risks of product-related child injury prevention and control, but critical methodological challenges and high costs of data acquisition and processing restrict practical use by stakeholders. We constructed a data platform through literature reviews and multi-round research group discussions. Developed components included standard search strategies, filtering criteria, textual document classification, information extraction standards and a keyword dictionary. We used ten thousand manually labelled media stories to validate the textual document classification model, which was established using the Bidirectional Encoder Representation from Transformers (BERT). Multiple information extraction methods based on natural language processing algorithms were adopted to extract data for 29 structured variables from media stories. They were evaluated through manual validation of 1000 media stories about product-related child injury. We mapped the geographic distribution of media sources and media-reported product-related child injury events. We developed an internet-based product-related child injury textual data platform, IPCITDP, consisting of four layers - automatic data search and acquisition, data processing, data storage, and data application - concerning product-related child injury online media stories in China. Each layer occurred daily. External validation demonstrated high performance for the BERT classification model we established (accuracy = 0.9703) and the combined information extraction strategies (accuracy >0.70 for 25 variables). As of 31 December 2023, IPCITDP collected 35 275 eligible product-related child injury reports from 13 261 news media websites or social media platform accounts which were geographically located across all 31 mainland Chinese provinces and covered over 97% of prefecture-level cities. The injury cases in IPCITDP were typically reported several months or years earlier than official announcements about the product-related child injury risks. Our data platform added data concerning 15 supplementary variables that the national product-related injury surveillance system lacks. Two examples demonstrate the value of IPCITDP in supplementing existing data and providing early epidemiological detection of emerging signals concerning product-related child injury: magnetic beads and electric self-balancing scooters. Our data platform provides injury data that can support early detection of new product-related child injury characteristics and supplement existing data sources to reduce the burden of product-related injury among Chinese children.

Factors associated with under- fives unintentional injuries in Kgalagadi South, Botswana

The study determined the prevalence and factors associated with unintentional injuries among under- fives in Kgalagadi South. A descriptive cross- sectional study was conducted between November 2020 and February 2021 using a multi- stage sampling technique to recruit 389 guardians with children aged five years and below. Self-administered questionnaires were used for the literate population, while interviewer-administered questionnaires were used for the population with limited literacy to elicit information from the guardians. Chi- square, univariate and multivariate logistic regression were used for inferential analysis. The prevalence of unintentional injuries was 48.8%. There was a significant association between injury occurrence and guardians’ employment status, alcohol consumption and non- medicinal drug use by the guardian, cigarette use by the guardian, household income level, gender and age of the child who got injured. The guardians age and cigarette use by the guardian were identified as independent risk factors for injury occurrence among under- five children. The findings highlight the need for policymakers and practitioners to develop policies that support comprehensive health education for caregivers on childhood injury prevention and creating a safe environment for children.

Recommendations on the management and prevention of spinal cord injury in children following backbend dance

Spinal cord injury (SCI) is a kind of disease that indiscriminately affects all age groups, although the number of SCI cases in children is far lower than that in adults. In this paper, we discuss the appropriate diagnostic methods and prevention methods for SCI caused by repetitive hyperextension movement. Case study reports available in the published literature concerning SCI due to hyperextension movement, which were categorized using the American Spinal Injury Association (ASIA) grades, were gathered. Moreover, the age, gender, lesion length on magnetic resonance image (MRI), time of symptoms appearance, initial spinal cord atrophy region, neurological level of injury, and initial and final ASIA grades were analyzed. A total of 144 cases with SCI after backbend dance were included in our analysis, with some cases with an incubation period ranging between 15 min and 4 h showing no symptoms. Most of the collected cases were young girls of &lt;11 years old. Early MRI showed that the pathological changes had extended toward cephalocaudal regions. In summation, the number of SCI cases, which are disabling for many children, is rapidly accumulating in China. Thus, SCI following repetitive hyperextension movements requires further research.

Hydroxyurea to prevent brain injury in children with sickle cell disease (HU Prevent)-A randomized, placebo-controlled phase II feasibility/pilot study.

Central nervous system (CNS) injury is common in sickle cell disease (SCD) and occurs early in life. Hydroxyurea is safe and efficacious for treatment of SCD, but high-quality evidence from randomized trials to estimate its neuroprotective effect is scant. HU Prevent was a randomized (1:1), double-blind, phase II feasibility/pilot trial of dose-escalated hydroxyurea vs. placebo for the primary prevention of CNS injury in children with HbSS or HbS-β0-thalassemia subtypes of SCD age 12-48 months with normal neurological examination, MRI of the brain, and cerebral blood flow velocity. We hypothesized that hydroxyurea would reduce by 50% the incidence of CNS injury. Two outcomes were compared: primary-a composite of silent cerebral infarction, elevated cerebral blood flow velocity, transient ischemic attack, or stroke; secondary-a weighted score estimating the risk of suffering the consequences of stroke (the Stroke Consequences Risk Score-SCRS), based on the same outcome events. Six participants were randomized to each group. One participant in the hydroxyurea group had a primary outcome vs. four in the placebo group (incidence rate ratio [90% CI] 0.216 [0.009, 1.66], p = .2914) (~80% reduction in the hydroxyurea group). The mean SCRS score was 0.078 (SD 0.174) in the hydroxyurea group, 0.312 (SD 0.174) in the placebo group, p = .072, below the p-value of .10 often used to justify subsequent phase III investigations. Serious adverse events related to study procedures occurred in 3/41 MRIs performed, all related to sedation. These results suggest that hydroxyurea may have profound neuroprotective effect in children with SCD and support a definitive phase III study to encourage the early use of hydroxyurea in all infants with SCD.

Optimisation design of child seat based on chaos mutation MOPSO

To improve the safety of the children in child seats when a vehicle collision occurs, a finite element model of a child safety seat is established, and LS-DYNA is used for crash simulation. Select backrest inclination, headrest inclination, and seat belt centre height as design variables to establish response surface models. The application of chaotic mutation theory in particle swarm optimisation (PSO) is proposed, and the optimal solution of child seat parameters is obtained by using the chaotic mutation based grouped multi-objective particle swarm optimisation (MOPSO). The optimal solution was used to carry out the simulation experiment again, and compared with the original performance. It turned out that the Head Performance Criterion (HPC) is 47.08% better than the original child seat. Besides, the rib deformation is reduced by 21.30%, the neck shear stress is reduced by 55.74%, and the thigh stress is reduced by 48.55%, which indicate significant improvements. The results suggest that a certain parameter combination of the child seat leads to the optimal overall performance in child injury prevention, which indicates significant improvement in the damage of all parts of the child.

Comparison between natural rubber knee support and sponge knee support on the protection of knee joint: A crossover randomized controlled study among patients with bleeding disorders.

Knee support, frequently made from sponge, is used to reduce injury. Sponge has less elasticity and durability compared with natural rubber. To our knowledge, there was no study that demonstrated the effectiveness of natural rubber and sponge in prevention of injury in children with bleeding disorders. The study aimed to demonstrate the effectiveness and satisfaction of natural rubber knee support compared with sponge knee support among children with bleeding disorders. The study consisted of threephases: (I) measuring reduced compression force, (II) producing size-appropriate knee support prototypes, and (III) conducting a randomized crossover trial, including 8 weeks wearing natural rubber knee support and sponge knee support with a 4-week wash-out period. The number of knee bleeds and user satisfaction were recorded. A better compression force reduction in natural rubber (60%) than sponge (12%) was demonstrated. Knee support comprised a body part, made from natural-stretchable cotton and a protection part, made from either natural rubber or sponge. They were produced in foursizes: S, M, L, and XL and appropriately applied to 42 patients (21 hemophilia, 21 platelet disorders) with a mean (SD) age of 7.0 (2.9) years. The results from randomization showed no significant difference in the number of knee bleeds between the two knee support groups (10 vs. 7, p = 0.37). In terms of satisfaction score, the natural rubber knee supports were more durable (45.2% vs. 23.8%, p = 0.04) and easier to use (28.5% vs. 14.3%, p = 0.03). In addition, a higher percentage of parents chose natural rubber knee support when compared with sponge knee supports (71.0% vs. 29.0%, p = 0.006). Natural rubber knee support showed comparable effectiveness in the prevention of knee bleeding but was superior to sponge knee support in compression force reduction and satisfaction.

Electrical injuries in children—a 6-year retrospective study

BackgroundThis study aimed to assess the clinical epidemiological characteristics of children with electrical injuries and discuss the countermeasures for the prevention of electrical injuries in children. MethodsThe children with electrical injuries were grouped according to whether or not they were admitted to the hospital for treatment into inpatient and outpatient groups. Clinical data such as gender, causes of injury and injury-causing voltage distribution in different age groups were analyzed. The factors affecting hospitalization were subjected to χ2 test, Kruskal-Wallis H test, and logistic regression analysis. ResultsA total of 321 children were included with 37 divided into inpatient group and 284 divided into outpatient group. The incidence of electrical injuries was highest in children ≤6 years old and in the summer. There were significantly different in gender, place of occurrence, cause of injury and injury-causing voltage between the two groups (p < 0.05). Injury-causing voltage is an independent risk factor affecting hospitalization of children with electrical injuries (OR = 0.116, 95 %CI = 0.040–0.334, p = 0.000). In children ≤6 years old, boys suffered electrical injuries more frequently than girls; battery powered vehicle (47.53 %) was primarily the cause of injury; most of the patients (64.64 %) were exposed to low voltage below 100 Vs, mainly in the case of adolescent children. ConclusionMale preschoolers accounted for the majority of electrical injury cases, and these accidents mostly happened in household electrical appliances and household battery cars. Overall, it is necessary to improve family electrical safety education and reinforce protective measures against electric injury to children.

Voices from the Ground: Community Perspectives on Preventing Unintentional Child Injuries in Low-Income Settings.

Unintentional injuries significantly contribute to mortality and morbidity among children under five, with higher prevalence in low- and middle-income countries (LMICs). Deprived communities in these regions face increased injury risks, yet there is limited research on child safety tailored to their unique challenges. To address this gap, we conducted focus group discussions in rural Uganda, involving parents, village health workers, community leaders, teachers, and maids. The objective was to understand community perceptions around child safety and determine what culturally and age-appropriate solutions may work to prevent child injuries. Analysis of discussions from ten focus groups revealed five main themes: injury causes, child development and behavior, adult behavior, environmental factors, and potential safety kit components. Common injuries included falls, burns, drowning, and poisoning, often linked to environmental hazards such as unsafe bunk beds and wet floors. Financial constraints and limited space emerged as cross-cutting issues. Participants suggested educational resources, first aid knowledge, and practical devices like solar lamps as potential solutions. The study presents invaluable insights into child safety in rural Ugandan homes, emphasizing the role of community awareness and engagement in designing effective, accessible interventions. It underscores the importance of context-specific strategies to prevent childhood injuries in similar resource-constrained environments.

Craniofacial wound from a traumatic pistol injury in a 3-year-old child

With the advent of traumatic self-defense weapons among Russian civilians (weapons of limited destruction and nonlethal kinetic weapons), several studies on injuries among the adult population have been published in the medical literature. Skull injuries are the most severe, often fatal, injuries. To date, there are only isolated descriptions of such injuries in children.&#x0D; Description of the observation. According to the parents, the 3-year-old boy shot himself in the face with an Osa-4 pistol at home. He did not lose consciousness, and the bleeding was light. He was admitted to the central district hospital, from where he was evacuated by an ambulance team to Children’s City Clinical Hospital No. 9 named after. G.N. Speransky, Moscow. Upon admission, the patient was in a serious condition, conscious, and lethargic, reacted negatively to examination, and had 14 points on the Glasgow coma scale, and his hemodynamics was stable. Local status: In the upper part of the dorsum of the nose, a bullet entry hole was observed in the form of a bruised wound of irregular shape, pronounced swelling in the area of the left orbit, and hematoma of the upper eyelid. X-ray images of the skull showed a shadow of a foreign body (bullet) in the projection of the left orbit and ethmoidal labyrinth. The location and extent of damage were clarified by computed tomography. Under endotracheal anesthesia, a supraorbital trans-eyebrow approach on the left with layer-by-layer tissue dissection along the wound canal exposed a part of the bullet, wedged into the medial wall of the orbit and cells of the ethmoid bone. The bullet was removed, and bone fragments and layer-by-layer sutures were removed. Diagnosis: Gunshot causing a blind craniofacial non-penetrating wound in the dorsum of the nose and left orbit, multiple comminuted fractures of the ethmoid bones and superior and medial walls of the left orbit, contusion of the basal parts of the left frontal region of the brain, blunt trauma OS stage 2, local contusion, and retinal hemorrhage The postoperative period passed without complications. The child received a combination of antibacterial and restorative therapy. Vision was preserved, no neurological disorders were detected, and the cosmetic result was good. The patient was discharged in satisfactory condition under the supervision of an ophthalmologist, neurologist, and maxillofacial surgeon. This observation is presented to demonstrate damage to skull structures from traumatic weapons and will aid in further generalization of the treatment results of this type of wound in children. Prevention of injuries in children from traumatic weapons requires extensive educational work among parents who own these weapons.

Effectiveness Of Skin Barrier Acrylate Terpolymer On Medical Adhesive Related To Skin Injury (MARSI) in Children At Pediatric Intensive Care Unit Dr. Cipto Mangunkusumo Hospital

BACKGROUND: For a long time, the use of medical adhesives in invasive device installation procedures can cause medical adhesive related to skin injury (MARSI) in children; in order to minimize the risk of MARSI incidents, so that a skin barrier is needed before applying the adhesive. OBJECTIVE: The purpose of this study is to determine the effectiveness of acrylate terpolymer skin barrier against medical adhesive related to skin injury (MARSI) prevention in children who are treated at the intensive care unit. METHOD: This study used a true experimental design which involved 46 children; it was divided into an intervention group of 24 respondents and a control group of 22 respondents who were treated by using medical adhesive due to the procedure for inserting an endotracheal tube and nasogastric tube. Samples were taken by using random sampling technique. The risk level of skin injury was assessed by using the Braden Q scale and the MARSI incidents were observed by using the observational format. RESULT: The results showed that the acrylate terpolymer skin barrier was effective in reducing the MARSI in children who were treated at the intensive care unit with having a p-value of 0.03 (α &lt;0.05). The use of an acrylate terpolymer skin barrier can be recommended to minimize the incidence of MARSI in children. CONCLUSION: The use of acrylate terpolymer skin barrier significantly minimizes the incidence of MARSI in children.

Understanding a community’s needs for an emergency department-based childhood injury prevention programme: a mixed-methods study

ObjectiveUnintentional injuries are the most common cause of childhood death in the USA and are preventable. We developed a framework for an injury prevention programme using local injury data and...

Parents’ knowledge towards prevention of unintentional injuries in children aged up to 14 years

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention &amp; Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. The study aims contribute to the epidemiological knowledge of injuries and accidents in Greece and Portugal, through the study of the knowledge of the perceptions of parents and caregivers of children and adolescents between 0 and 14 years old. A descriptive, observational, cross-sectional study was developed in these countries during the period from february till april 2023, under the CHILD Vigilance project. In this study was obtained a total of 577 valid responses, involving 890 children (53,1% male; 46,8% female), with an average age of 8,9 years old. In both countries the mother was the main child carer (60,3% in Greece vs 60,1% in Portugal). In majority of the cases parents had two children (30,1% in Greece vs 44,9% in Portugal). The results revealed that almost all the parents knew about unintentional injuries (82,4 % in Greece vs 92,3% in Portugal), considered that have a big impact on children (89,8% in Greece vs 66,9% in Portugal) and injuries are preventable (63,2% in Greece vs 88,4% in Portugal). Considering data from both countries, the analysis of the association of parents’ knowledge with their occupation showed that civile servant were those who most considered that injuries have a big impact on children (86,5% - mother; 83,2% - father) and that injuries can be preventable (87,9% - mother; 84,9% - father), these differences were statistically significant (p &amp;lt; 0,01). The results may inform the design, implementation and evaluation of interventions to promote safety and prevent accidents in these both countries. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • Education injuries prevention programs addressed to parents should be design considering demographic variables.

Forensic and forensic aspects of childhood traumatism as a result of domestic injuries and traffic accidents: A review

Childhood injuries are a major cause of death and disability worldwide, particularly in low-, and middle-income countries. Recent data showed that about 5 million children die from injuries per year. About 1 million children under 18 years old die of injury and more than 2000 children die per day, of which child injuries account for 5.4% (265 000348 000) of child deaths annually worldwide. A detailed analysis of the epidemiology of childhood injuries can provide possible insights into their prevention and early intervention to reduce future disability due to childhood injuries.&#x0D; In this review, the specificity of childhood body injuries in accidents and road traffic accidents and their qualitative differences from adult injuries were investigated, and current techniques for the detection, fixation, and recovery of childhood body trauma were reviewed through forensic investigation.&#x0D; A literature search was conducted in the Pubmed, Scopus, Ebscohost, Medline, The Cochrane Library, SpringerLink, Web of Knowledge, Paragraph Medicine, and ScienceDirect databases to identify published studies for the last 20 years: from 1993 to 2023. Inclusion criteria were reports of randomized and cohort studies conducted on large populations, meta-analyses and systematic reviews, and articles in English, and Russian. Exclusion criteria were articles describing single cases and case series, published earlier than 1993, materials with no evidence base, abstracts of reports, abstracts, and newspaper articles. Out of 56 literature sources, 44 were selected as an analytical material for this article.&#x0D; The literature review demonstrated that the absolute number of major childhood injuries has not declined over the past decade. Road traffic crashes remain the leading cause of injury and death in children. Adolescents are at greatest risk of serious injuries. Appropriate use of child restraints and safety equipment remains a key factor of the prevention. The adaptation of the urban environment is also a promising approach to child injury prevention among pedestrians and cyclists. As the social environment is a strong determinant of collisions, new road safety interventions must be implemented and evaluated with equity in mind to ensure safe roads for all.

Challenges and Opportunities to the Flow of Communication: Online Focus Groups with Parents of Young Children, Professional Caregivers, and Intermediaries

To explore the information behavior in the context of child injury prevention, we conducted online focus groups with parents, professional caregivers, and intermediaries as part of a larger project. In this paper, we discuss our qualitative interview design: audiovisual, synchronous online focus groups. To do so, we analyze a crucial methodological issue of focus group interviews: the flow of communication. In our study, three main topics emerged that influenced the flow of communication in online focus groups: (a) communication mode(s), (b) (co-)moderation, and (c) distractions and interjections of other people. We conclude that depending on the research topic and target group, audio-only communication may be advantageous compared to audiovisual communication because lay people may disclose more on sensitive topics. Moreover, the considerate composition of the focus group is essential for participants’ interaction, so that all participants feel they have an important part to contribute to the discussion. Skilled co-moderation is crucial to successfully integrating all participants and evolving communication threads, and dealing with disruptions.

Conducting a child injury prevention RCT in the wake of COVID-19: lessons learned for virtual human subjects research.

Unintentional injury is the leading cause of death among children in the United States, and children living in low-income households are particularly at risk for sustaining unintentional injuries. Close parental supervision has been found to reduce young children's risk for injury; however, few studies have examined interventions to increase parental supervision. This paper discusses COVID-19 related modifications that were made to a federally funded randomized controlled trial to reduce low-income children's risk for unintentional injury. The study's procedures (data collection and intervention delivery) had to be transitioned from in-person to a fully virtual format. Modifications that were made to the study included use of: participant cell phones to conduct data collection and intervention sessions; virtual meeting software to conduct sessions with participants and; an online platform to collect questionnaire data. In addition, many modifications were required to complete the in-home observation virtually. In terms of feasibility, the investigators were able to collect all of the data that was originally proposed; however, recruitment and retention was more challenging than anticipated. Lessons learned during the modification process are included to provide guidance to researchers seeking to conduct virtual human subjects research in the future.

Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged

Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app's architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies.