Proper Restraint Use Research Articles

Analysis of rapidly synthesized guest-filled porous complexes with synchrotron radiation: practical guidelines for the crystalline sponge method.

A detailed set of synthetic and crystallographic guidelines for the crystalline sponge method based upon the analysis of expediently synthesized crystal sponges using third-generation synchrotron radiation are reported. The procedure for the synthesis of the zinc-based metal-organic framework used in initial crystal sponge reports has been modified to yield competent crystals in 3 days instead of 2 weeks. These crystal sponges were tested on some small molecules, with two being unexpectedly difficult cases for analysis with in-house diffractometers in regard to data quality and proper space-group determination. These issues were easily resolved by the use of synchrotron radiation using data-collection times of less than an hour. One of these guests induced a single-crystal-to-single-crystal transformation to create a larger unit cell with over 500 non-H atoms in the asymmetric unit. This led to a non-trivial refinement scenario that afforded the best Flack x absolute stereochemical determination parameter to date for these systems. The structures did not require the use of PLATON/SQUEEZE or other solvent-masking programs, and are the highest-quality crystalline sponge systems reported to date where the results are strongly supported by the data. A set of guidelines for the entire crystallographic process were developed through these studies. In particular, the refinement guidelines include strategies to refine the host framework, locate guests and determine occupancies, discussion of the proper use of geometric and anisotropic displacement parameter restraints and constraints, and whether to perform solvent squeezing/masking. The single-crystal-to-single-crystal transformation process for the crystal sponges is also discussed. The presented general guidelines will be invaluable for researchers interested in using the crystalline sponge method at in-house diffraction or synchrotron facilities, will facilitate the collection and analysis of reliable high-quality data, and will allow construction of chemically and physically sensible models for guest structural determination.

Traffic Safety Benefits of Appropriate Adjustment of Head Restraints

Whiplash is the most common injury type arising from motor vehicle collisions, often leading to long-term suffering and disability. Appropriately positioned geometrically suitable head restraints play a important role in protecting vehicle occupants from whiplash injury. Previous available literature suggests that many drivers do not correctly adjust their head restraints due to a lack of awareness of the consequences of incorrect adjustment. Surveys conducted on the general population demonstrated that they were unaware of how head restraints protect them and believed that their current head restraint adjustment was adequate. In general, there is a low awareness about the protective value of head restraint appropriate adjustment. Based on the available literature, there is a significant lack of public awareness surrounding the proper use and correct adjustment of head restraints. It is not only the general public who are unaware of correct positioning, but also those in the medical profession [7]. Health care practitioners are well poised to play a vital role in preventing whiplash injury by educating their patients about traffic safety value of appropriate head restraint adjustment.

Impact of errors in age estimates on the classification of proper child occupant restraint use: an observational survey

BackgroundProper classification of child occupant restraint use is dependent on the age of the child occupant. Observations of vehicle restraint use involve estimating child age. If estimates of age are...

Child Passenger Safety

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

Booster seat legislation: does it work for all children?

ObjectiveTo assess the impact of a booster seat law in Wisconsin on booster seat use in relation to race, ethnicity and socioeconomic status.MethodsA longitudinal study in Milwaukee County, Wisconsin, involving...

Seat belt use during pregnancy in Iran: attitudes and practices

Objective Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use. Methods In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis. Results The mean age of study subjects was 27.3 years±5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy. Conclusion The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.

Factors influencing premature graduation from the use of child restraints in Japan

This study examined the association of child passenger restraint use by younger and older children taking into account situational factors and driver/child passenger characteristics. The Japanese national traffic accident data pertaining to children injured in rear-end collisions where the drivers were not-at-fault was analyzed, while applying the quasi-induced exposure method. Multivariate logistic regression analyses were conducted to examine the adjusted effects of predictors for proper restraint use by 0–5, 6–9, and 10–12-year-old children. Unbelted drivers, child's seating position, the number of total occupants, and the child's age were significantly associated with restraint use by both younger and older children. Riding in the rear seats was strongly associated with older SB-age children not being properly restrained, suggesting a link between the lack of booster seat-use requirements and the generally low restraint use rate in rear seats as well as the premature graduation from CRS use in general. The results were discussed in light of other international findings in this field.

Using in-depth investigations to identify transportation safety issues for wheelchair-seated occupants of motor vehicles

In-depth investigations of motor-vehicle crashes involve detailed inspection, measurement, and photodocumentation of vehicle exterior and interior damage, evidence of belt-restraint use, and evidence of occupant contacts with the vehicle interior. Results of in-depth investigations thereby provide the most objective way to identify current and emerging injury problems and issues in occupant safety and crash protection, and provide important feedback on the real-world performance of the latest restraint-system and vehicle crashworthiness technologies. To provide an objective understanding of real-world transportation safety issues for wheelchair-seated travelers, the University of Michigan Transportation Research Institute (UMTRI) has been conducting and assembling data from in-depth investigations of motor-vehicle crashes and non-crash adverse moving-vehicle incidents, such as emergency vehicle braking, turning, and swerving, in which there was at least one vehicle occupant sitting in a wheelchair. The results of 39 investigations involving 42 wheelchair-seated occupants have been assembled and entered into a wheelchair-occupant crash/injury database. In addition, a biomechanical analysis of each case has been performed to identify key safety issues for wheelchair-seated travelers. The wheelchairs of 34 of the 42 occupants who were seated in wheelchairs while traveling in motor vehicles were effectively secured by either a four-point, strap-type tiedown system or a docking securement device, and all but one of these properly secured wheelchairs remained in place during the crash or non-collision event. However, 30 of the 42 occupants were improperly restrained, either because of non-use or incomplete use of available belt restraints, or because the belt restraints were improperly positioned on the occupant's body. Twenty-six of the 42 occupants sustained significant injuries and 10 of these occupants died as a direct result of injuries sustained, or from complications resulting from those injuries. These findings, when combined with the analyses of the individual cases, point to a need for better driver and caregiver education and training on how to properly secure wheelchairs and position belt restraints on wheelchair-seated passengers. They also point to a need for improved restraint systems used by wheelchair-seated drivers, and a need for wheelchair designs that facilitate the proper use and positioning of vehicle-anchored belt restraints.

Pediatric Cervical Spine Fracture Caused by an Adult 3-Point Seatbelt

The development and use of seatbelts has saved numerous lives and prevented serious injuries in the setting of automobile crashes. However, restraints designed for adults are not necessarily effective in preventing injury to small children and may actually be harmful. Here, we present a case of upper cervical spine fracture in a 5-year-old female patient caused by neck flexion over an inappropriately applied adult 3-point seatbelt during a motor vehicle collision. The American Academy of Pediatrics currently advises against the use of vehicle safety belts until the shoulder belt can be positioned across the chest with the lap belt snug across the thighs. As clinicians who care for children, it is imperative that we continue to educate parents about proper use of age-appropriate child safety restraints.

Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance

Little is known regarding the patterns of appropriate restraint use among minority children involved in motor vehicle collisions. The purpose of this study was to characterize patterns of restraint use among children hospitalized after motor vehicle collision and to examine the effects of race and socioeconomic status on compliance. All children admitted to our level I trauma center over a 10-year period were identified. Patterns of appropriate restraint use were compared between African American (AA) and white children. Compliance was also compared between children insured with Medicaid (as a surrogate for socioeconomic status) and those with private insurance coverage. One thousand two hundred sixty-eight patients were included with an overall restraint use of 44.8% with only 20.3% restrained properly. Compared with white children, AAs were significantly less likely to be properly restrained (12.7% vs 22.2%, P < .001) or to be restrained by any means (28.8% vs 48.7%, P < .001). The greatest disparity between groups was observed in the use of car seats (16.0% vs 47.4%, P < .001). Medicaid patients were less likely to be restrained compared with those with commercial insurance (40.6% vs 48.3%, P = .022); however, race remained a significant predictor of noncompliance after controlling for the effect of insurance status. These data demonstrate an alarming trend because nearly 80% of all children in our study were improperly restrained. Marked disparities in compliance were observed in the AA population even after controlling for insurance coverage. Future studies will need to further characterize the complex interplay between race and socioeconomic status with proper restraint use.

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: U.S. Preventive Services Task Force Recommendation Statement

An assessment of the independent effectiveness of primary care interventions to increase the proper use of child safety seats, booster seats, and lap-and-shoulder belts to prevent motor vehicle occupant injuries (MVOIs) and to prevent alcohol-related MVOIs in adolescents and adults. The U.S. Preventive Services Task Force reviewed evidence on the effectiveness of counseling in primary care about the proper use of child restraints in motor vehicles to prevent injury, as well as evidence on the impact of primary care counseling to prevent alcohol-related MVOIs in adolescents and adults. This included information gathered in the process of making their 1996 recommendation, as well as the accompanying systematic review of English-language articles published through 2005. Current evidence is insufficient to assess the incremental benefits, beyond the efficacy of legislation and community-based interventions, of counseling in the primary care setting to improve rates of proper use of motor vehicle occupant restraints. (I statement) Current evidence is insufficient to assess the balance of benefits and harms of routine counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired. (I statement).

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Motor vehicle-related injuries are the leading cause of death among children, adolescents, and young adults. To systematically review evidence of the effectiveness of counseling people of any age in primary care settings about occupant restraints or alcohol-related driving to prevent injuries. MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, and Traffic Research Information Service; published systematic evidence reviews; experts; and bibliographies of selected trials. Randomized, controlled trials (RCTs); controlled clinical trials (CCTs); or comparative observational research studies that evaluated behavioral counseling interventions feasible to conduct in primary care or referral from primary care. Investigators abstracted data on study design, setting, patients, interventions, outcomes, and quality-related study details. Trials report that counseling to increase the use of child safety seats leads to increased short-term restraint use (7 CCTs, 6 RCTs). Interventions that included a demonstration of correct use or distribution of a free or reduced-cost child safety seat reported larger effects. Few trials described the effect of counseling children 4 to 8 years of age to use booster seats (1 RCT); counseling older children, adolescents, or adults to use seat belts (1 CCT, 2 RCTs); or counseling unselected primary care patients to reduce alcohol-related driving behaviors (no trials). Most of the relevant trials were published before the widespread enactment of child safety seat legislation and had methodological flaws. The incremental effect of primary care counseling to increase the correct use of child safety seats in the current regulatory environment is not established. The effectiveness of primary care counseling to reduce alcohol-related driving has not been tested. Studies are needed.

Counseling About Proper Use Of Motor Vehicle Occupant Restraints And Avoidance Of Alcohol Use To Prevent Injury: U.S. Preventive Services Task Force Recommendation Statement: United States Preventive Services Task Force

Counseling About Proper Use Of Motor Vehicle Occupant Restraints And Avoidance Of Alcohol Use To Prevent Injury: U.S. Preventive Services Task Force Recommendation Statement: United States Preventive Services Task Force

A DESCRIPTIVE ANALYSIS OF MOTOR VEHICLE CRASHES AT AN URBAN CHILDRENʼS HOSPITAL FOLLOWING AN EDUCATIONAL INTERVENTION ON CHILD RESTRAINT.

Purpose Motor vehicle crashes (MVCs) are the leading cause of morbidity and mortality in children. Studies have shown that use of proper safety restraints can improve the rate of death and injuries. Since 1998, Alabama has made significant improvements in MV legislation, educational services, and established car seat-fitting programs. Consequently, significant increases in car seat use have occurred. This study analyzes MVC trauma patient visits at a local pediatric trauma center from 1998 through 2005. The primary study question is do recent improvements in MV safety in Alabama lead to discernible changes in pediatric MVC visits at a hospital trauma center? Methods A trauma database is maintained by the trauma service coordinator at the Children9s Hospital of Alabama. All patients who are activated as trauma patients are entered into the database. MVC data include basic demographic information, type of trauma, if restraints were used, and, if so, what kind. Injury severity scores and disposition information were also noted. After institutional review board approval, the database was accessed for MVA trauma code information. Data were analyzed using Epi Info®. Results Since 1998, the total number of trauma codes has averaged 446 per year. The proportion of MVC codes has decreased from 52.6% of total codes in 1998 to 46.4% in 2005 (z = 1.78, p = 08). The average age of the MVC patient in 1998 was 8.2 years compared with 9.0 years in 2005. The percentage of MVC trauma patients discharged from the hospital has not changed (95.3% in 1998 compared with 95.9% in 2005). The number of MVC trauma patients using some form of restraint increased from 37.6% in 1998 to 51.3% in 2005 (z = 4.05, p Conclusions Statewide MV laws, educational interventions, and car seat-fitting services working in tandem can lead to significant increases in car seat use with corresponding decreases in MVC injury. This research demonstrates that such decreases can be detected at local levels using trauma code patient data sets. These data sets are a useful surveillance method that can help evaluate the effectiveness of statewide interventions.

Parenteral injections.

This unit describes the techniques for the following routes of injection for mice, rats, hamsters and rabbits: intramuscular, intradermal, subcutaneous, intravenous, intraperitoneal, footpad, and intrathymic. Guidelines are also given regarding injection volumes and temperatures, and the use of proper restraints.

Parenteral Injections

AbstractThis unit describes the techniques for the following routes of injection for mice, rats, hamsters and rabbits: intramuscular, intradermal, subcutaneous, intravenous, intraperitoneal, footpad, and intrathymic. Guidelines are also given regarding injection volumes and temperatures, and the use of proper restraints.

Seatbelt Use During Pregnancy: A Comparison of Women in Two Prenatal Care Settings

This study examines knowledge of proper automobile restraint use during pregnancy and attitudes toward restraint use. This manuscript, the second in a series, compares knowledge and attitudes in two populations of pregnant women, those receiving prenatal care at several county clinics and those receiving care in a private practice. A survey requesting demographic information and frequency and knowledge of proper automobile restraint use was administered during prenatal visits. County clinic patients (n = 450, 70% black) were younger and less educated than private practice patients (n = 203, 75% non-Hispanic white). Fewer county patients (49%) always wore seatbelts prior to the pregnancy than private practice patients (88%). Correct use was reported by fewer county clinic patients (67%) than private practice patients (83%). Few (25-28%) in either setting reported receiving information on seatbelt use. Despite existing knowledge with respect to the consequences of seatbelt non-use in pregnant women, the proportion of women receiving information about correct seatbelt use during pregnancy appears to be low, regardless of care source.

Use of Physical Restraints in Nursing Homes: Current Practice in Singapore

Introduction: One of the indicators of quality care in nursing homes is the proper use of physical restraints. Restraints have been associated with multiple complications, such as pressure ulcers, incontinence and immobility. The aim of our study was to assess the indication, use and complications related to physical restraints in Singapore nursing homes. Materials and Methods: All residents aged &gt;65 years old from 3 nursing homes were included in the study. A geriatrician reviewed the medical records of all elderly residents on restraints. Nursing staff interviews were also done to assess their knowledge regarding restraint use. A brief medical record review was also done for the elderly residents without restraints. Results: Out of 390 elderly residents, 91 were on physical restraints. The mean age of these residents were 80.1 years; 67% were female, 90.1% were Chinese and 82.4% belonged to functional category IV. Both urinary and faecal incontinence were observed in 97.8% of residents. Forty-six (50.5%) residents had no documented indication for restraints. It was noted that 20 (22%) residents were restrained to prevent dislodgement of the feeding tube, 17 (18.7%) were restrained to prevent falls and 8 (8.8%) were restrained for agitation. There were documented trials of removal of restraints for only 21 (23.1%) residents. Alternative approaches, such as diversion technique, were used for 31 (34.1%) residents to avoid restraint use. Conclusion: Our study revealed a high rate of restraint use in the nursing homes. A restraint protocol should be available in every nursing home, requiring physician approval for the long-term application of physical restraints and intermittent reviews by physicians to assess the continued need for restraints.

GREENBERG-SETH ET AL. RESPOND

We agree with the points raised by Hyder. It is important to design programs that effectively communicate injury prevention messages to people with lower incomes, limited literacy, or limited access to media. We think that community participation in program design and evaluation is a key to accomplishing this. Any intervention, domestic or abroad, in low- or high-income communities, should begin with formative evaluation to determine literacy needs, community resources, and credible and accessible sources of information. Involving members of the population one is trying to reach is critical. Proven strategies should be modified or adapted for different settings or countries and evaluated in those settings. In our study, the goal was to increase child rear seating in conjunction with proper restraint use by reinforcing educational messages with incentives for positive behavior. We made special attempts to reach lower-income segments of the population through collaboration with existing community organizations, including those that primarily serve low-income residents. The community task force formulated much of the intervention design. Focus groups and interviews with members of the target population were used to test for appropriateness of materials and distribution channels. The greater improvement at observation sites in higher-income areas was unexpected, given the level of community participation and our formative research. We are unable to assess whether the difference in impact is because our message did not reach as many of the families we observed in lower-income areas or because the families we observed in higher-income areas were more likely to change their behavior. However, even if the direct impact of an intervention is greater in higher-income areas, programs that take a participatory approach to design and implementation can have indirect or unanticipated benefits in addition to changing the intended behavior. Organizing the community to address a specific issue allows people and organizations to collaborate in new ways. Building these relationships can strengthen the community’s capacity for addressing other issues. Through surveys and informal observations, we learned that members of our community task force began to extend their relationships beyond the project and were collaborating on other injury prevention, health promotion, and community-building projects. We think that a participatory approach can be effective regardless of the country in which the intervention takes place, the target audience, or the injury topic being addressed.

Knowledge, Beliefs, and Practices Concerning Seat Belt Use During Pregnancy

This study seeks to evaluate the comprehension of and attitudes toward proper restraint use among women attending prenatal care clinics. Four-hundred and fifty women were asked to complete a survey during prenatal care visits at county health department clinics; the response rate was 92.0%. Women were asked to provide demographic information and report their frequency and knowledge of proper automobile restraint use. Nearly all subjects (95.4%) either maintained or increased their pre-pregnancy frequency of restraint use. Three-hundred (72.5%) subjects demonstrated that they wore their restraints in the correct location, with women who wore restraints more frequently being more likely to report correct placement. Two-hundred and forty-nine (60.1%) of women reported that restraints would protect their baby if they were involved in a collision, while 48 (11.6%) thought the restraints would cause injury to their baby, and 153 (37.0%) were unsure. Women who reported that restraints would protect them and their baby if involved in a collision were significantly more likely to report always wearing restraints compared with those who were unsure or had negative perceptions of restraints (84.4% vs. 64.6%; p < 0.0001). The most commonly reported reasons for lack of restraint use were lack of comfort (52.8%) and forgetfulness (42.5%). Only 36.9% percent of women reported receiving information regarding restraint use during their current pregnancy. Many gravid women lack information regarding proper seat belt use and their role in injury prevention. Consequently, the frequency of seat belt use and its correct placement are negatively impacted. Health care workers should take an active role in educating pregnant gravid women about proper restraint use.