Safe Play Areas Research Articles

Peculiar penetrating oropharyngeal foreign body accident: a case report and review of literatures

BackgroundChildren are curious to learn and are always explorative. This exploration is sometimes by keeping things in the oral cavity resulting in cases of foreign body in the aerodigestive tract. Penetrating oropharyngeal foreign bodies can result in significant morbidity and mortality if not treated promptly. The usual objects implicated in children are pens, pipes and toys which are cylindrical. The injury commonly occurs when the child falls with foreign body in the mouth. Here, we present a case report of a peculiar penetrating oropharyngeal foreign body accident.Case presentationA 7-year-old boy was brought to the emergency room with an alleged history of foreign body insertion into the mouth while playing with a rigid metallic rod which was bent in the end. Following a forceful hit on the head of the child by his sibling from behind, the rod got impacted into the mouth. The screening X-ray revealed an impacted foreign body. Non-contrast computed tomography scan was done on an emergency basis. It revealed hook-shaped metallic foreign body in the oral cavity and penetrating the oropharynx at the tongue base region. The effective total length of FB was 30 cm with an embedded intraglossal component of 2.5 cm. To aid in intubation, the extraoral part of the foreign body was cut short preoperatively. C-MAC video laryngoscope was used to aid in intubation. A backup plan for emergency tracheostomy was made in case of failed intubation. The foreign body was held using Kocher’s artery forceps and removed completely under endoscopic visualisation without any significant bleeding from the site of entry.ConclusionThe unusual shape, the relatively narrow space in the patient and the tongue being a vascular structure were challenges in the removal of the foreign body. Due to the hook shape, it had to be withdrawn cephalad for removal. Penetrating oropharyngeal foreign body should not be pulled out either at primary care or in the emergency room but should be referred to experienced ENT surgeons. Critical teamwork between the ENT surgeon and the anaesthetist with well-defined preoperative plans for airway management is necessary. Awareness and ensuring safe play areas for children will prevent a great deal of penetrating oropharyngeal foreign body.

How Can Physical Inactivity in Girls Be Explained? A Socioecological Study in Public, Subsidized, and Private Schools.

In the last few years, the World Health Organization has highlighted that physical inactivity is a global issue affecting women to a greater extent than men. Faced with this, different nation states have developed public policies to reduce physical inactivity at school; however, the biomedical and individualistic models used have generated widespread criticism, as figures remain the same. In the context of failed interventions on increasing levels of physical activity, this study utilizes a socioecological model to analyze and understand how physical inactivity is reproduced in girls in the Chilean education system. A qualitative study was implemented, as it allows a focus on the entailed meanings, context, and processes. Active semi-structured interviews were conducted with 40 groups comprising headmasters, teachers, non-teachers, students, and families. The results show that physical inactivity is linked to factors that go beyond the individualistic model; that is, consideration must include intrapersonal, interpersonal, organizational, community, and public policy dimensions. Furthermore, gender stereotypes gain relevance in physical education classes, in addition to friendships and family, teaching, and administrative work, access to safe play areas, use of spaces, and widespread cultural factors associated with men and women. This study concludes that the assessed gender differences should be approached from a pedagogical perspective beyond common sense, further reporting that the individualized explanation for physical inactivity is irrelevant to answer why women are more inactive than men.

Child Farm-Related Injury in Australia: A Review of the Literature.

Children on farms have been identified as a population vulnerable to injury. This review seeks to identify child farm-related injury rates in Australia and to determine the key hazards and contributing risk factors. This critical review utilised the PRISMA guidelines for database searching. Research from the year 2000 onward was included as well as earlier seminal texts. Reference lists were searched, and the relevant research material was explored. Our primary focus was on Australian peer-reviewed literature with international and grey literature examples included. Evidence suggests that there is limited Australian research focusing on child farm-related injuries. Child representation in farm-related injuries in Australia has remained consistent over time, and the key hazards causing these injuries have remained the same for over 20 years. The factors contributing to child rates of farm injury described in the literature include child development and exposure to dangerous environments, the risk-taking culture, multi-generational farming families, lack of supervision, child labour and lack of regulation, limited targeted farm safety programs, underuse of safe play areas, financial priorities and poor understanding and operationalisation of the hierarchy of control. It is well known that children experience injury on farms, and the key hazards that cause this have been clearly identified. However, the level of exposure to hazards and the typical attitudes, behaviours and actions of children and their parents around the farm that contribute to chid injury remain unexplored.

Breastfeeding practices in the United Kingdom: Is the neighbourhood context important?

A cross-sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual- and familial-level socio-demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area-based approaches and the broader determinants of social inequalities.

Are children playgrounds safe play areas? Inorganic analysis and lead isotope ratios for contamination assessment in recreational (Brazilian) parks.

In city playgrounds, there is a potential risk of harming children's health by contamination coming from anthropogenic activities. With the aim to determinate the sources and the risk of hazardous elements, soil samples were collected in 19 selected playgrounds of different urban and rural areas from the Rio Grande do Sul state (Brazil). The concentration of 23 metals and metalloids and lead isotopic ratios were determined by ICP-MS. The methodology proposed here, firstly, classified the parks according to the average metal content by means of the NWACs (Normalized-and-Weighted Average Concentrations) and assess the contamination risk determining the Contamination Factors (CFs). Finally, statistical tools (correlation analysis and principal component analysis) were used to identify the most important contamination sources. The statistical tools used, together with lead isotopic composition analysis of the samples, revealed that coal combustion is the main source of contamination in the area. Vegetation was identified as a barrier for the contamination coming from the city. Nonetheless, some of the soils present a possible toxicological risk for humans. In fact, Cr, Sb, and Pb concentrations were higher than the Residential Intervention Values (VIRs) defined by the Environmental Protection Agency of the State of São Paulo, also in Brazil.

The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach

ObjectivesThis study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama. MethodsTo address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors. ResultsDuring concept mapping, residents generated statements that clustered into three distinct concepts, “Increased Leisure Physical Activity,” “Safe Play Areas,” and “Generating Health Promoting Resources.” The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant. ConclusionsThese results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained.

Evolving from reactive to proactive medicine: community lead (Pb) and clinical disparities in pre- and post-Katrina New Orleans.

In 2012 the U.S. Centers for Disease Control (CDC) set the blood Pb reference value at ≥5 µg/dL. Clinical analysis of children’s blood Pb levels is the common way to diagnose environmental Pb contamination, and intervention ensues with education and household dust cleanup. Recent review indicates that education and household dust cleanup are not effective at reducing children’s Pb exposure. Here we review mapping environmental Pb and children’s blood Pb response as an alternative approach for proactive Pb dust intervention. New Orleans was divided into a high (≥100 mg/kg) and low (<100 mg/kg) soil Pb communities. The children’s blood Pb prevalence ≥5 µg/dL for the high and low Pb domains were 58.5% and 24.8% respectively pre-Katrina vs. 29.6% and 7.5% post-Katrina. Elevated soil Pb (mg/kg) and consequently Pb loading (µg/square area) permeates the high Pb domain and outdoor locations lack Pb dust safe play areas. The U.S. EPA 400 mg/kg soil Pb standard poses an outside Pb dust loading burden >37 times larger than allowed on interior residential floor environments. Environmental Pb dust is decreasing because of the transfer of large quantities of low Pb soil into selected communities. City-scale soil Pb mapping is an alternative diagnostic tool that provides information for planning proactive medicine to prevent clinical Pb exposure in the first place.

Safe play areas on farms in New South Wales

To assess the prevalence and security of fenced house yards on NSW farms and rural properties with a view to providing information to increase the development of safe play areas on farms. A cross-sectional stratified study using computer-assisted telephone interviewing. Interviews were conducted in the four rural Area Health Services throughout February to December 2008. Randomly selected sample of 1117 adults living on a farm or rural property in the study areas. Self-reported issues involving fenced house yards or safe play areas for children. Overall, 79.8% of farm respondents reported that they had a fenced house yard or safe play area. For those respondents with a fenced house yard, 66.6% reported that it was secure enough to prevent /make it difficult for a young child to wander away unsupervised. Based on these figures, it is estimated that only 53.1% of all farms or rural properties have a secure fenced house yard or safe play area. There were statistically significant variations between geographic locations, with the North Coast (37.7%) being lower. This study illustrates a need across rural NSW to further promote, install or upgrade secure fenced house yards or safe play areas. While all geographic regions of the state could improve provision to protect children, there may also be some that are in need of more intensive intervention programs to enhance compliance. Such a proposition may also be relevant on a national level.

A Place to Play: Teaching Communities How To Build Playgrounds

This case study focuses on the development of a train-the-trainer program which blends online resources and face-to-face instruction to assist people in leading communities which want to design and build safe and culturally-appropriate play areas. The case outlines the development of online resources and the iterations involved in developing and implementing strategies for face-to-face instruction.

Children’s physical activity and parents’ perception of the neighborhood environment: neighborhood impact on kids study

BackgroundPhysical activity is important to children’s physical health and well-being. Many factors contribute to children’s physical activity, and the built environment has garnered considerable interest recently, as many young children spend much of their time in and around their immediate neighborhood. Few studies have identified correlates of children’s activity in specific locations. This study examined associations between parent report of their home neighborhood environment and children’s overall and location-specific physical activity.MethodsParents and children ages 6 to 11 (n=724), living in neighborhoods identified through objective built environment factors as high or low in physical activity environments, were recruited from Seattle and San Diego metropolitan areas, 2007–2009. Parents completed a survey about their child’s activity and perceptions of home neighborhood environmental attributes. Children wore an accelerometer for 7 days. Multivariate regression models explored perceived environment correlates of parent-reported child’s recreational physical activity in their neighborhood, in parks, and in general, as well as accelerometry-based moderate-to-vigorous activity (MVPA) minutes.ResultsParent-reported proximity to play areas correlated positively with both accelerometery MVPA and parent-reported total child physical activity. Lower street connectivity and higher neighborhood aesthetics correlated with higher reported child activity in the neighborhood, while reported safety from crime and walk and cycle facilities correlated positively with reported child activity in public recreation spaces.ConclusionsDifferent aspects of parent’s perceptions of the neighborhood environment appear to correlate with different aspects of children’s activity. However, prioritizing closer proximity to safe play areas may best improve children’s physical activity and, in turn, reduce their risk of obesity and associated chronic diseases.

Black Mothers' Perceptions about Urban Neighborhood Safety and Outdoor Play for their Preadolescent Daughters

Using narratives of single low-income Black mothers with preadolescent children in a high-crime neighborhood in Newark, New Jersey, this study aims (1) to understand if and how neighborhood safety influences mothers' decisions about allowing their daughters to play outdoors and (2) to identify what neighborhood changes would need to occur to alter their perceptions about safety. Mothers reported that unpredictable violence, related to drug and gang activity of neighbors, and the absence of safe play areas in their neighborhood led them to sequester their daughters indoors. Hostile neighborhood conditions contributed to children's physical inactivity and put girls at risk for obesity.

The Use of Focus Groups to Mobilize a High-Risk Community in an Effort to Prevent Injuries

Youth involved in supervised activities and provided with safe play areas during high-risk times will sustain fewer injuries. This qualitative focus group study of community organizations, parents, and youth in a high-risk community demonstrated barriers to participation in and resources available for after-school programs, as well as components of an ideal after-school program. Community organizations believed pooling resources and holding programs in centralized locations, such as schools, would make programs more affordable and overcome transportation barriers. Parent and youth also preferred to hold activities in schools; however, parents were concerned with the cost of programs and times they were offered, while students were more concerned with age appropriate, safe programs that prohibited “bullies” from participating. Specific suggested program contents were similar between parents and youth. Information gathered from the focus groups had significant implications for program and resource development in the targeted community.

Associations between health and different types of environmental incivility: A Scotland-wide study

Concern about the impact of the environment on health and well-being has tended to focus on the physical effects of exposure to toxic and infectious substances, and on the impact of large-scale infrastructures. Less attention has been paid to the possible psychosocial consequences of people's subjective perceptions of their everyday, street-level environment, such as the incidence of litter and graffiti. As little is known about the potential relative importance for health of perceptions of different types of environmental incivility, a module was developed for inclusion in the 2004 Scottish Social Attitudes survey in order to investigate this relationship. A random sample of 1637 adults living across a range of neighbourhoods throughout Scotland was interviewed. Respondents were asked to rate their local area on a range of possible environmental incivilities. These incivilities were subsequently grouped into three domains: (i) street-level incivilities (e.g. litter, graffiti); (ii) large-scale infrastructural incivilities (e.g. telephone masts); and (iii) the absence of environmental goods (e.g. safe play areas for children). For each of the three domains, the authors examined the degree to which they were thought to pose a problem locally, and how far these perceptions varied between those living in deprived areas and those living in less-deprived areas. Subsequently, the relationships between these perceptions and self-assessed health and health behaviours were explored, after controlling for gender, age and social class. Respondents with the highest levels of perceived street-level incivilities were almost twice as likely as those who perceived the lowest levels of street-level incivilities to report frequent feelings of anxiety and depression. Perceived absence of environmental goods was associated with increased anxiety (2.5 times more likely) and depression (90% more likely), and a 50% increased likelihood of being a smoker. Few associations with health were observed for perceptions of large-scale infrastructural incivilities. Environmental policy needs to give more priority to reducing the incidence of street-level incivilities and the absence of environmental goods, both of which appear to be more important for health than perceptions of large-scale infrastructural incivilities.

Safe Play Areas for Prevention of Young Children Drowning in Farm Dams

INJURIES ARE THE LEADING cause of death to young children in rural Australia, with drowning in farm dams being a major risk. This paper assesses the impact of an intervention to increase safe play areas on farms to prevent unsupervised access by young children to water bodies and other hazards. Surveys of 1,117 adult farmers attending Ag Quip Agricultural Field Days in NSW between 2003 and 2007 were used to identify the child security level of fences and changes in the percentage of farms with fenced house yards. Over this four-year period, the percentage of people who had a fenced yard on their farm ranged from 75 per cent to 79 per cent with no significant fluctuations. However, those with a safe play area who stated the area was difficult/almost impossible for a child 0-5yrs to breach, ranged from 40 per cent to 55 per cent over the period, with a statistically significant positive trend (X2=13.46 df=4 p≤.01). Actions to improve child safety on farms and recall of child farm safety messages in the media in association with programs promoting securely fenced house yards are also discussed. In order to affect further reduction in child drowning incidents, there is an ongoing need to promote improved security of fenced house yards on farms in Australia.

Making a reality of the slogan.

Making a reality of the slogan.

An evidence-consultation base for developing child injury prevention priorities for Australian farms

Child injury on farms is a significant public health problem. This article describes the evidence and consultation base for development of a national strategy for child safety on farms in Australia. A data profile describing farm child injury was compiled, with evidence for the effectiveness of solutions being defined and the strength of recommendations determined. Representative working groups played a key role in assessing the evidence and advising on the best ways to communicate prevention messages within the farming community. The main risks identified were drowning; farm vehicle and machinery injury; and injury associated with motorbikes and horses. Prevention recommendations were: (1) creating effective safe play areas on farms; (2) use of seatbelts/restraints in farm vehicles, (3) prevention of children riding as passengers on tractors, ATVs or the back of utilities; and (4) use of helmets when riding horses and motorbikes. Evidence on key injury risks and solutions has been a cornerstone to set the agenda for child safety on farms. An evidence-consultation base has achieved credibility with potential partners at all levels for adopting priority child safety messages.

What do parents and preschool staff tell us about young children's physical activity: a qualitative study.

BackgroundPhysical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours.MethodsThis research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17 carers) participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia) metropolitan region.ResultsAll participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff expressed concern that free, creative active play was being lost and that alternate activities were increasingly sedentary.ConclusionThe findings support the relevance of the socioecological model of behavioural influences to young children's physical activity. In this age group, efforts may best be directed at emphasising national guidelines for small screen recreation and educating families and carers about the importance of creative, free play to reinforce the child's inherent nature to be active.

Reducing Injury Rates Using a Community-Based Approach

Injuries are the number one cause of morbidity and mortality to persons aged 1-44 years in the United States. Community-based interventions offer one approach to reducing injuries. To determine whether injuries could be reduced over a 5 year period by at least 20% in a midwestern community using a proven community-based model compared with three control communities. The Injury Free Coalition for Kids of Greater Cincinnati began its injury-reducing efforts within one Intervention Community (IC) in 2000. After reviewing injury data, engaging community members, and holding focus groups to assess community needs, specific structural and social alterations were made to engage youth in safe, supervised activities and provide them with safe play places. Data were obtained from the Hamilton County Injury Surveillance System from 1999-2004 for deaths, hospitalizations, and emergency department visits. Data in our IC were compared with three control communities in the city with similar demographics and socioeconomic characteristics. 2000 Census data were used to calculate injury rates. During study period, 5065 IC youth sustained 3796 injuries, while 9297 youth from the control settings sustained 5445 injuries. Injury rate in the IC decreased 42% from 1999 to 2004, 17551.83 to 10187.56 injuries/100,000 children/year, respectively, compared with the mean rate among the three control sites, which decreased 25.7%, 12950.41 to 9626.76 injuries/100,000 children/year. This difference was statistically significant, p < 0.001. Community prevention efforts that engage youth in supervised activities and provide safe play areas can help to reduce youth injuries within specific high-risk communities.

Perceptions of the Local Environment and Their Associations With Health

TM2-O-08 Introduction: Concern about the impact of the environment on health and well-being has tended to focus on the physical effects of exposure to toxic and infectious substances. The focus has been on large-scale infrastructure rather than on more subjective perceptions of street-level aspects of neighborhoods such as litter and graffiti, which are increasingly regarded as components of environmental justice. It has been suggested that more attention should be focused on psychosocial impacts (eg, feelings about the quality of the local environment) upon health and well-being. However, little is known about the relative importance upon health of perceptions of different components of environmental justice. Methods: A random sample of 1637 adults across a range of neighborhoods in Scotland were interviewed as part of the 2004 Scottish Social Attitudes survey. Respondents were asked to rate their local area on the amount of, and perceived problem with (both currently or potentially present), a range of aspects of their local neighborhood. These were subsequently grouped into 3 domains: 1) “street level incivilities” (eg, litter, graffiti), 2) large-scale infrastructure (eg, phone masts), and 3) the absence of “environmental goods” (eg, safe play areas for children). In addition to collecting information on respondents' socio-demographic characteristics, we also gathered data on respondents' views of their own health and well-being and health behaviors (smoking and physical activity). For each of the 3 domains of perceived local environment, we examined their prevalence, and extent to which they presented a problem, according to respondents' individual characteristics or the characteristics of the area in which they live; we then explored relationships between reported experience of each of the 3 domains and self-assessed health and behavior (using logistic regression). Results: Higher levels of perceived “street-level incivilities” and absence of “environmental goods” were associated with increased anxiety and depression and an increased likelihood of smoking, even after taking other known correlates into account (such as gender, age, and social class). Few associations with health were observed for perceptions of the larger-scale infrastructural items. Conclusions: Environmental policy needs to give more priority to reducing the incidence of “street-level incivilities” and the absence of “environmental goods,” both of which appear to be more important for health than perceptions of larger scale infrastructural items. We propose the construction of a new index of environmental quality, which could be used to monitor the quality of local neighborhoods and inform policy aimed at reducing health inequalities.

The best of times and the worst of times

The best of times and the worst of times