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Biomedical subjects

D Kendrick

Publications and source records attributed to D Kendrick.

At least 37 records · Page 2Linked to original sources
PubMed2001

Practice nurse and health visitor management of acute minor illness in a general practice.

OBJECTIVE: To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. DESIGN: Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. SETTING: A general practice in Nottingham, England. MAIN OUTCOME MEASURES: Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. RESULTS: About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P < 0.001). CONCLUSION: With suitable training, PNs and HVs can successfully manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

Community Health Nursing↗
PubMed2001

Randomised controlled trial assessing the impact of increasing information to health visitors about children's injuries.

AIMS: To assess the effect on health visitor action of providing community health visitors with information on all injury attendances in children under 5 attending an accident and emergency (A&E) department and of providing additional information about each injury. METHODS: Children under 5 years attending the A&E department at Queen's Medical Centre, Nottingham between October 1998 and April 1999 were studied, using a randomised controlled trial with a 2x2 factorial design. All attendances or selected attendances (all children under 1, burns and scalds, poisonings, head injuries, and repeat attendances in preceding six months) were notified. Provision of standard (diagnosis, circumstances surrounding injury, and disposal) or additional information (standard information plus place of injury, number of A&E attendances for injury in previous year, and any information recorded about safety equipment) was noted. RESULTS: Many notifications (56%) do not result in any action. Health visitors were nearly twice as likely to take action of some kind and three times as likely to undertake a home visit on receipt of notifications for selected attendances than on those for all attendances. A greater number of actions per notification were taken on receipt of information about selected attendances. Providing additional information had little effect on the action taken. CONCLUSIONS: A selective policy for notifying community health visitors of child injury attendances at A&E results in a greater proportion of attendances in which the health visitor takes action and in a greater number of actions per attendance being taken. The utility of notifying all injury attendances is questionable, as many do not result in any action.

Accident Prevention↗
PubMed2001

Do self reported safety behaviours predict childhood unintentional injuries?

OBJECTIVE: The aim of this study was to investigate the validity of self reported safety behaviours as a proxy for injuries in unintentional injuries research. SETTING: The study population comprised parents and guardians of children aged 3-12 months in 18 general practices throughout Nottingham (n = 764) who responded to a questionnaire on safety practices. METHOD: Injury data were collected by searching the primary and secondary care records of each child in the study. Safety behaviour was measured by computing a safety practices score from self reported safety practices for each respondent to a postal baseline questionnaire survey of safety behaviours. The score was used to classify families into low, medium, and high risk of injury occurrence. Two further scores were calculated, firstly for those safety practices which required obtaining an item of safety equipment, and secondly those safety practices requiring behavioural change without cost implications. RESULTS: High risk families were no more likely than low risk families to sustain an injury (odds ratio (OR) 1.08; 95% confidence interval 0.65 to 1.79). Medium risk families were also no more likely than low risk families to have a medically attended injury (OR 1.09; 0.73 to 1.61) suggesting no association between safety score and future medically attended injury. Similarly, compared to low risk families, medium risk (OR 0.93; 0.33 to 2.61) and high risk (OR 0.46; 0.08 to 2.43) families were no more likely to have a child admitted to hospital with an injury. There was no correlation between the total number of injuries sustained during the study period and the baseline safety practices score (Spearman's rho = 0.004; p = 0.917). Subgroup analyses for safety behaviours requiring passive and active safety measures did not reveal significant associations with injury outcomes. CONCLUSION: Self reported safety behaviours do not appear to be good predictors of childhood unintentional injuries. Further research is required to ascertain valid proxy outcome measures for injury research.

Attitude to Health↗
PubMed2001

Do safety practices differ between responders and non-responders to a safety questionnaire?

OBJECTIVE: To compare reported safety practices between responders and non-responders to a safety survey. DESIGN: Cross sectional survey at baseline compared with safety practices reported at subsequent child health surveillance checks. SUBJECTS: Parents of children aged 3-12 months registered with practices participating in a controlled trial of injury prevention in primary care that did, and did not, respond to the baseline survey and who subsequently attended child health surveillance checks. RESULTS: No difference in safety practices was found between responders and non-responders to the survey at the 6-9 month check. Responders were more likely to report owning a stair gate (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.82 to 4.16) and socket covers (OR 2.16, 95% CI 1.53 to 3.04) at the 12-15 month check, and owning socket covers (OR 2.19, 95% CI 1.34 to 3.61) at the 18-24 month check. Responders were more likely to report greater than the median number of safety practices at the 18 month check. CONCLUSIONS: Non-responders to a safety survey appear to be less likely to report owning several items of safety equipment than responders. Further work is needed to confirm these findings. Extrapolating the results of safety surveys to the population as a whole may lead to over estimation of safety equipment possession.

Attitude to Health↗
PubMed2001

The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial.

OBJECTIVES: To test the hypotheses that: (1) Lumbar spine radiography in primary care patients with low back pain is not associated with improved patient outcomes, including pain, disability, health status, sickness absence, reassurance, and patient satisfaction or belief in the value of radiography. (2) Lumbar spine radiography in primary care patients with low back pain is not associated with changes in patient management, including medication use, and the use of primary and secondary care services, physical therapies and complementary therapies. (3) Participants choosing their treatment group (i.e. radiography or no radiography) do not have better outcomes than those randomised to a treatment group. (4) Lumbar spine radiography is not cost-effective compared with usual care without lumbar spine radiography. DESIGN: A randomised unblinded controlled trial. SETTING: Seventy-three general practices in Nottingham, North Nottinghamshire, Southern Derbyshire, North Lincolnshire and North Leicestershire. Fifty-two practices recruited participants to the trial. SUBJECTS: Randomised arm: 421 participants with low back pain, with median duration of 10 weeks. Patient preference arm: 55 participants with low back pain, with median duration of 11 weeks. INTERVENTION: Lumbar spine radiography and usual care versus usual care without radiography. MAIN OUTCOME MEASURES: Roland adaptation of the Sickness Impact Profile, visual analogue pain scale, health status scale, EuroQol, use of primary and secondary care services, and physical and complementary therapies, sickness absence, medication use, patient satisfaction, reassurance and belief in value of radiography at 3 and 9 months post-randomisation. RESULTS: Participants randomised to receive an X-ray were more likely to report low back pain at 3 months (odds ratio (OR) = 1.56; 95% confidence interval (CI), 1.02 to 2.40) and had a lower overall health status score (p = 0.02). There were no differences in health or functional status at 9 months. A higher proportion of participants consulted the general practitioner (GP) in the 3 months following an X-ray (OR = 2.72; 95% CI, 1.80 to 4.10). There were no differences in use of any other services, medication use or sickness absence at 3 or 9 months. No serious spinal pathology was identified in either group. The commonest X-ray reports were of discovertebral degeneration and normal findings. Many patients did not perceive their information needs were met within the consultation. Satisfaction with care was greater in the group receiving radiography at 9 months. Participants randomised to receive an X-ray were not less worried, or more reassured about serious disease causing their low back pain. Satisfaction was associated with meeting participants' information needs and reduced belief in the necessity for investigations for low back pain, including X-rays and blood tests. In both groups, at 3 and 9 months 80% of participants would choose to have an X-ray if the choice was available. Participants in the patient preference group achieved marginally better outcomes than those randomised to a treatment group, but the clinical significance of these differences is unclear. Lumbar spine radiography was associated with a net economic loss at 3 and 9 months. CONCLUSIONS: Lumbar spine radiography in primary care patients with low back pain of at least 6 weeks duration is not associated with improved functioning, severity of pain or overall health status, and is associated with an increase in GP workload. Participants receiving X-rays are more satisfied with their care, but are not less worried or more reassured about serious disease causing their low back pain. CONCLUSIONS - RECOMMENDATIONS FOR FURTHER RESEARCH: Further work is required to develop and test an educational package that educates patients and GPs about the utility of radiography and provides strategies for identifying and meeting the information needs of patients, and the needs of patients and GPs to be reassured about missing serious disease. Guidelines on the management of low back pain in primary care should be consistent about not recommending lumbar spine radiography in patients with low back pain in the absence of red flags for serious spinal pathology, even if the pain has persisted for at least 6 weeks.

Adult↗
PubMed2000

Near miss and minor injury information--can it be used to plan and evaluate injury prevention programmes?

AIM: To assess the usefulness of collecting information on near miss and minor injuries for use in planning and evaluating injury prevention programmes for children aged under 5 years in the home environment. METHOD: The research was set within the context of a controlled intervention study based in 36 general practices across Nottingham. All parents of children aged between 3 and 12 months who had completed the intervention study questionnaire (n = 1594) were used as the sampling frame for the diary study. A diary, developed specifically for the main intervention study, was administered to a systematically assigned sample of 434 parents. Information provided by the Home Accident Surveillance System on 252 randomly selected children, of the same age and sex, who had attended an accident and emergency department, was used to compare the circumstances surrounding near miss and minor injuries with those of medically attended injuries. The children whose parents had completed a diary were followed over a two year time period. The children who had had a medically attended injury were identified from a search of the child's general practice records and the Queens Medical Centre accident and emergency records. The definition of a near miss used in the study was: A near miss incident is something your child does or that happened to your child which could have resulted in him/her being hurt, but fortunately it did not. RESULTS: Overall two hundred and thirty one (53%) diaries were completed and returned. Three hundred and fifty incidents were recorded of which 207 were near misses and 143 minor injuries. The circumstances surrounding near miss and minor injuries, although not identical when compared to medically attended injuries, were very similar. The relationship between the occurrence of near miss, minor injuries and future medically attended injuries appeared weak, for all categories the negative predictive value was higher than the positive predictive value. CONCLUSION: Although the circumstances surrounding all the incident categories were similar, the numbers were too small to see whether specific injury mechanisms predict future injuries of the same type. It appeared that near miss and minor injuries are of limited use in predicting medically attended injuries, however this hypothesis needs to be tested on a much larger sample.

Accident Prevention↗
PubMed2000

The diagnosis and management of acute childhood illness: is there a role for health visitors?

Much of the published literature on nurse practitioners relates to nurses with backgrounds, training and nursing experience other than health visiting. Health visitors however may be ideally placed to develop their role in the identification and management of acute childhood illness, and such a development may benefit patients, the health service and health visitors themselves. This study examines the current practice and attitudes of heath visitors in identifying and managing acute childhood illness using a postal questionnaire survey in one community National Health Service (NHS) Trust. The majority of responding health visitors reported that they were already identifying and advising on a range of acute childhood illnesses. Their confidence in undertaking these activities varied by condition. They were less confident in identifying and advising on conditions requiring the use of diagnostic equipment, viral illnesses which are becoming increasingly rare, and those with potentially serious outcomes. More knowledge and more training were seen as methods for increasing confidence. Most health visitors could see advantages in taking on this role; almost two thirds felt it would become part of the role of the health visitor in the future and a high level of interest was expressed in developing such a role.

Acute Disease↗
PubMed2000

The effect of home visiting programmes on uptake of childhood immunization: a systematic review and meta-analysis.

BACKGROUND: The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. METHODS: A systematic review was carried out of the literature of controlled studies evaluating home visiting programmes involving at least one post-natal visit, which included tasks within the remit of British health visiting and reporting outcomes relevant to British health visiting. Eleven studies were considered, nine of which used socio-economically disadvantaged families. The outcome measure was uptake of a range of childhood immunizations. RESULTS: Eleven studies reported uptake of immunization. Effect sizes from nine studies were included in the meta-analysis. Fixed effects models demonstrated a significant effect of home visiting for all studies and also for several subgroups of studies, but with significant heterogeneity of effect sizes. A random effects model failed to demonstrate an effect of home visiting. CONCLUSIONS: Home visiting programmes have not been shown to be effective in increasing the uptake of immunization. Other methods of increasing uptake and reducing inequalities in uptake will need to be explored.

Child, Preschool↗
PubMed2000

How well do socio-demographic characteristics explain variation in childhood safety practices?

BACKGROUND: Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and sociodemographic characteristics, hence this study has been undertaken to examine this relationship. METHODS: The study population comprised all parents and guardians of children aged 3-12 months in 36 practices throughout Nottingham (n = 2,152). A postal questionnaire was used to survey current childcare safety practices (from which safe practices scores were derived), together with socio-demographic variables and known risk factors for childhood unintentional injury. RESULTS: Unsafe childcare practices were common. Socioeconomically disadvantaged families had more unsafe practices than more affluent families, but few parents undertook safe practices all the time. The child's age (p<0.01), ethnicity (p<0.01) and living in non-owner-occupied accommodation (p<0.01) were independently associated with the safe practices score. Multivariate regression modelling showed that these risk factors explained only 11 per cent of the variation in the safety practices score. Socio-economic factors explained more of the variation in possession and use of items of safety equipment (13 per cent) than the variation in safety behaviours with no cost implications (3 per cent). CONCLUSIONS: Most of the variation in the number of safety practices is not explained by socio-demographic characteristics and further work is required to examine other possible determinants of safe practice.

Accidents, Home↗
PubMed2000

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.

AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Child↗
PubMed2000

Assessing adult attachment status with clinically-orientated interviews: a brief report.

The object of this study was to examine the possibility of using clinically-orientated interviews to gain a similar attachment classification to the Adult Attachment Interview. Little agreement on classifications was shown between the two interviews, showing insufficient evidence to suggest that it is possible to assess adult attachment status using clinically-orientated interviews.

Adult↗
PubMed1999

Preventing injuries in children: cluster randomised controlled trial in primary care.

OBJECTIVE: To assess the effectiveness of safety advice at child health surveillance consultations, provision of low cost safety equipment to families receiving means tested state benefits, home safety checks, and first aid training on frequency and severity of unintentional injuries in children at home. DESIGN: Cluster randomised controlled trial. SETTING: 36 general practices in Nottingham. SUBJECTS: All children aged 3-12 months registered with participating practices. INTERVENTIONS: A package of safety advice at child health surveillance consultations at 6-9, 12-15, and 18-24 months; provision of low cost safety equipment to families on means tested state benefits; and home safety checks and first aid training by health visitors. OUTCOME MEASURES: Primary outcomes measures were frequency and severity of medically attended injuries. Secondary outcome measures were self reported safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk of injury and risk of hazards assessed by postal questionnaire at baseline and follow up at 25 months. RESULTS: At baseline, both groups had similar risk factors for injury, sociodemographic characteristics, safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk. No significant difference was found in frequency of at least one medically attended injury (odds ratio 0.97, 95% confidence interval 0.72 to 1.30), at least one attendance at an accident and emergency department for injury (1.02, 0.76 to 1.37), at least one primary care attendance for injury (0.75, 0.48 to 1.17), or at least one hospital admission for injury (0.69, 0.42 to 1.12). No significant difference in the secondary outcome measures was found between the intervention and control groups. CONCLUSIONS: The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home, and larger trials are required to assess the effect on more severe injuries.

Child Welfare↗
PubMed1999

Using a diary to record near misses and minor injuries--which method of administration is best?

OBJECTIVES: To determine the effect of different methods of administering a diary to collect information from parents on near miss and minor injuries on responses, completeness and accuracy, the number of incidents reported, the effect of a financial incentive on response, and the cost of administering each method. SETTING: The study was set within the context of a cluster randomised controlled trial of injury prevention in 36 practices in Nottingham. METHODS: The study population comprised the 1594 parents who responded to the baseline questionnaire. Parents were allocated systematically to one of four groups: postal administration, with and without financial incentive, telephone administration, with and without financial incentive (102 in each group). A clinic visit method with and without financial incentive (50 in each group) was also used. RESULTS: A significant trend was found, with decreasing response rates with increasing degree of contact with the parent, such that administering the diary in the clinic had the lowest response (chi2 for trend = 5.54, 1 df, p = 0.02). Offering a financial incentive increased responses from 47% to 59% (chi2 = 5.78, 1 df, p = 0.016). The most complete recording was found in the diaries handed out at clinic visits. Importantly, parents were accurate in their recording of near miss and minor injuries, suggesting they understood the differences between the two types of incident. Postal methods were the least expensive method of administering the diary in terms of average cost per returned diary. Using a financial incentive resulted in a lower cost per returned diary for telephone and clinic visit methods. CONCLUSIONS: Parents can accurately and reliably complete diaries recording near miss and minor injuries occurring to their preschool children. More work is needed to investigate methods of increasing response. Postal diaries achieve the highest response but have the least complete recording of data. Diaries administered through child health clinics were most complete but achieved the lowest response. The administration method chosen in future work should be influenced both by the response and completeness of recording that is required by the research.

Ambulatory Care Facilities↗
PubMed1998

A randomised controlled trial of general practitioner safety advice for families with children under 5 years.

OBJECTIVE: To assess effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on use of safety equipment and safe practices at home. DESIGN: Randomised, unblinded, controlled trial with initial assessment and six week follow up by telephone survey. Twenty families from intervention and control groups were randomly selected for a home visit to assess validity of responses to second survey. SETTING: A general practice in Nottingham. SUBJECTS: 98% (165/169) of families with children aged under 5 years registered with the practice. INTERVENTIONS: General practitioner safety advice plus, for families receiving means tested state benefits, access to safety equipment at low cost. Control families received usual care. MAIN OUTCOME MEASURES: Possession and use of safety equipment and safe practices at home. RESULTS: Before intervention, the two groups differed only in possession of fireguards. After intervention, significantly more families in intervention group used fireguards (relative risk 1.89, 95% confidence interval 1.18 to 2.94), smoke alarms (1.14, 1.04 to 1.25), socket covers (1.27, 1.10 to 1.48), locks on cupboards for storing cleaning materials (1.38, 1.02 to 1.88), and door slam devices (3.60, 2.17 to 5.97). Also, significantly more families in intervention group showed very safe practice in storage of sharp objects (1.98, 1.38 to 2.83), storage of medicines (1.15, 1.03 to 1.28), window safety (1.30, 1.06 to 1.58), fireplace safety (1.84, 1.34 to 2.54), socket safety (1.77, 1.37 to 2.28), smoke alarm safety (1.11, 1.01 to 1.22), and door slam safety (7.00, 3.15 to 15.6). Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others. CONCLUSIONS: General practitioner advice, coupled with access to low cost equipment for low income families, increased use of safety equipment and other safe practices. These findings are encouraging for provision of injury prevention in primary care.

Accidents, Home↗
PubMed1998

Injury prevention training: is it effective.

The aim of this controlled follow-up study was to assess the effectiveness of a multi-disciplinary training programme in increasing knowledge, changing attitudes and practice in injury prevention amongst primary health care professionals. All primary health care team members in Nottinghamshire were invited to participate in the training programme. Thirty-one health visitors, 11 general practitioners and 16 practice nurses attended the training programme, and completed the study questionnaire 3-4 months before and after the training. A comparison was made with a professional of the same status, who had not attended the training session who had also completed both questionnaires, and who was matched with a trained participant on the basis of pre-training attitude and knowledge scores (to within 1 point of each score). A significant increase in the number of individuals answering correctly to questions on accidental injury epidemiology was demonstrated in the trained group (Wilcoxon matched-pairs signed rank, health visitors P = 0.002, practice nurses P = 0.0004, general practitioners P = 0.02), but no significant change was demonstrated in the control group. Changes in attitude scores were only significant for the practice nurses (Wilcoxon matched-pairs signed rank, P = 0.01). Increases were also demonstrated in the frequency of health visitors identifying hazards on home visits and discussing them with parents (chi 2 = 6.19, d.f. = 2, P = 0.04) and in the number of health visitors who, on receiving notification of a child attending the A&E department following an injury, carried out a home visit to discuss injury prevention (chi 2 = 9.19, d.f. = 2, P = 0.01). The number of general practitioners displaying posters in the surgery waiting rooms also increased significantly (chi 2 = 9.21, d.f. = 2, P = 0.002). The number of contacts with representatives of other agencies and individuals concerning child safety significantly increased in the trained group (Wilcoxon matched-pairs, P = 0.02). We conclude that education and training with regard to injury prevention was effective in increasing knowledge and some injury prevention practices. Although training did not appear to change the attitudes of health visitors and general practitioners to a significant extent, a marked change was unlikely due to high baseline attitude scores.

Adult↗
PubMed1998

Babywalkers: prevalence of use and relationship with other safety practices.

OBJECTIVE: To examine the prevalence of walker use, and to compare sociodemographic factors, perceptions of the risk of injury and of household hazards, and safety practices in families by walker use. SETTING: 36 Primary care practices across Nottingham, UK. METHODS: Postal questionnaire to all parents of children aged 3-12 months registered at each practice (n = 2152) to assess safety practices, perceptions of risk of injury, and of the risk associated with household hazards and sociodemographic factors. Data were analysed using chi 2 tests for categorical data, Mann-Whitney U tests for ordinal data, and logistic regression analysis. RESULTS: The response rate was 74%. Fifty per cent of parents used babywalkers. Receipt of means tested benefits (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.02 to 1.99), non-owner occupation (OR 1.46, 95% CI 1.04 to 2.04), residence in a deprived area (OR 1.42, 95% CI 1.06 to 1.91), and unemployment (OR 0.64, 95% CI 0.41 to 0.99) were independently associated with use of walkers. Families using babywalkers were less likely to use stair gates (chi 2 = 4.36, 1 df, p = 0.037), fireguards (chi 2 = 6.80, 1 df, p = 0.009), and had a higher total number of unsafe practices (Mann-Whitney U test, Z = -2.90, p = 0.004). Perceptions of risk of injury and of the risk associated with household hazards however, did not differ by walker use. CONCLUSIONS: Babywalker use is common across all social groups and is associated with other unsafe practices such as not using stair gates or fireguards. Health professionals should support campaigns to limit the sale of babywalkers, but, in addition, they should ascertain each family's reasons for walker use and try to find acceptable alternatives. They should also make the family aware of the importance of properly fitted stair gates and fireguards and help the family to obtain and use such items of safety equipment.

Child, Preschool↗