The effect of safer play equipment on playground injury rates among school children.
Ontology highlight
ABSTRACT: Background
Changes to Canadian Standards Association (CSA) standards for playground equipment prompted the removal of hazardous equipment from 136 elementary schools in Toronto. We conducted a study to determine whether applying these new standards and replacing unsafe playground equipment with safe equipment reduced the number of school playground injuries.Methods
A total of 86 of the 136 schools with hazardous play equipment had the equipment removed and replaced with safer equipment within the study period (intervention schools). Playground injury rates before and after equipment replacement were compared in intervention schools. A database of incident reports from the Ontario School Board Insurance Exchange was used to identify injury events. There were 225 schools whose equipment did not require replacement (nonintervention schools); these schools served as a natural control group for background injury rates during the study period. Injury rates per 1000 students per month, relative risks (RRs) and 95% confidence intervals (CIs) were calculated, adjusting for clustering within schools.Results
The rate of injury in intervention schools decreased from 2.61 (95% CI 1.93-3.29) per 1000 students per month before unsafe equipment was removed to 1.68 (95% CI 1.31-2.05) after it was replaced (RR 0.70, 95% CI 0.62-0.78). This translated into 550 injuries avoided in the post-intervention period. In nonintervention schools, the rate of injury increased from 1.44 (95% CI 1.07-1.81) to 1.81 (95% CI 1.07-2.53) during the study period (RR 1.40, 95% CI 1.29-1.52).Interpretation
The CSA standards were an effective tool in identifying hazardous playground equipment. Removing and replacing unsafe equipment is an effective strategy for preventing playground injuries.
SUBMITTER: Howard AW
PROVIDER: S-EPMC557979 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSupracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces-particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards.MethodsCases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated.ResultsForty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m.ConclusionsThe majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.
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Project description:OBJECTIVES:To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. DESIGN:Cross-sectional ecological analysis. SETTING:43 primary schools in New South Wales, Australia. PARTICIPANTS:Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. OUTCOME MEASURES:Self (for age ?11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. RESULTS:Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15?m2 and 25?m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30?m2 returned to levels comparable to students in schools with no equipment (0.18, 95%?CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15?m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20?m2 per student. There was no relationship between space and FMS. CONCLUSIONS:School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25?m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.
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Project description:BackgroundHandwashing prevalence in schools in Kenya is low due to lack of access to water and soap and lack of drive for handwashing. Soapy water made from detergent powder is an inexpensive alternative to bar soap and disgust and social norms change can be powerful drivers of handwashing, but their effectiveness has not been assessed in school setting. In Kenyan public schools, we evaluated an equipment-behavior change intervention's effect on handwashing outcomes. We also monitored functionality of the Povu Poa prototypes to identify design improvements necessary for continued high usage in institutional settings.MethodsThe intervention included the "Povu Poa", a new type of handwashing station that dispensed foaming soap and rinse water, combined with school-wide behavior change promotion based on disgust and social norms. In this stepped-wedge cluster-randomized trial, we randomly selected 30 schools and divided them into 3 groups of 10. Following baseline data collection, we delivered the intervention sequentially (Group 1: 3-5 weeks after baseline; Group 2: 6-8 weeks; Group 3: 19-24 weeks). We observed outcomes [1] availability of handwashing materials at handwashing places, and; 2) observed handwashing behavior after toilet use among schoolchildren) at baseline and in three follow-up rounds. We compared the outcomes between schools that had received the intervention and schools that had not yet received the intervention.ResultsWater and soap/soapy water were available at 2% of school visits before intervention, and at 42% of school visits after intervention.. Before intervention, we observed handwashing with water after 11% of 461 toilet use events; no one was observed to wash hands with soap/soapy water. After intervention, we observed handwashing after 62% of 383 toilet use events (PR = 5.96, 95% CI = 3.02, 11.76) and handwashing with soap/soapy water after 26% of events (PR incalculable). Foaming soap dispenser caps were cracked in 31% of all observations, but were typically still functional.ConclusionsOur combined equipment-behavior intervention increased availability of handwashing materials and improved the compliance with handwashing after using the toilet, but handwashing with soap was still rare. Equipment durability must be improved for deployment in schools at scale. American Economic Association's Registry for Randomized Controlled Trials; Trial Registry Number (TRN): AEARCTR-0000662; Date of Registry: April 14, 2015.
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Project description:This study examined the effects and specificity of structured and unstructured activities played at the playground Primo Sport 0246 in Northern Italy on motor skill competence in five years old children. The playground was specifically designed to promote gross motor skills in preschool children; in this study 71 children from local kindergartens came to the park once a week for ten consecutive weeks and were exposed to 30 minutes of free play and 30 minutes of structured activities. Before and after the ten visits, each child completed nine tests to assess levels of motor skills, three for fine-motor skills and six for gross-motor skills. As control, motor skills were also assessed on 39 children from different kindergartens who did not come to the park. The results show that the experimental group who practiced gross-motor activities in the playground for 1 hour a week for 10 weeks improved significantly in 4 out of the 6 gross motor tasks and in none of the fine motor tasks. The data indicate that limited transfer occurred between tasks referring to different domains of motor competences while suggesting cross feeding for improvement of gross-motor skills between different exercises when domains related to physical fitness and strength of specific muscle groups are involved. These results are relevant to the issue of condition(s) appropriate for maintaining and developing motor skills in this age group as well as for the planning, organization and implementation of play and physical activities in kindergartens.
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Project description:Although ankle injuries occur frequently in high school football players, no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence and severity of ankle and other lower extremity injuries in these athletes.This study was conducted to determine if lace-up ankle braces reduce the incidence and severity of lower extremity injuries sustained by high school football players.Randomized controlled trial; Level of evidence, 1.A total of 2081 players from 50 high schools were randomly assigned to a braced or control group. Braced group players wore lace-up ankle braces during the 2010 football season. Athletic trainers recorded brace compliance, athlete-exposures, and injuries. Cox proportional hazards models were utilized to compare injury rates between groups. Injury severity (days lost) was tested with Wilcoxon rank sum.The rate of acute ankle injury (per 1000 exposures) was 0.48 in the braced group compared with 1.12 in the control group (Cox hazard ratio [HR] = 0.39; 95% confidence interval [CI], 0.24-0.65; P < .001). The severity (median days lost) of acute ankle injuries was the same (5 days) in both groups (P = .985). The rate of acute knee injury was 0.70 in the braced group compared with 0.69 in the control group (HR = 0.92; 95% CI, 0.57-1.47; P = .721). There was no difference (P = .242) in the severity of knee injuries between the groups (controls = 11.5 days, braced = 17 days). The rate of other lower extremity injuries was 0.95 in the braced group and 1.32 in the control group (HR = 0.72; 95% CI, 0.48-1.09; P = .117), while the severity was similar in both groups (6 days vs 7 days; P = .295).Players who used lace-up ankle braces had a lower incidence of acute ankle injuries but no difference in the incidence of acute knee or other lower extremity injuries. Braces did not reduce the severity of ankle, knee, or other lower extremity injuries.
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Project description:BackgroundThe risk of playground injuries, especially fractures, is prevalent in children, and can result in emergency room treatment and hospital admissions. Fall height and surface area are major determinants of playground fall injury risk. The primary objective was to determine if there was a difference in playground upper extremity fracture rates in school playgrounds with wood fibre surfacing versus granite sand surfacing. Secondary objectives were to determine if there were differences in overall playground injury rates or in head injury rates in school playgrounds with wood fibre surfacing compared to school playgrounds with granite sand surfacing.Methods and findingsThe cluster randomized trial comprised 37 elementary schools in the Toronto District School Board in Toronto, Canada with a total of 15,074 students. Each school received qualified funding for installation of new playground equipment and surfacing. The risk of arm fracture from playground falls onto granitic sand versus onto engineered wood fibre surfaces was compared, with an outcome measure of estimated arm fracture rate per 100,000 student-months. Schools were randomly assigned by computer generated list to receive either a granitic sand or an engineered wood fibre playground surface (Fibar), and were not blinded. Schools were visited to ascertain details of the playground and surface actually installed and to observe the exposure to play and to periodically monitor the depth of the surfacing material. Injury data, including details of circumstance and diagnosis, were collected at each school by a prospective surveillance system with confirmation of injury details through a validated telephone interview with parents and also through collection (with consent) of medical reports regarding treated injuries. All schools were recruited together at the beginning of the trial, which is now closed after 2.5 years of injury data collection. Compliant schools included 12 schools randomized to Fibar that installed Fibar and seven schools randomized to sand that installed sand. Noncompliant schools were added to the analysis to complete a cohort type analysis by treatment received (two schools that were randomized to Fibar but installed sand and seven schools that were randomized to sand but installed Fibar). Among compliant schools, an arm fracture rate of 1.9 (95% confidence interval [CI] 0.04-6.9) per 100,000 student-months was observed for falls into sand, compared with an arm fracture rate of 9.4 (95% CI 3.7-21.4) for falls onto Fibar surfaces (p< or =0.04905). Among all schools, the arm fracture rate was 4.5 (95% CI 0.26-15.9) per 100,000 student-months for falls into sand compared with 12.9 (95% CI 5.1-30.1) for falls onto Fibar surfaces. No serious head injuries and no fatalities were observed in either group.ConclusionsGranitic sand playground surfaces reduce the risk of arm fractures from playground falls when compared with engineered wood fibre surfaces. Upgrading playground surfacing standards to reflect this information will prevent arm fractures.Trial registrationCurrent Controlled Trials ISRCTN02647424.
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Project description:Using Brofenbrenner's socio-ecological model as a conceptual framework, the objective of this study was to determine playground users (primary school staff and pupils) perceptions of the barriers and facilitators to a physically active school playground at an intra-personal (individual), inter-personal (social), environmental and policy level. Results from a series of qualitative interactions with children (n = 65) from years five and six (9 to 11 years old), and structured interviews with adult teachers (n = 11) revealed key differences in the child and adult perceptions of the playground and the purpose of break-times. A number of inter-related environmental boundaries and school policies were identified as restrictive to children's explorations and activity levels during 'free play' periods, which centred on resource availability, accessibility and health and safety. Further, traditional playground hierarchies act to promote and prevent physical activity engagement for different groups (e.g. gender and age). Finally, differences between the adult and child perception of the primary school playground were observed. Playground physical activity, during break-times appears to be affected by a number of variables at each level of the socio-ecological model. This study provides an opportunity for primary schools to reflect on primary school playground strategies and practices that are implemented at each level of the socio-ecological model to encourage a more effective use of the playground during school break-times.
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Project description:BackgroundThe remarkable socioeconomic changes in United Arab Emirates (UAE) necessitate regular monitoring of obesity in our population. This study explored the epidemiology of obesity in a large cohort of UAE students.MethodsThis population-based study investigated the prevalence of obesity in 44,942 students attending governmental schools in Ras Al-Khaimah. Body-mass-index (BMI) was calculated in 15,532 children (4-12 y) in 2013-2014, and in 29,410 children (3-18 y) in 2014-2015. The International Obesity Task Force, World Health Organization, and Centers for Disease Control (CDC) reference methods were used to identify overweight, obesity, and extremely-obesity.ResultsUsing CDC interpretation of BMI, from 11 to 14 y, the prevalence of BMI ≥85th percentile was 41.2%, BMI ≥95th percentile 24.3% and BMI ≥99th percentile 5.7%. Obesity increased linearly from 3 to 12 y (R2 ≥ 0.979); each year an additional 2.36% of the students became obese and 0.28% became extremely obese. The rate of extreme-obesity was 9.6-fold higher in boys than girls (0.58% vs. 0.06%). From 15 to 18 y, 10.3% of boys were extremely obese and 3.0% of girls were extremely obese.ConclusionsThese results confirm a steady rise in obesity in children 3-18 y. The rising rate of extreme obesity is also alarming, especially among boys.
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Project description:BackgroundGiven the emerging literature regarding the impacts of lockdown measures on mental health, this study aims to describe the psychosocial health of school-aged children and adolescents during the COVID-19 Safer-at-Home School mandates.MethodsA cross-sectional study was conducted in April 2020 (n = 280) among K-12 students at a research school in North Central Florida. Bivariate analysis and logistic and multinomial logistic regression models were used to examine socio-demographic and knowledge, attitude, and practice (KAP) predictors of indicators of anxiety-related, depressive, and obsessive-compulsive disorder(OCD)-related symptoms. Outcomes (anxiety, OCD, and depressive related symptoms) were measured by indices generated based on reported symptoms associated with each psychosocial outcome.ResultsLoss of household income was associated with increased risk for all three index-based outcomes: depressive symptoms [aOR = 3.130, 95% CI = (1.41-6.97)], anxiety-related symptoms [aOR = 2.531, 95%CI = (1.154-5.551)], and OCD-related symptoms [aOR = 2.90, 95%CI = (1.32-6.36)]. Being female was associated with being at higher risk for depressive symptoms [aOR = 1.72, 95% CI = (1.02-2.93)], anxiety-related symptoms [aOR = 1.75, 95% CI = (1.04-2.97)], and OCD-related symptoms [aOR = 1.764, 95%CI = (1.027-3.028)]. Parental practices protective against COVID-19 were associated with children being at higher risk of depressive symptoms [aOR = 1.55, 95% CI = (1.04-2.31)]. Lower school level was associated with children being at higher risk of anxiety-related and OCD-related symptoms.ConclusionsAs the COVID-19 pandemic continues, schools should prioritize mental health interventions that target younger, female students, and children of families with income loss. Limiting the spread of COVID-19 through school closure may exacerbate negative psychosocial health outcomes in children, thus school administrators should move quickly to target those at greatest risk.
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Project description:BackgroundQuestions remain regarding the traditional protocols used in rehabilitation and clearance for return to sports after anterior cruciate ligament reconstruction (ACLR).Purpose/hypothesisTo investigate the impact on injury rates after return to sports by developing and validating a Safer Return to Play Following ACL Reconstruction Checklist consisting of subjective and objective functional tests that can be quickly and easily implemented into a sports medicine practice. It was hypothesized that patients who successfully passed the checklist before returning to sports would experience lower rates of ipsilateral and contralateral knee injuries at a 2-year follow-up as compared with patients who returned to play before completing the checklist.Study designCohort study; Level of evidence, 2.MethodsFirst, a systematic review was performed to generate a list of the most common outcome measures used to assess return to play after ACLR. To refine our checklist, we conducted a survey with an expert panel of 10 medical professionals utilizing the Delphi technique. After the creation of the checklist, validation was performed by prospectively evaluating patients who had undergone ACLR for injury of the ipsilateral or contralateral knee, with a minimum 2-year follow-up.ResultsAfter our systematic review of 60 studies, 7 criteria were included in the final checklist. During the period studied, October 2014 to December 2017, a total of 222 patients met the inclusion criteria and were enrolled in the study. At a minimum 2 years of follow-up, there were 146 patients who successfully passed the checklist and 38 who did not. Overall, 24 (16.4%) patients who had passed the checklist sustained an injury to either knee, as compared with 10 (26.3%) from the group that did not pass the checklist (P = .162). Of the group that passed the checklist, 8 (5.5%) patients sustained an injury to the ipsilateral knee, as compared with 7 (18.4%) in the group that did not pass (P = .017).ConclusionProspective validation of our checklist demonstrated that patients who successfully passed the checklist before returning to play experienced a significantly lower incidence of ipsilateral anterior cruciate ligament injury as compared with patients who did not pass the checklist.
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