Elizabeth M. L. Towner

Measuring the Population Burden of Injuries—Implications for Global and National Estimates: A Multi-centre Prospective UK Longitudinal Study

Ronan Lyons and colleagues compared the population burden of injuries using different approaches from the UK Burden of Injury and Global Burden of Disease studies and find that the absolute UK burden of injury is higher than previously estimated.

Preventing childhood unintentional injuries--what works? A literature review.

AIM: The aim of this paper is to report on a systematic review of the world literature to provide information about the most effective forms of health promotion interventions to reduce childhood (0-14 years) unintentional injuries. The findings are of relevance to policy makers at a local or national level, to practitioners and researchers. METHODS: The relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with key informants. RESULTS: Examples of interventions that have been effective in reducing injury include: bicycle helmet legislation, area wide traffic calming measures, child safety restraint legislation, child resistant containers to prevent poisoning, and window bars to prevent falls. Interventions effective in changing behaviour include bicycle helmet education and legislation, child restraint legislation, child restraint loan schemes, child restraint educational campaigns, pedestrian education aimed at the child/parent, provision of smoke detectors, and parent education on home hazard reduction. For the community based campaigns, the key to success has been the sustained use of surveillance systems, the commitment of interagency cooperation and the time needed to develop networks and implement a range of interventions. Education, environmental modification and legislation all have a part to play and their effect in combination is important. CONCLUSION: The design of evaluations in injury prevention needs to be improved so that more reliable evidence can be obtained. Better information is needed on process, so that successful strategies can be replicated elsewhere. There is also a need for literature reviews on effectiveness to be updated regularly and for their findings to be widely disseminated to policy makers, researchers, and practitioners.

Updating the evidence. A systematic review of what works in preventing childhood unintentional injuries: Part 1

In the last 10 years there has been considerable progress in the science and art of injury prevention. The scientific study of what works in different fields of health care and health promotion has expanded, and evidence-led policy development has dominated health planning. We have collected evidence on evaluated intervention studies related to childhood injury prevention since 1992, and published reviews in 1993 and 1996.1,2 This paper updates this evidence. We attempt to answer three questions: 1. Have there been any changes in the evidence relating to the effectiveness of childhood injury prevention? 2. What additions have been made to the literature, relating to the target groups and implementation strategies of interventions? 3. What additions have been made to the literature, relating to the ways interventions have been evaluated? A database of primary studies has been built up over the years in the Department of Child Health in the University of Newcastle. We identified the relevant literature by a search of computerised databases (for example, BIDS, Medline, Excerpta Medica, the DHSS database, the Social Science Research Index, Web of Science, Transport Research Laboratory databases). This was supplemented by …

Measuring exposure to injury risk in schoolchildren aged 11-14

Abstract Objective : To apply a measure of exposure to injury risk for schoolchildren aged 11-14 across a population and to examine how risk factors vary with sex, age, and affluence. Design : Self completion questionnaire survey administered in schools in May 1990. Setting : 24 schools in Newcastle upon Tyne. Subjects : 5334 pupils aged 11-14, of whom 4637 (87%) completed the questionnaire. Results : Boys were exposed to greater risk than girls in journeys to places to play outdoors: they took longer trips and were more likely to ride bicycles (relative risk 5.30 (95% confidence interval 4.23 to 6.64) and less likely to travel by public transport or car. Younger pupils (aged 11-12) were less exposed to traffic during journeys to and from school: their journeys were shorter, they were less likely to walk (trip to school, relative risk 0.88 (0.83 to 0.94), and they were more likely to travel by car (trip to school, relative risk 1.33 (1.13 to 1.56)) or school bus (1.33 (1.10 to 1.62)). Poorer children were exposed to greater risk than affluent children (from families that owned a car and a telephone): they were less likely to travel to school by car (relative risk 0.26 (0.20 to 0.33)) or to be accompanied by an adult (0.39 (0.32 to 0.48)). Conclusion : Injury risk data can provide useful information on child injury prevention and can be used to identify priorities and target resources for injury prevention on a citywide scale or for an individual school.

Injury prevention and the attainment of child and adolescent health

Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The issue of injuries is too often absent from child and adolescent health agendas. In December 2008, WHO and the United Nations Childrens Fund published the World report on child injury prevention, calling global attention to the problem of child injuries. This article expands on the reports arguments that child injuries must be integrated into child health initiatives and proposes initial steps for achieving this integration.

Annual incidence of unintentional injury among 54,000 children.

OBJECTIVE: To enhance the case definition of unintentional injuries in childhood by applying an objective severity measure to fatal and non-fatal cases. DESIGN: A descriptive prospective epidemiological study of a defined resident childhood population (< 16 years of age) for a one year period, 1990. SETTING: Newcastle upon Tyne, England. Child population estimate for 1990 was 54,400. SUBJECTS: Resident children who died, were admitted to local hospitals, or attended local accident and emergency departments. OUTCOME MEASURES: Using recognised severity scoring systems (for example the injury severity score, trauma score) injuries were classified as severe, moderate, or mild. RESULTS: There were six deaths, 904 admissions, and 11,682 accident and emergency department attendances. All deaths, 25% of admissions, and 1% of accident and emergency attenders were classified as severe. The underlying determinants of severe injuries are different than those for all other injuries (for example age, social class). A comparison with a local survey in 1986 showed a 26% rise in hospital admissions, but no significant rise in the frequency of severe or moderately injured children. Comparisons with other international data showed higher rates of injury admissions and attendances for England, but no significant differences in the frequency of severe injuries. CONCLUSIONS: Objective severity scoring enhances the case definition of unintentional injuries in childhood by allowing for the identification, and, therefore, the more reliable ascertainment of severely injured children. This more completely ascertained set of population cases increases the accuracy of comparisons of injury frequency over time and by place, and, in addition, enhances our basic understanding about the epidemiological characteristics of childhood unintentional injury.

Unintentional injuries in school-aged children and adolescents: lessons from a systematic review of cohort studies

Objectives: To critically synthesise current knowledge of the patterns of injuries and risk factors for injury in school-aged children, to summarise the evidence and support effective child injury prevention initiatives. Design: Systematic review. Selection criteria and methods: Prospective cohort studies reporting unintentional injuries in healthy children aged 5–18 years were identified by searching 15 electronic databases and additional grey literature sources. A narrative synthesis was conducted of papers meeting quality criteria, with risk factors analysed at individual, family and environmental levels. Limitations of existing evidence were considered. Results: 44 papers from 18 different cohort studies met the inclusion criteria. There were broad and consistent patterns of injury across time and place. Male sex, psychological, behavioural and risk-taking behaviour problems, having a large number of siblings, and a young mother were all associated with increased injury occurrence across more than one cohort and setting. Conclusions: Descriptive epidemiology and risk factors for injury were derived from prospective cohort studies, but few studies used the full potential of their design. Opportunities to use repeated measures to assess temporal changes in injury occurrence, and the exploration of risk factors, particularly those related to the child’s environment, have rarely been undertaken. Few studies were conducted in low/middle-income countries where the burden of injury is greatest. These findings should be considered when planning future research and prevention initiatives.

Evidence into practice: combining the art and science of injury prevention

Objectives: To bring together scientific evidence of what works in injury prevention with the knowledge and experience of practitioners, using a case study of smoke alarm installation from England. Design: There is good evidence of strategies to reduce injuries but less is known about the art of translating those strategies to implementation in real-world settings. England’s Health Development Agency developed a structured process applicable to many public health fields, which integrates practitioner knowledge into the evidence base and reflects local contexts. The multistep process includes convening structured field meetings with local practitioners and policy makers, which focus on a mapping exercise of strategies, policies, targets, and funding streams related to childhood injury prevention, and barriers and facilitators relating to implementation of specific interventions. Setting: Meetings were held in six venues across England with 98 participants from a range of professional backgrounds and sectors. Results: The collective knowledge of participants provided many local insights unlikely to emerge in conventional research. Discussion topics covered key partners and sectors to include when planning a program; national policies and programs that could be used to drive the agenda; potential sources of funding; the importance of providing and installing appropriate smoke alarms; targeting of programs; and suggestions for gaining access to hard-to-reach populations. Conclusion: This methodology represents an efficient way of gaining insight necessary for successful implementation of evidence based programs. It may be particularly useful in lower and middle income countries, serving to translate evidence into the local contexts and circumstances within which practitioners operate.

Prevention of injuries to children and young people: The way ahead for the UK

Injury in children and young people is not inevitable. Accidents and the injuries that result from them, are not chance events. Patterns of injury can be identified that reflect a persons age, the environment in which children and young people live, and the activities in which they are engaged. Greater understanding of the causes of injury can help us in the development of effective preventive strategies. Opportunities to prevent injuries occur through a range of educational, environmental, and legislative approaches. We need to fully mobilise these opportunities to save lives and improve the health of children and young people in the UK. When one considers the worldwide public health importance of injuries to this age group, it is surprising that only a small number of potential interventions have been rigorously evaluated. Moreover, of those with proven efficacy, many prevention measures have been poorly implemented. But there are a number of interventions that we know to be effective and others that have the potential to be effective. In this chapter, we attempt to distill the essence of injury prevention by first providing an overview of the broad approaches. We then discuss the specific interventions and methods that have been shown to be effective. The broader context of policies and cultures that affect injury are then set out. Finally, we pull together the strands to consider what is still required for more effective preventive action in the UK. The problems of injuries to children and young people stem from their complexity and wide ranging nature. Typical examples include an 18 month old child reaching up in a kitchen and pulling down a mug of scalding tea, an 8 year old falling from a climbing frame in a playground and fracturing her leg, or a 12 year old pedestrian knocked down by a …

Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature

Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process.