Robert Ekman

The Lidköping Accident Prevention Programme--a community approach to preventing childhood injuries in Sweden.

OBJECTIVES: In Sweden about 100 children 0-14 years die from accidental injuries every year, roughly 40 girls and 60 boys. To reduce this burden the Safe Community concept was developed in Falköping, Sweden in 1975. Several years later a second programme was initiated in Lidköping. The objectives of this paper are to describe the programme in Lidköping and to relate it to changes in injury occurrence. SETTING: The Lidköping Accident Prevention Programme (LAPP) was compared with four bordering municipalities and to the whole of Skaraborg County. METHODS: The programme included five elements: surveillance, provision of information, training, supervision, and environmental improvements. Process evaluation was based mainly on notes and reports made by the health planners, combined with newspaper clippings and interviews with key people. Outcome evaluation was based on information from the hospital discharge registry. RESULTS: In Lidköping there was an on average annual decrease in injuries leading to hospital admissions from 1983 to 1991 of 2.4% for boys and 2.1% for girls compared with a smaller decline in one comparison area and an increase in the other. CONCLUSION: Because the yearly injury numbers are small there is a great variation from year to year. However, comparisons over the nine year study period with the four border municipalities and the whole of Skaraborg County strengthen the impression that the programme has had a positive effect. The findings support the proposition that the decrease in the incidence of childhood injuries after 1984 could be attributed to the intervention of the LAPP. Nevertheless, several difficulties in drawing firm conclusions from community based studies are acknowledged and discussed.

Making sense of safety

Beyond injury prevention The concept of “safety” can have many different meanings. The Concise Oxford Dictionary defines it as “freedom from danger and risks”, while the Merriam-Webster Dictionary describes safety as “the condition of being safe from undergoing or causing hurt, injury, or loss”. According to etymologist Douglas Harper, the word safe first came into use in the English language around 1280, derived from the Old French sauf , which in turn stemmed from the Latin salvus , meaning “uninjured, healthy, safe”. The Latin word is related to the concepts of salus (“good health”), saluber (“healthful”), and solidus (“solid”), all derived from the Proto-Indo-European base word solwos , meaning “whole”.1 Thus, at its root, the concept of safety revolves around wholeness and health. Injury prevention researchers have defined safety as “a state or situation characterised by adequate control of physical, material, or moral threats”, which “contributes to a perception of being sheltered from danger” (Andersson and Svanstrom, as quoted in Welander et al , page 122). Safety is commonly viewed through the lens of specific injury domains: for some researchers in the injury prevention field, safety has come to mean the prevention of crime and violence; for others, a reduction in motor vehicle deaths or a feeling of being out of danger rather than being in a positive state of human growth and development.3 Due to the multitude of views on the definition of safety, a collaborative effort was launched in 1996 by two World Health Organisation (WHO) Collaborating Centers on Safety Promotion and Injury Prevention, sponsored by the Ministry of Health, Quebec, Canada, and Karolinska Institute, Stockholm, Sweden, to develop international consensus on the conceptual and operational aspects of safety and safety promotion.2 A document was published in 1998 entitled Safety and Safety Promotion: Conceptual …

Community-based assessment of unintentional injuries: a pilot study in rural Vietnam

Aims: Although unintentional injuries are recognised as a major public health problem globally, little is known about their patterns and rates at the community level in most low-income countries. Rapid social development, leading to increased traffic and industrialization, may be changing patterns of injury. Injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries in Vietnam, largely because they have not been effectively counted. This study took place in northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi, as a pilot project aiming to determine the community incidence of unintentional injury and to explore appropriate methods for community-based injury surveillance. Methods: An initial study population of 23,807 was identified and asked about their experience of injury in the preceding three months. Results: Overall 450 new injuries were detected over 5,952 person-years, a rate of 76 per 1,000 person-years. Males were injured at 1.6 times the rate of females, and home and road traffic accidents were most common. Most injuries occurred during unpaid household tasks. Cutting and crushing injuries occurred most frequently. Of 221 deaths from all causes in the FilaBavi population during 1999 among 43,444 person-years, 25 were attributed to unintentional injuries and two to suicide. Unintentional injury was the third leading cause of death in this community, with a case-fatality rate of 0.8%. Discussion: The findings suggest that greater attention needs to be directed toward the prevention of injuries occurring in the home in rural Vietnam. On the basis of this pilot study, a one-year study using the same approach is under way to characterize the patterns of unintentional injury in more detail, including any seasonal variation.

School accidents during a three school-years period in a swedish municipality

The aim of this study was to analyse the scope and nature of accidents that occurred at school as a basis for countermeasures. There were a total of 204 school accidents during the three school-years period, causing 222 injuries. Accidents during breaks and physical education were most common (85%). Fractures (24%), wounds (21%), sprains/strains (15%) and dental injuries (14.5%) were the dominating types of injuries. The site of injury was most commonly the upper extremity (22%), head and neck (18.5%), and lower extremity. Accidents during breaks dominated in age-group 7-12 years, while sports accidents were most common in age-group 13-19 years. Surveillance of school accidents on the municipal level is needed as a base-line for countermeasures as well as the evaluation of their effects.

Temporal trends, gender, and geographic distributions in child and youth injury rates in Sweden

Objective: Sweden has the lowest child injury mortality rate in the world, 5.2/100 000 for children under 15. This paper describes temporal trends in Sweden, as well as gender related and geographic differences. Design: The Swedish Cause-of-Death Register (1987–2001) and the Hospital Patient Register (1987–2002) were used to compare rates for the country as a whole and for discharges aged 0–20 by municipality, using the SEATS time series analysis program. Results: There was a decrease in the rate of fatal unintentional injuries from 7 to 4 per 100 000 for girls and from 16 to 10 per 100 000 for boys since 1987. The gap between girls and boys was reduced and boys now have almost the same mortality rate as girls for violence related deaths. Road and other unintentional injuries show a general decrease whereas the pattern for falls varies by age and sex. Self inflicted injuries increased for both sexes, but more for girls. Substantial differences in injury rates between municipalities were also found—up to six times for girls and eight times for boys. Conclusion: Substantial declines in injury fatalities over time were found, but these were different for boys and girls. There remain substantial differences between municipalities. These data, published in a child injury atlas, have prompted substantial interest among media and the authorities.

Road traffic accidents in a Swedish municipality

A continuous all embracing registration of acute, in-patient and out-patient visits at hospitals and primary health care centres, was conducted in Skaraborg County in western Sweden. A special focus was directed at accident cases which account for 20% of the total number of acute visits. The accidents were divided up by environment: home, work, traffic and other. Cases of road traffic accidents have been mapped out in more detail with the help of standardised and structured surveys via telephone interviews, information from hospital records, and death certificates. This study aimed at achieving an increased understanding and knowledge about the accident pattern in the traffic environment in a municipality. Road traffic accidents accounted for 6.5% of all accidents. Cyclists, car drivers, car passengers and pedestrians were the most common victims. Children showed a high frequency of bicycle accidents. There was an increased risk of injury for young car-drivers. Thirty-six per cent were single-accidents. Cars and bicycles dominated among injury-inducing vehicles. Head, arm and knee injuries were most common. Twenty-six per cent of the victims were hospitalized. Safety devices were not used in 10% of cases where they should have been used according to legislation. A comparison of our registration system for road traffic accidents with the official statistics of Sweden reveals a substantial under-reporting of road traffic accidents in the latter. Consequently, a need exists for the surveillance of injuries by the public health services as a basis of injury control.

Prevention-oriented epidemiology of burns in Ardabil Provincial Burn Centre, Iran

In preventing burns, it is essential to know how they occur and which population groups, environments and heating appliances can be targeted for prevention work. The aim of this study was to determine the epidemiological characteristics of burns leading to hospitalisation in the northwest of Iran with a focus on the pre-event phase of injury. Between 2007 and 2008, 237 burn victims hospitalised in Ardabil provincial burn centre were enrolled into a descriptive study. A questionnaire was filled in during hospital stay for all patients, with a focus on obtaining information necessary for prevention purposes. Males constituted 56% of victims. Mean age was 22 years. The most severe burns occurred between the ages of 18 and 32 years, and were mainly flame related. Both in case of flame and non-flame burns, women suffered more severe burns and mortality than men. However, with respect to non-flame burns of which most were scalds, the majority of the severe cases involved children under the age of 5 years. More than 80% of burns occurred at home. The kitchen was the main place of injury in 47% of cases, followed by living rooms in 28%. Nearly 45% of burns were scalds and 47% were flame burns. The main container was the samovar in 37%, followed by kettles in 32% and pots in 22%. The overturning of a container was the major mechanism of contact with hot liquids in 86%. Bumping into a container was the main scenario of a scald injury, constituting nearly 70% of the cases. The difference between flame and non-flame burns in the distribution of burns in extremities was not statistically significant, but head and neck burns were 3.7 times more likely to be caused by flame. The two most important injury patterns, more common among women, were getting burned while using a camping gas stove or while refilling the chamber of kerosene-burning appliances without first extinguishing them. Domestic burns among children and young women are a priority in injury-prevention programmes. Camping gas stoves, valors (traditional dual-purpose heating and cooking appliances) and samovars can be considered as target appliances for burn-specific home-safety-promotion efforts in this area or in similar settings.

Epidemiology of minor and moderate burns in rural Ardabil, Iran

Epidemiology of minor burns is not well defined worldwide. The aim of this study was to examine epidemiological features of minor and moderate burn events that could be beneficial for prevention purposes. The study was conducted in Ardabil province in north-west Iran in 2005-2006. A total of 1700 minor and moderate burns were studied using a pretested questionnaire. Using the SAS 9.1 statistical program analyses were made. Females comprised the majority of cases (n=1000, 58.8%) and children, aged six and younger, made up 36.4% of burn victims. The majority of burns were caused by hot water and tea with the primary containers being kettles in 37.8%, cups or glasses in 24.2%, pots in 13.6% and samovars in 7.9%. Samovars, gas stoves, valors and picnic gas stoves were the primary heating devices involved in burns. In 56% of the cases, overturning of liquid containers was the primary injury mechanism of scalds. 43% had a second-degree burn with a mean total body surface area of 1.3%. This study provides possible beneficial information for burn prevention in the Ardabil area and other similar settings.

Bicycle injuries in Western Sweden: a comparison between counties

The objectives of the study were to investigate whether there are differences in the incidence of bicycle-related injuries by geographic district (county), age, and gender in Swedens Western Road Administration Region, and to utilize any detected differences to suggest priorities for intervention and prevention. Injury data come from the Swedish national hospital-discharge registry and a specialized national register of occupational injuries. Both bodily injuries in general and head injuries in particular show intra-regional differences. The rural part of Skaraborg County was shown to have a significantly higher injury incidence than other parts of the Western Region. Females generally show a lower incidence than males, but older women are more likely to be seriously injured than younger (age-related differences being greater than for males). Some striking findings were found with regard to occupational differences. Females sustain more work-related bicycle injuries than males. Head injuries account for more than half of the bicycle injuries in the Western Region that require hospitalization. All this indicates that targeted measures are required. Some studies have shown that the use of bicycle helmets reduces the incidence of head injuries, the degree of their severity, and the number of bicycle-related fatalities. There is a need for mandatory helmet-wearing legislation, which must go hand-in-hand with special efforts to reach groups with a low rate of helmet wearing, in particular those in the middle age range. Although the grown-up/older cycling population has been the subject of targeted action in some countries, the focus of preventive activity has generally been on children. The results of the study suggest the need for further injury-related research into adult cycling.

Injury mortality in local communities in Sweden and in the three Baltic States: implications for prevention

This study provides a comparative time-trend evaluation of injury mortality in local communities in Sweden and the three Baltic States, considering their national socio-political and economic situations and with analysis of local injury prevention structures and activities. Data for the period from 1990 to 2002 were gathered from national statistical offices for the cities of Borås, Tartu, Jelgava and Kaunas and from WHO databases for national level analyses. The death rates for Borås remained relatively stable over the time period, while the Baltic communities had increasing rates until 1994 and seemed to stabilize after 1997. The differences in injury mortality in the studied communities were highest for the 0 – 19 year age group and especially in the 20 – 64 year age group, but not for the 65+ year age group. Local communities in the Baltic States should consider coordinated safety promotion and injury prevention programmes as a complement to national safety promotion framework.