Therese Dowswell

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 …

Antenatal home blood pressure monitoring: a pilot randomised controlled trial

Objective To measure recruitment to, compliance with, and the acceptability of a trial designed to test whether a reduced schedule of antenatal visits combined with training in self‐measurement of blood pressure at home may improve hypertension screening and save money. To test the specific hypothesis that even after taking into account extra unscheduled visits, the reduced schedule with ambulatory monitoring reduces total visits.

Primary care groups: Modernising primary and community health services

This is the second in a series of five articles The governments plan for the NHS, published in July 2000, sets out an ambitious programme of investment, recognising that “the development of primary care services is key to the modernisation of the NHS.”1 Since the founding of the NHS primary care has been one of its greatest strengths but also its weakness. It has provided low cost, easily accessible care, but it has also been characterised by wide variability in quantity and quality, fragmentation, and a lack of coordination. The Labour governments 1997 white paper on the NHS proposed sweeping away the internal market and promoting a culture of collaboration and partnership.2 The establishment of primary care groups in England in 1999—which were charged with developing primary and community health services, commissioning hospital services, and improving the health of communities of around 100 000 people—represented a radical change in the organisation of primary and community health services. By 2004 all of these groups will become fully fledged primary care trusts, controlling most of the budget for providing health care to the populations that they serve. These organisations, led by local health professionals, will play a vital role in delivering the changes to primary and community services that the government sees as key to modernising the NHS. Within a framework of goals and performance standards set at the national level, the NHS plan asserts that the responsibility for decisions about services should be devolved to those who best understand local needs and circumstances.1 In this article, we focus on three key components of the governments strategy for modernising primary and community services: promoting a more efficient use of resources through collaboration and sharing, improving access to primary care, and enhancing the capacity of the workforce. #### Summary points Developing primary and …

Mother's Employment and Child Health Care

A decline in the number of young people entering the UK labour force has led to growing interest in the recruitment and retention of women workers. As yet the child care needs of school age children have not been addressed. Using interview data the strategies mothers employ to meet their work commitments outside of school hours and during childhood illnesses are described. Although mothers remained the main carers of their children, they frequently depended on unpaid help from relatives. These informal arrangements were sometimes complicated and potentially vulnerable. This dependence on informal support networks has a range of policy implications.

Joining the Learning Society and working in the NHS: some issues

In this paper we discuss the concept of the Learning Society in relation to staff working in the NHS (National Health Service) and taking part in formal courses. We outline the changing context within the NHS and draw on evidence from interviews with 38 participants on two courses. While motives for participation in courses were mixed, many staff felt under some pressure to engage in formal courses and in some cases undertook work‐related training in their own time and at their own expense. We conclude by discussing the implications of these findings for the development of a Learning Society.

Schools, Maternal Employment and Child Health Care

abstract For primary school children episodes of illness are almost inevitable and their occurrence is frequently unpredictable. To examine whether maternal employment is a factor which is associated with school sickness absence a study was carried out in Leeds of 139 families with children aged 6—7 attending five study schools. Some 282 episodes of illness leading to school absence occurred over two school terms. Children of mothers working full‐time had less than half the time off school than children whose mothers were not in paid employment. A number of factors could explain these differences including the use of differing severity thresholds in the two groups and social class differences in the distribution of illness. Perceptions about school policies and school staff were both taken into account by mothers in the decision‐making process leading up to school absence and before the return to school. They also influenced the way the illness episode was managed.