Effectiveness of community-based injury prevention. Long-term injury rate levels, changes, and trends for 14 Swedish WHO-designated Safe Communities

Injuries and Safe Communities Accreditation: Is there a link?

Safe Communities (SC) is a global movement that brings together community stakeholders to collaboratively address injury concerns. SC accreditation is a formal process through which communities are recognized for strengthening local injury prevention capacity. Six million Americans live in 25 SC sites, but no research has been done to understand the model's potential impact on this population. This study explored the temporal relationship between SC accreditation and injury trends in three SC sites from the state of Illinois-Arlington Heights, Itasca, and New Lenox. Hospitalization data, including patient demographics, exposure information, injury outcomes, and economic variables, were obtained from a statewide hospital discharge database for a 12-year period (1999-2011). Joinpoint regression models were fitted to identify any periods of significant change, examine the direction of the injury trend, and to estimate monthly percent changes in injury counts and rates. Poisson random-intercept regression measured the average total change since the official SC accreditation for the three communities combined and compared them to three matched control sites. In joinpoint regression, one of the SC sites showed a 10-year increase in hospitalization cases and rates followed by a two-year decline, and the trend reversal occurred while the community was pursuing the SC accreditation. Injury hospitalizations decreased after accreditation compared to the pre-accreditation period when SC sites were compared to their control counterparts using Poisson modeling. Our findings suggest that the SC model may be a promising approach to reduce injuries. Further research is warranted to replicate these findings in other communities.

Impact of Community-Based Approach as Policy Tool: World Health Organization-Designated Safe Communities of Korea and Health Action Zones of the United Kingdom

Objectives

The aim of this study is to ascertain and identify the effectiveness of area-based initiatives as a policy tool mediated by societal and individual factors in the five World Health Organization (WHO)-designated Safe Communities of Korea and the Health Action Zones of the United Kingdom (UK).

Methods

The Korean National Hospital discharge in-depth injury survey from the Korea Centers for Disease Control and Prevention and causes of death statistics by the Statistics Korea were used for all analyses. The trend and changes in injury rate and mortality by external causes were compared among the five WHO-designated Safe Communities in Korea.

Results

The injury incident rates decreased at a greater level in the Safe Communities compared with the national average. Similar results were shown for the changes in unintentional injury incident rates. In comparison of changes in mortality rate by external causes between 2005 and 2011, the rate increase in Safe Communities was higher than the national average except for Jeju, where the mortality rate by external causes decreased.

Conclusion

When the Healthy Action Zones of the UK and the WHO Safe Communities of Korea were examined, the outcomes were interpreted differently among the compared index, regions, and time periods. Therefore, qualitative outcomes, such as bringing the residents' attention to the safety of the communities and promoting participation and coordination of stakeholders, should also be considered as important impacts of the community-based initiatives.

Occupational accidents in the Finnish local government sector: utilisation of national statistics

Occupational accidents in the Finnish local government sector in 2004 are analysed by gender, age and occupation class in order to identify particular risk groups. The accident data are compared with data concerning the number of employees, using frequency distributions and accident incidence rates. The possibilities of providing occupation class-specific accident incidence rates are also discussed. According to the results, commuting accidents are more common and severe in the local government sector than in general in Finland. In the local public sector occupational accidents more often involved women than men. Compared to other age groups and occupational classes, occupational accidents are more common in the age band of 45-54 and in the occupational class of medical and nursing work. However, compared to the employees' data, men and younger employees had an increased workplace accident risk, while women and older employees had an increased risk of commuting accidents. The highest accident incidence rate was in farming and animal husbandry work. Currently, the calculation of occupation class-specific accident incidence rates is difficult. Improving the consistency of the occupation classifications used in the various data sources would facilitate more reliable calculation of rates.

Controlled evaluation of injury in an international Safe Community: Kashmar, Iran

OBJECTIVES

To determine the degree to which the Safe Community (SC) model is effective in reducing injuries. Although positive results have been reported for some communities in developed countries, there is no consistent relationship between being an international designated SC and subsequent changes in observed rate of injury, and no controlled studies have examined the effectiveness of the SC model in developing countries. The aim of this study was to evaluate and compare the injuries in the SC programme of Kashmar (population 149,358) with injuries in counties in Iran that have not applied the SC model.

STUDY DESIGN

Retrospective study using available data from 20 March 2005 to 19 March 2008.

METHODS

Data were obtained from the Injury Prevention and Safety Promotion Department of the Disaster and Emergency Management Centre of the Ministry of Health and Medical Education of Iran. These data are collected upon presentation of injured patients to the emergency room. Different types of injuries are evaluated, including motor vehicle injuries (including pedestrians, passengers, drivers and motorcyclists), falls, blows by an object or a person, violence, burns, scorpion and snake bites, electrocution, animal attack, toxicity, suicide and other causes. A control group was selected from all counties in Iran with a population between 100,000 and 200,000. The mean injury rate of these counties was calculated, and counties which had an injury rate within one standard deviation (SD) of the mean rate for all 3 years of the study were included in the control group (n=44 counties).

RESULTS

The mean population of the 44 control counties was 142,123 in 2006. The numbers of injuries per 100,000 population in Kashmar were 4654.6 [95% confidence interval (CI) 4584.3-4762.6], 4570.9 (95% CI 4465.5-4678.0) and 4949.2 (95% CI 4839.7-5060.4) in 2005-2006, 2006-2007 and 2007-2008, respectively. At the same time, the mean numbers of injuries per 100,000 population in the 44 control counties were 822.7 (95% CI 815.6-829.8), 1130.0 (95% CI 1121.7-1138.3) and 1245.5 (95% CI 1236.8-1254.2). The injury-related fatality rate in the emergency room was 57.6, 52.9 and 44.2 per 100,000 population in Kashmar and 12.2, 13.0 and 11.9 per 100,000 population in the control counties in the three study years. Although a comparison of the fatality rate between the first and third years of the study shows a decrease of 13.4 per 100,000 population in Kashmar, this was not significant (P=0.1056). In the 44 control counties, the injury-related fatality rate decreased by 0.3 per 100,000 population between the first and third years of the study. The difference between the decrease in injury-related fatality rate in Kashmar (13.4 per 100,000 population) and the 44 control counties (0.3 per 100,000 population) was significant (P<0.0001).

CONCLUSION

The controlled evaluation of injury in the international SC of Kashmar showed an increase in the number and rate of injuries in Kashmar and in the 44 control counties over 3 years, but the injury-related fatality rate decreased over the same time period. A greater decrease was seen in Kashmar than in the control counties. Long-term evaluation is necessary to confirm these results.

Is Sweden still a role model for safety? An overview of unintentional injury data over the past two decades

This study investigates injury-related mortality and hospitalisations, during 1987-2007 in Sweden. Injuries were classified according to International Classification of Diseases (ICD)--8 for pre-1987 injuries, ICD-9 for 1987-1996 injuries and ICD-10 for injuries occurring in 1997 and later. Data on mortality from injuries during 1987-2007 were collected from Sweden's national Cause-of-Death Register, while data concerning injury diagnoses leading to hospitalisation stays of at least 24 h, occurring during 1987-2007, were obtained from the national Patient Register. Crude rates were derived for injury-related deaths and injury-related hospitalisations for age-gender groups, using population data from Statistics Sweden. Our results showed a mixed picture of injury-related hospitalisations and deaths over the study period. Absolute numbers of injury-related deaths and injury-related hospitalisations decreased over time for the population as a whole and for many, but not all, age-gender groups. When assessing crude injury-related death rates and crude injury-related hospitalisation rates over time, as categorised by gender and age groupings, we also found unchanging or increased risks for injury-related deaths and/or hospitalisations for several age-gender groups. While Sweden has made remarkable progress in reducing injury-related deaths and hospitalisations, there are clear differences in risk that remain.

The 'WHO Safe Communities' model for the prevention of injury in whole populations

BACKGROUND

The World Health Organization (WHO) 'safe communities' approach to injury prevention has been embraced around the world as a model for co-ordinating community efforts to enhance safety and reduce injury. Approximately 150 communities throughout the world have formal 'Safe Communities' designation. It is of public health interest to determine to what degree the model is successful, and whether it reduces injury rates. This Cochrane Review is an update of a previous published version.

OBJECTIVES

To determine the effectiveness of the WHO Safe Communities model to prevent injury in whole populations.

SEARCH STRATEGY

Our search included CENTRAL, MEDLINE and EMBASE, PsycINFO, ISI Web of Science: Social Sciences Citation Index (SSCI) and ZETOC. We handsearched selected journals and contacted key people from each WHO Safe Community. The last search was December 2008.

SELECTION CRITERIA

Two authors independently screened studies for inclusion. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

MAIN RESULTS

We included evaluations for 21 communities from five countries in two geographical regions in the world: Austria, Sweden and Norway, and Australia and New Zealand. Although positive results were reported for some communities, there was no consistent relationship between being a WHO designated Safe Community and subsequent changes in observed injury rates.

AUTHORS' CONCLUSIONS

There is marked inconsistency in the results of the studies included in this systematic review. While the frequency of injury in some study communities did reduce following their designation as a WHO Safe Community, there remains insufficient evidence from which to draw definitive conclusions regarding the effectiveness of the model.The lack of consistency in results may be due to the heterogeneity of the approaches to implementing the model, varying efficacy of activities and strategies, varying intensity of implementation and methodological limitations in evaluations. While all communities included in the review fulfilled the WHO Safe Community criteria, these criteria were too general to prescribe a standardised programme of activity or evaluation methodology.Adequate documentation describing how various Safe Communities implemented the model was limited, making it unclear which factors affected success. Where a reduction in injury rates was not reported, lack of information makes it difficult to distinguish whether this was due to problems with the model or with the way in which it was implemented.

What promotes sustainability in Safe Community programmes?

BACKGROUND

The theory and practice of safety promotion has traditionally focused on the safety of individuals. This study also includes systems, environments, and organizations. Safety promotion programmes are designed to support community health initiatives taking a bottom-up approach. This is a long-term and complex process. The aim of this study was to try to empirically identify factors that promote sustainability in the structures of programmes that are managed and coordinated by the local government.

METHODS

Four focus group sessions with local government politicians and administrators in designated Safe Communities were conducted and analyzed using qualitative content analysis.

RESULTS

Collaboration was found to be the basis for sustainability. Networks, enabling municipalities to exchange ideas, were reported to positively influence the programmes. Personal contacts rather than organizations themselves, determine whether collaboration is sustained. Participants reported an increase in cross-disciplinary collaboration among staff categories. Administrators and politicians were reported to collaborate well, which was perceived to speed up decision-making and thus to facilitate the programme work. Support from the politicians and the county council was seen as a prerequisite. Participants reported an increased willingness to share information between units, which, in their view, supports sustainability. A structure in which all local authorities' offices were located in close proximity to one another was considered to support collaboration. Appointing a public health coordinator responsible for the programme was seen as a way to strengthen the relational resources of the programme.

CONCLUSION

With a public health coordinator, the 'external' negotiating power was concentrated in one person. Also, the 'internal' programme strength increased when the coordination was based on a bureaucratic function rather than on one individual. Increased relational resources facilitated the transfer of information. A regular flow of information to policy-makers, residents, and staff was needed in order to integrate safety programmes into routines. Adopting a bottom-up approach requires that informal and ad hoc activities in information management be replaced by formalized, organizationally sanctioned routines. In contrast to injury prevention, which focuses on technical solutions, safety promotion tries to influence attitudes. Collaboration with the media was an area that could be improved.

Effects of neighbourhood and individual factors on injury risk in the entire Swedish population: a 12-month multilevel follow-up study

In this cumulative incidence study of the entire population of Sweden, we examined the association between neighbourhood income level and injury risks across a comprehensive set of individual variables. The population, stratified by age (0-14, 15-64, and > or =65 years), was followed for incident injury events in 1998. Multilevel logistic regression was used to examine the associations between neighbourhood income level and injury, including deaths from injury. Risks were analyzed, taking individual demographic and socioeconomic variables and alcohol/substance abuse into account. Falls were the most frequent non-fatal injuries in all age groups. People (0-14 years and 15-64 years) in the most deprived neighbourhoods exhibited higher odds of injuries (OR = 1.15; CI = 1.08-1.22 and OR = 1.34; CI = 1.26-1.43, respectively) than those in the same age groups in the most affluent neighbourhoods (OR = 1). In the full model, injury odds ratios decreased but remained significant in people 0-14 years. The large between-neighbourhood variance in all age groups indicated variation between neighbourhoods in injury incidence. Our results suggest that interventions focused on contextual aspects of neighbourhoods, in addition to individual behaviours, may have a positive impact on injury prevention.