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Objectives: Evidence that health interventions work is not enough to ensure implementation into policy and practice. The complexity of public health systems requires more diverse actions. This paper proposes a conceptual model to enhance understanding of interlinking factors that influence the evidence implementation process. Methods: A literature review was conducted to explore factors that influence the process of evidence implementation in complex public health systems, including research findings and observations from 32 case studies of injury prevention interventions underway in 24 countries and results from evidence research networks. Concepts and themes identified through a critical review were organised, ordered and interlinked to build the model. Results: An Evidence Implementation Model for Public Health Systems and four concepts or themes: Evidence implementation target; Actors involved in implementation; Knowledge transfer; and Barriers and facilitators to evidence implementation were developed to provide a simplified, yet broad framework that highlights multiple factors and back and forth inter-linkages within and between the concepts that influence the uptake of evidence into public health systems policy and practice. Conclusions: Understanding the factors discussed within and amongst the four concepts of this model should ultimately help to positively influence the uptake of evidence into real world public health systems. This model has relevance for decision makers, researchers, knowledge brokers, and implementers.

Background: Injury to children in Europe, resulting in both death and disability, constitutes a significant burden on individuals, families and society. Inequalities between high and low-income countries are growing. The World Health Organisation Health 2020 strategy calls for inter-sectoral collaboration to address injury in Europe and advocates the whole of government and whole of society approaches to wicked problems. In this study we explore which sectors (e.g. health, transport, education) are relevant for four domains of child safety (intentional injury, water, road and home safety). Methods: We used the organigraph methodology, originally developed to demonstrate how organizations work, to describe the governance of child safety interventions. Members of the European Child Safety Alliance, working in the field of child safety in 24 European countries, drew organigraphs of evidence-based interventions. They included the different actors involved and the processes between them. We analyzed the organigraphs by counting the actors presented and categorizing them into sectors using a pre-defined analysis framework. Results: We received 44 organigraphs from participants in 24 countries. Twenty-seven sectors were identified across the four domains. Nine of the 27 identified sectors were classified as 'core sectors' (education, health, home affairs, justice, media, recreation, research, social/welfare services and consumers). Conclusions: This study reveals the multi-sectoral nature of child safety in practice. It provides information for stakeholders working in child safety to help them implement inter-sectoral child safety interventions taking a whole-of-government and whole-of-society approach to health governance.

The efficiency and effectiveness of child safety interventions are determined by the quality of the implementation process. This multinational European study aimed to identify facilitators and barriers for the three phases of implementation: adoption, implementation and monitoring (AIM process). Twenty-seven participants from across the WHO European Region were invited to provide case studies of child safety interventions from their country. Cases were selected by the authors to ensure broad coverage of injury issues, age groups and governance level of implementation (eg, national, regional or local). Each participant presented their case and provided a written account according to a standardised template. Presentations and question and answer sessions were recorded. The presentation slides, written accounts and the notes taken during the workshops were analysed using thematic content analysis to elicit facilitators and barriers. Twenty-six cases (from 26 different countries) were presented and analysed. Facilitators and barriers were identified within eight general themes, applicable across the AIM process: management and collaboration; resources; leadership; nature of the intervention; political, social and cultural environment; visibility; nature of the injury problem and analysis and interpretation. The importance of the quality of the implementation process for intervention effectiveness, coupled with limited resources for child safety makes it more difficult to achieve successful actions. The findings of this study, divided by phase of the AIM process, provide practitioners with practical suggestions, where proactive planning might help increase the likelihood of effective implementation.

Objectives: The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix. Method: The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review.Results: Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention.Conclusion: The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level.

Mortality and morbidity rates, traditionally used indicators for child injury, are limited in their ability to explain differences in child injury between countries, are inadequate in capturing actions to address the problem of child injury and do not adequately identify progress made within countries. There is a need for a broader set of indicators to help better understand the success of countries with low rates of child injury, provide guidance and benchmarks for policy makers looking to make investments to reduce their rates of fatal and non-fatal child injury and allow monitoring of progress towards achieving these goals. This article describes an assessment of national leadership, infrastructure and capacity in the context of child injury prevention in 18 countries in Europe and explores the potential of these to be used as additional indicators to support child injury prevention practice.Partners in 18 countries coordinated data collection on 21 items relating to leadership, infrastructure and capacity. Responses were coded into an overall score and scores for each of the three areas and were compared with child injury mortality rankings using Spearman's rank correlation.Overall score and scores for leadership and capacity were significantly negatively correlated to child injury mortality ranking.Findings of this preliminary work suggest that these three policy areas may provide important guidance for the types of commitments that are needed in the policy arena to support advances in child safety and their assessment a way to measure progress.

There is considerable confusion about the nature of indicators, their use in the injury field and surprisingly little discussion about these important tools. To date discussions of injury indicators have focused on the content and presentation of health outcome measures and on the dearth of data on exposure measures. Whereas these are valuable measures and assessing the optimal use of available routinely collected data in forming indicators is important, they do not provide sufficient information to support comprehensive prevention efforts, nor do they harness the full potential of indicators as tools to support prevention efforts. This paper provides an overview of the characteristics and uses of indicators for the field of injury prevention in order to make the case for action indicators and provide a framework for their appropriate use.

The focus on evidence-based practice is critical to addressing the issue of injuries, yet advances in the science of injury prevention have not always led to advances in practice. Effective approaches are not always adopted, or when adopted and transferred from one setting to another, they do not always achieve expected results. These challenges were the basis of two breakout sessions at the second European Injury Control and Safety Promotion Conference in Paris, France (October 2008). In summarising the key issues raised during those sessions, this article describes what is meant by evidence-based practice, discusses why evidence-based practice tends not to occur and considers approaches that may facilitate the adoption and implementation of evidence-based strategies. To address the challenge, specific action is required, both on the part of the research community and those responsible for developing and implementing injury prevention policies and programmes.

Background The School Travel and Child Safety Survey (STCSS) was developed as part of the European TACTICS project (Tools to Address Childhood Trauma, Injury and Children’s Safety) to address the lack of standardised data on children’s safety and exposure to risk across Europe. Description of the Problem Current methods used to collect data on child safety and exposures to risk are not collected in a coordinated way, making research and policy evaluation in these areas difficult. The STCSS was developed with European partners, as a standardised tool which could be adopted by member states, to collect child safety data and enable comparisons between different regions/countries for policy development and evaluation. Travel behaviour data (e.g. mode of transport and distance travelled) is also limited; but vitally important for monitoring active travel and road safety interventions. Results The STCSS was developed for children aged 10–13 years to be undertaken in school, and was successfully piloted in 5 countries across Europe (n = 636, participation rate = 88.37%). A sample of children were retested to establish the survey reliability, and per cent agreements were ≥96%. The STCSS has been further developed in Wales, to enable the results to be anonymised and incorporated into the Secure Anonymised Information Linkage (SAIL) databank at Swansea University. Data linkage methods within SAIL allow the STCSS results to be linked to other individual and household level datasets; for example, socioeconomic, demographic, health and education data. Conclusions The ability to link the results from this survey to other routinely collected data in the SAIL database, will provide much needed evidence on the medium and long-term effectiveness of child safety interventions and policies; as well as provide regional, national and international policy makers with data to support the planning and evaluation of interventions.

Aim: Risk factors for child injury are multi-faceted. Social, environmental and economic factors place responsibility for prevention upon many stakeholders across traditional sectors such as health, justice, environment and education. Multi-sectoral collaboration for injury prevention is thus essential. In addition, co-benefits due to injury prevention initiatives exist. However, multi-sectoral collaboration is often difficult to establish and maintain. We present an applied approach for practitioners and policy makers at the local level to use to explore and address the multi-sectoral nature of child injury. Methods: We combined elements of the Haddon Matrix and the Lens and Telescope model, to develop a new approach for practitioners and policy makers at the local level. Results: The approach offers the opportunity for diverse sectors at the local level to work together to identify their role in child injury prevention. Based on ecological injury prevention and life-course epidemiology it encourages multi-disciplinary team building from the outset. The process has three phases: first, visualising the multi-sectoral responsibilities for child injury prevention in the local area; second, demonstrating the need for multi-sectoral collaboration and helping plan prevention activities together; and third, visualising potential co-benefits to other sectors and age groups that may arise from child injury prevention initiatives. Conclusion: The approach and process encourages inter-sectoral collaboration for child injury prevention at the local level. It is a useful addition for child injury prevention at the local level, however testing the practicality of the approach in a real-world setting, and refinement of the process would improve it further., South Eastern European Journal of Public Health (SEEJPH), Volume I, 2014

Children have a right to safety, but this is still not optimally implemented throughout Europe. Furthermore, no joint commitment to change has been undertaken by the European Parliament, European Commission, or collectively by the EU Member States. This paper summarizes a White Book presented to governments entitled 'Priorities for Child Safety in the European Union,' requesting concerted action.The report is based on statistics provided by the World Health Organization as well as by research centers in the European Union Member States. Original research was contracted to the Mori Social Research Institute in 2001 in order to obtain an update on parents' and leading government officials' views on child safety.The leading causes of child injury deaths in the EU (road accidents, 48%, other unintentional 16%, intentional 13%, drowning 11%, fires 5%, falls 5%, and poisoning 2%) are the same in all Member States, but it is the distribution of injuries within each category that determines the unique profile of each. Adopting a number of best practices that have been identified for each injury area can reduce these injury deaths. Survey results show that the parents of children in Europe are concerned regarding child injuries, while government officials are still not making strong commitments to advance safety for children. A review of EU standards and legislation related to child safety shows that these are still incomplete and require changes.A joint commitment to reduce child accidental injury deaths in the EU is advocated, with a clear set of recommendations to act upon.

Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions.

Objective:Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries.Methods:All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injuryspecific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Postintervention documentation was compared to pre-intervention documentation for the 14 predefined data elements.Results:Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting “the presence of an adult observer” to 0.09 (95%CI, 0.01 to 0.76) for charting “sports equipment related to the injury.” The “flagging” of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention.Conclusion:A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

Drowning is a major public health issue which needs to be effectively addressed. Drowning prevention policies are a means to reduce the impact drowning has on individuals, families and communities as a whole.

Background To reduce child injuries, particularly inequities between different population groups, regions and countries; it is important to understand factors affecting child safety at several levels e.g. national, regional, local and individual. Local data is particularly important, as it is often at this level where injury prevention priorities are established and services are designed and delivered. The TACTICS project identified this need, and assessed two approaches, top-down and bottom-up to …

Issue/problem Effective advocacy for change in healthy policies and interventions requires knowledge of which actors are involved in the adoption, implementation and monitoring phase. This is often not transparent, particularly in the area of child safety where multiple sectors are often involved. Advocacy efforts could be facilitated by a tool that provides a way to explore and describe existing relationships between actors involved in a given intervention. The mapping of responsibilities …

Head injury (HI) in sport is common and can have serious consequences. This study examines the epidemiology of sport/recreational (SR)-related HI presenting to the emergency department (ED).Retrospective review of medical records.Five EDs in the Capital Health Region (Edmonton) located in the province of Alberta, Canada.All persons in a 1-year period reporting to the EDs with an HI. HI was defined as IC9-CM coded skull fracture, loss of consciousness, or concussion.Hospitalization, utilization of diagnostic testing, and discharge destination.In total, 10,877 (3%) of 288,948 ED encounters were for sports and recreational injuries; 358 (3%) were for HI. Males (71%) were more frequently injured; patients20 years old were involved in 66% of all HI cases. The highest proportion of HI occurred during ice hockey (21%), cycling (13%), and playground-related activities (8%). 9% of HI were hospitalized (versus 4% admission rate for other SR injuries: p0.01).These results demonstrate the utility of an ED-based injury registry and indicate that patients with HI presenting to the ED from SR activities are common. These injuries appear to be more severe than other types of SR injuries treated in the ED.

A pilot study to survey the attitudes of emergency department (ED) personnel regarding their role in injury prevention education in children and parents was conducted at a tertiary care trauma center. The survey consisted of 14 statements, asking staff members their level of agreement (from strongly agree to strongly disagree) on a forced-choice four-point scale. These were followed by two questions asking staff members to rank schools, physician’s offices, emergency departments, and public health units on their value in providing injury prevention information to children and parents. Before the intervention (an in-service training program on the importance of documenting the circumstances of injury on a patient’s chart), a 50% randomly selected sample of ED staff members was asked in May 1997 to complete the survey. After the data collection prepilot (4 months later), the remaining 50% was asked in September 1997 to complete the same questionnaire. Administration of the preintervention survey resulted in 53 of 62 surveys being returned (85%). The postintervention survey was completed by 35 of the 41 staff members still eligible (85%), those who were employed in the ED during the entire pilot project. There was no statistically significant difference between the pre- and post-pilot groups on any demographic characteristics. Staff members agreed least with the statement that ED physicians and staff members could impact the severity of injuries to children by providing counseling to parents (68.1% preintervention and 64.5% postintervention agreement). Of most significance was the fact that a lower percentage of staff members agreed postintervention that almost all injuries to children were avoidable. The emergency department was the lowest ranked information dissemination venue for both parents and children.

This abstract is from proceedings of the Safety 2012 World Conference Background Despite the existence of effective measures to reduce child unintentional injury, they are not always adopted and implemented. A lot of what is known to work requires government action in the form of national level policy or legislation. Child Safety Report Cards, developed in Europe in 2005, identify policy gaps, allow general European-level comparisons and measurement of improvements over time. Aims/Objectives/Purpose To measure uptake and implementation of national level policies to support child injury prevention in 31 European countries in 2012 and progress over 5 years. Methods Data for 115 policy indicators addressing unintentional child injury were obtained using English language survey tools. Issue specific and overall scores were calculated. Trend analyses to compare scores in 2007, 2009 and 2012 were conducted using paired t-tests. Results/Outcome None of the countries have adopted and implemented all recommended policies. Uptake is highest for road safety, while uptake of those related to home safety is lower. Between 2007 and 2012 the change in overall score for the 16 countries participating in both time periods ranged from −6.5 to +18.5 with the greatest improvements occurring in fall prevention, burn/scald prevention, pedestrian safety and leadership, and in countries where investments have been made in the last 5 years (eg, Czech Republic, Hungary, Scotland and Spain). The average increase of 5.09 was statistically significant (p=0.019; 95% CI 0.96 to 9.22). Significance/Contribution to the field While a crude measurement tool, the Child Safety Report cards have become an accepted benchmarking tool and have proved to be an effective advocacy tool driving action toward evidence-based good practices.

On 12 June 2012, in the European Parliament, MEP Malcolm Harbour, Chair of the Internal Market and Consumers Protection Committee, and John Dalli, European Commissioner for Health and Consumer Policy launched, in conjunction with the European Child Safety Alliance, Child Safety Report Cards for 31 countries, and a European summary. The Report Cards score countries on their level of adoption, implementation and enforcement of over 100 proven strategies and policies to prevent unintentional injury—good practices that are known to save children's lives. This multi-country assessment provides thoughts for similar actions in other countries worldwide. This is the third round of Child Safety Report Cards to be released by the European Child Safety Alliance, with 18 countries participating in 2007, 26 in 2009 and now 31 in 2012. A trend analysis for countries participating in both 2007 and 2012 found significant improvements in overall country scores over the 5 years. Encouragingly, some of the greatest improvements were reported in countries where investments in unintentional injury prevention have been made in the last 5 years (eg, Czech Republic, Finland, Hungary, Scotland and Spain). A notable decrease in overall score since 2009 in Greece probably …