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International injury control conferences: surely we can do better?
  1. John Langley
  1. Injury Prevention Research Unit, Department of Preventive and Social Medicine, PO Box 913, Dunedin, New Zealand

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    The Fourth World Conference on Injury Prevention and Control has come and gone and planning is well under way for the fifth conference in Delhi. I have been fortunate to attend three of the four conferences to date. When I return home from these conferences my colleagues invariably ask “what was it like?” “worth going?”. I regret to say I have never been effusive in response, even with respect to the Melbourne conference where I had a small hand in assisting with planning the scientific programme. So why have I been not been effusive in my praise? I will illustrate by reference to previous conferences but especially the recent conference in Amsterdam, for no other reason than it is fresh in my mind.

    One of the reasons I attend such conferences is to strengthen my current contacts and establish new ones, “network” as they say. There is no substitute for previous face to face contact when communicating by mail, especially if you want assistance from the recipient of your correspondence! It has also been my experience that the establishment of positive interpersonal relationships is critical to collaborative endeavours.

    Being from an English speaking country I am naturally drawn to communicating with others in countries where English is the first language for both oral and written communication. I have, however, often wondered to what degree this language limitation has hindered my learning of new and interesting developments in other countries. By definition, international conferences afford the opportunity to address this problem, albeit in a small way.

    It was thus my expectation that the Amsterdam conference would provide an excellent opportunity to “network” with Europeans whose first language is not English. I was thus surprised at the small size of the European contingent relative to the US contingent, which had a greater distance to travel.

    While I doubt that cost was a barrier to European participation it would have been a significant consideration for many of those contemplating coming from outside Europe, especially from the southern hemisphere. If we wish to increase participation in these meetings more attention must be given to reducing the costs of all aspects of the meeting.

    In view of the importance of networking, one area which warrants attention is the cost of the dinners. The cost was very high in Amsterdam and I know that this deterred many people. I am sure a simpler and thus less expensive dinner would have satisfied the majority. In many areas some of the fixed costs are difficult to reduce, and while costs in some other areas by themselves represent a small part of the overall cost they can add up to significant amount. As one colleague said to me “ how many of these fancy conference bags do you need?” .

    Given that these meetings are in some sense “public health” meetings it is appropriate that we provide nutritious food and small to moderate servings. The efforts in Amsterdam were in marked contrast to what could be described as excesses at some of the previous conferences.

    Another reason I attend these conferences is to recharge my batteries, to be inspired, to be challenged, and to be stimulated by new ideas. I have always assumed that plenary sessions are intended to make a significant contribution in this respect. Regrettably most of the plenary speakers at this conference, and the previous two international conferences I have attended, failed to do any of the above. If the studious reading of abstracts, tourist brochures, newspapers, and the like during these sessions is anything to go by I am not alone. Of perhaps greater concern is that it was abundantly clear that a number of speakers were not abreast of recent developments in injury control.

    Presenting one's work to one's colleagues serves several purposes. For many it is critical to securing approval and funds to attend. Organisers of these conferences are thus faced with somewhat of a dilemma when reviewing an over subscription of abstracts, many of which can be quite poor. One method of dealing with this is to assign some abstracts to poster sessions. That strategy was used extensively at Amsterdam. I spent a considerable time scanning the abstracts and identifying those I particularly wanted to visit. In a number of cases I was disappointed to find there was no poster displayed. I understand from some authors that they took umbrage at having their paper relegated to a poster and as consequence withdrew their paper. In several cases I was pleasantly surprised at the quality and significance of some of the work displayed. In my opinion it was superior to much of that presented at the oral sessions I attended. A number of posters presented research findings which challenged conventional wisdom on specific aspects of injury control. For example, small craft water safety literature recommends that if your craft overturns and you are unable to rectify the situation you stay with the craft until, hopefully, assistance arrives. The authors of one poster I visited argued that their research had shown that under adverse conditions where immediate rescue is unlikely, especially for good swimmers wearing a floatation device, it is preferable to swim immediately for shore rather than stay with the boat or swim after a delay. Given the significant contribution that drowning makes to injury mortality in many countries, and the paucity of evidence supporting many drowning prevention strategies, this poster deserved an oral presentation and an ensuing audience discussion.

    One of the problems planners face is having too many parallel sessions which result in low average attendances and a high proportion of attendees wishing to hear two presentations which are running at the same time. There is no easy solution to this but it does raise the question as to why abstracts are selected for an a oral or poster presentation. It is my impression that selection for a poster presentation is second prize. But why should this be so? Why not encourage all those selected for oral presentations to also have a poster. In this way those who are unable to attend a presentation would have the opportunity to learn more about the project than a written abstract can convey and, equally important, interact with the authors. This would, however involve extra cost and effort for the presenter.

    This matter raises the obvious question about the criteria used for the selection of abstracts for oral presentation. Those for research papers should be different for programmatic papers. Moreover, they need to be made clear well in advance of the abstract submission date.

    An associated issue which must be grappled with by future organisers, is that there are two main types of attendees at these meetings, researchers and programmatic people. While they share some common conference needs and expectations there are some important differences. This is well illustrated by one session I attended where a researcher having made his presentation was searchingly queried by several members of audience about his study design and analyses. During the discussions a member of the audience leaned over to me and said “I hate these sessions where all these academics argue with one another about things I have not a clue about”. Constructive criticism is of course part of the day-to-day exchange of scientific investigation. Researchers clearly have some needs which are different to programmatic people. Oral sessions should be planned and advertised to reflect this.

    There appeared to be two types of symposia. One appeared to be based on a selection of abstracts which were submitted for consideration as oral presentations. The other type appeared to be proactively managed and was intended to present a synthesis of the state-of-the-art on a specific issue. It was often difficult to determine in advance what type a symposium it was. An example of what I assume was a proactively organised symposium was “Societal Costs of Injury”. This was, without a doubt, the best attended session I went to for the entire conference. If a fire officer had entered, or at least tried to get through the entrance, they undoubtedly would have called a halt to proceedings.

    A feature of the Amsterdam conference was the “pre” and “post” conferences. I was also fortunate to attend the International Collaborative Effort (ICE) on Injury Statistics, a small pre-conference at which there was a “state of the art” session on measuring injury severity. I suspect that had this been part of the main conference it would have been over subscribed.

    Injury control research has developed rapidly over the last decade or so. For many of us who are expected to be knowledgable in a number of areas it is becoming extremely difficult to keep abreast of developments. Attending a traditionally organised proffered paper session on, say, injury severity may bring one up date on some specific issues. However, you would be unlikely to obtain the same insight as you would from a proactively managed session which has as its objective an overview of the state-of-the-art on injury severity.

    Another state-of-the-art session I attended was “Best Evidence for Effective Injury Interventions”. This was on 7:00–8:30 pm after a full day of plenaries and symposia. The fact that it was relatively well attended, despite its scheduling, is further testimony to the demand for such sessions. In this case it was described as a “Round Table”, although in no sense did I feel I was sitting around a table discussing a range of issues relevant to the presentations.

    Injury can be viewed from a variety of perspectives. These include the nature of injury (for example thermal, drowning), type of event (for example motor vehicle crash, fall), intent (for example assault), activity (for example sport, work), place (for example farm, school), and risk factors (for example alcohol). Given the variety of perspectives, and that they are not mutually exclusive, conference organisers face a challenge in designing a programme that will attract attendees from a wide cross section of the injury control community. One approach would be to reduce the emphasis on traditional themes by having sessions with cross cutting themes. This certainly was the intention for the Australian conference and it appears also to have been the case in Amsterdam. While there is some merit in this approach we simply cannot afford to ignore the fact that potential participants, and their funders, are looking for evidence that there will be sufficient content to warrant their attendance. By way of illustration, there was no mention in any of the publicity material beforehand of any session devoted specifically to occupational injury. Given the enormous personal and social burden of occupational injury in most countries, and the large number of agencies charged with managing this problem, we are missing an opportunity to exchange experiences.

    Of course some could argue that international “all cause” injury conferences will never satisfy the majority of people working solely in specialist areas. They have their own national or international conferences, which in some cases are bigger than the “all cause” conferences.

    While that is undoubtedly true, many of us are working in a variety of areas and simply could not afford the time or money to attend all such relevant meetings. We thus need to hear from experts in a variety of fields at one meeting. We also need to share experiences and learn from one another. For example, many of the issues associated with undertaking research or implementing a programme in one area may be applicable to another. The encouragement of “pre” and “post” conferences offers an opportunity to meet both needs.

    In summary my prescription for the future would be:

    1. Devote only one half day to plenaries. Ensure speakers are leaders in injury control, have a vision for the future, and are able to challenge the audience to join with them in this vision.

    2. Develop criteria, and advertise well in advance, for acceptance of abstracts for proffered paper sessions. Encourage all those selected to also have a poster presentation.

    3. Have oral proffered paper sessions which: have a very strong research theme, others which are very strong on programmatic matters, and combined programmatic and research streams on clearly defined issues.

    4. Make a clear distinction between proffered paper sessions, symposia, and round tables, and provide strong direction to those offering to organize the latter.

    5. Ensure there is a core of the traditional streams (for example occupational, motor vehicle traffic).

    6. Continue to encourage “pre” and “post” conferences.

    7. Proactively organize more “state of knowledge and practice sessions” on specific issues (for example drowning, injury severity measurement). Ensure that these are distinguishable from proffered paper sessions. These would be a substitute for plenaries.

    8. Get the costs down!

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