News and Notes
Volume 14, Issue 5, October

News and Notes is published online in advance of the official publication date.

Contact details for News and Notes submissions

News and Notes Editor:
Michael Hayes

PEOPLE IN THE NEWS
Dr Ayub Khan Ommaya, a neurosurgeon who was an internationally known expert on brain injuries and traffic safety, died on July 10 at his home in Islamabad, Pakistan. Among his many achievements, Dr Ommaya developed the centripetal theory of traumatic brain injury, which allowed scientists to understand and model how brains are affected by blunt force. As chief medical adviser to the US National Highway Traffic Safety Administration and director of its head injury prevention program, he created a model for brain injuries that led to design changes and the development of safety devices in motor vehicles worldwide. He moved to the United States in 1961 as a visiting scientist at the National Institutes of Health and later became an associate neurosurgeon. As a transportation safety expert, he commissioned "Injury in America" (1985), a report that led to the creation of the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control. He also invented an inflatable collar, similar to an airbag, that attaches to motorcycle helmets as a protection against spinal injury.

Dr Steve Beerman of Nanaimo, British Columbia, Canada, has been elected as president of the International Life Saving Federation. The ILS is an international federation representing more than 100 national lifesaving organizations from around the world. ILS leads the worldwide effort to reduce injury and death in, on, or around the water.

Bob Baker has been appointed as the new President & CEO of SMARTRISK. The organisation, founded in 1991, is a Canadian national charity dedicated to preventing injuries and saving lives. Mr. Baker brings to the position 23 years of experience in the charitable sector, spanning healthcare, social services and education. .

NEW CHILD SAFETY POST IN WALES
Children in Wales (CIW) has been successful in securing a grant through Health Challenge Wales (Welsh Assembly Government) to employ a full time worker in Child Safety for the next three years with a possible extension of a further two years. Karen McFarlane, who has worked in the safety field for several years, has been appointed to the new post. The grant will ultimately enable CIW to build on work previously carried out by Child Safe Wales (CSW). The post will enable a programme to be implemented that includes the continued development of the Child Safety Action Plan for Wales as well as looking at ways to improve the knowledge an expertise of the children and young people’s workforce through an ongoing programme of activity. Although the child safety post will be managed by CIW it will be guided by a steering group of experts in child safety including the Collaboration for Accident Prevention and Injury Control (CAPIC).

BRAZIL TAKES STEPS TOWARDS A SAFER TRAFFIC
On June 19, the Brazilian Government enacted a radical and uncompromising law that lowers per se blood-alcohol concentration limit for drivers from 0.06% to zero. From now on, driving under the influence of the slightest quantity of alcohol will be considered a severe offense, subject to both a R$957 fine (US$610, €390) and a 12-month license suspension. Moreover, breath testing will be no longer optional, and anyone who refuses it may be charged as a drunken driver. Although there is a clear trend in the international community to reduce alcohol limits, such zero tolerance rule makes Brazil the first country in the Americas to join the few selected ones (like Armenia, Azerbaijan, the Czech Republic, Estonia, Hungary, Kyrgyzstan, Malaysia, Romania and Slovakia) that have set non-religiously-mandated prohibitions of drivers ingesting any amount of alcoholic beverage whatever. Alcohol consumption is a health issue in Brazil, accounting to up to 70% of traffic crashes, which the present shift in legislation will try to address, and it is expected to bring stark changes in traffic, especially during weekends and late at night, as well as profound cultural modifications regarding drinking in the large. Earlier in the same month, the Traffic National Council, the federal government agency that regulates traffic-related matters, issued a long awaited resolution that amends the 1998 Brazilian Traffic Code by restating that children under ten years must ride in the back seat of motor vehicles using an individual restraint device, and requiring infants up to one year to use a rear-facing safety seat, toddlers and preschoolers up to four years to use a forward-facing safety seat, and children between four and seven and a half to use a belt-positioning booster seat.

GUIDANCE ON BEHAVIOUR CHANGE AND COMMUNITY ENGAGEMENT
England’s National Institute for Health and Clinical Excellence (NICE) has produced two guidance documents that are relevant to injury prevention (and other areas of health promotion). There is continued debate in the injury field about the effectiveness of educational approaches. These guidance documents draw their evidence from a broader field of health related interventions, but some of the generic approaches are relevant to the injury field when behavioural counter measures are planned or broader community based approaches are used. The first report examines evidence in relation to behaviour change (http://www.nice.org.uk/PH006). The messages from the guidance document include the need to plan interventions and programmes aimed at changing behaviour, taking into account the local and national context and working in partnership with recipients. Practitioners need to be equipped with the necessary competencies and skills to support behaviour change, using evidence-based tools. Courses for practitioners thus need to be based on theoretically informed, evidence-based best practice. The report also stresses the need to evaluate all behaviour change interventions and programmes, either locally or as part of a larger project and that there should be an attempt to include an economic component. The second document relates to community engagement and community development approaches to improving health, including the use of collaborative methodology and community champions (http://bit.ly/1tya6F). This report examines different levels of community engagement, such as informing, consulting and delegating power, which can have a direct or indirect health effect. The report emphasises that community engagement is a long term investment which can involve organisational and cultural change and the need for mutual trust and respect. Training and resources, participative working and area based initiatives are considered and how community members can work as agents of change, peer leaders and educators and health champions..

A FATAL CONTRADICTION SAYS ANEC REPORT
Children up to four years of age would be better protected in cars if they travelled rearward-facing in a suitable child restraint, rather than forward-facing as is the usual practice in most of Europe. Suitable seats are widely used in the Nordic countries, but are not readily available in the rest of Europe. The law and the supply of seats, together with the information for parents, are in urgent need of revision. These are the conclusions of a study commissioned by European consumer group ANEC, undertaken by Vehicle Safety Consultancy, looking at the lessons to be learned from accidents in the UK, US and Sweden. ANEC undertook the study to evaluate the limits of protection offered by both forward and rearward-facing restraints for children up to four years of age. The US, Swedish and UK data showed that children in forward-facing seats suffered head, neck, chest and abdominal injuries in circumstances in which a rearward facing restraint would have provided much better protection. ANEC concluded, in common with all other researchers who have examined this topic, that the rearward-facing restraints offer a higher level of safety over forward-facing restraints to children at least up to the age of four years and would have prevented many fatalities had their use been more widespread. It is clear that a gulf has developed between the conclusions of the technical community, based on accident and test data, and advice provided to consumers through legislation. ANEC considers that the consumer is not receiving the best technical advice. ANEC is urging legislators to revise the law on the use of child restraints in order to provide children with improved levels of protection. Through the study, ANEC not only calls for changes to the legislation but also invites the standardisers to take into account the findings in the development of a new standard. The report of the study is available at http://www.anec.eu/attachments/ANEC-R&T-2008-TRAF-003.pdf.

IRELAND VEHICLE SPEED REPORT
The results of a nationwide ‘free speed’ survey on Irish roads conducted in 2006 by Road Safety Authority were published in March 2008. The study shows mixed results. The number of car drivers breaking the posted speed limit of 80km/h on regional roads dropped from 63% in 2005 to 26% in 2006 and from 37% to 19% on county roads in the same period. However, on motorway, national primary and national secondary routes the proportion of cars complying with speed limits decreased. For example the number of cars breaking the 100km/h speed limit on national secondary routes increased from 9% in 2005 to 13% in 2006, national primary routes increased from 23% to 27%, on dual carriageways from 28% to 30%, and on Motorways from 15% to 20%. The proportion of cars exceeding the speed limit on urban arterial roads (in 50 km/h zones) fell by 5 percentage points to 86 per cent in 2006. However there was a significant increase in the percentage of cars breaking the 50km/h speed limit in residential areas – from 20% in 2005 to 47% in 2006. The 2006 ‘Free Speeds’ Survey can be viewed on the RSA’s website (http://bit.ly/8lNI9).

PROTECTION OF PEDESTRIANS AND OTHER VULNERABLE ROAD USERS
Each year 8 000 pedestrians and cyclists are killed and 300 000 injured across the EU. In June, the European Parliament plenary adopted at first reading the European Commission proposal for a regulation, laying down requirements for the construction and functioning of vehicles and frontal protection systems to reduce the number and severity of injuries to pedestrians and other vulnerable road users hit by the fronts of those vehicles. The initiative is also intended to avoid such collisions. This regulation repeals the current Directive on the protection of pedestrians and other vulnerable road users (Directive2003/102/EC), the Directive relating to the use of frontal protection systems on motor vehicles (Directive 2005/66/EC) and related national legislation in all Member States. The proposal will now be discussed by the Council of Ministers.

NEW GUIDELINES FOR SAFE COMMUNITIES MEMBERSHIP UNDER REVIEW
Proposals are being developed for the revision of the Safe Communities (SC) model. The changes are needed to reflect the changing times and structure, with the majority of work now being done by Affiliate Supporting and Certifying Centres. They will also strengthen the capacity of local Safe Community organisations, continuing to promote excellence in community safety programming. The proposed changes to the SC model have been developed in partnership with many volunteers around the world. A final version of this document has now been posted on the SC website, http://bit.ly/1H3bF2 for comment. The proposed changes will affect everyone in the network. These include a requirement for current programmes to send a very short annual report each year and a re-designation every five years. The most noticeable proposed changes to the model will affect new applicants to the network: a requirement for evidence of long term programme sustainability; the organisation must normally have been active in two years prior to application; the organisation’s reference group, or governing group, must be documented to have representation from important community sectors; and the applicant organisation must provide evidence of at least six Task Force groups, addressing specific injury prevention and-or safety promotion issues in the community.

INJURY ISSUES MONITOR
The Monitor is published approximately three times annually by the Research Centre for Injury Studies at Flinders University, Adelaide, Australia. It provides a clearinghouse for information about developments in injury surveillance and prevention. The June 2008 issue, accessible at http://bit.ly/3no6OE, includes information on drowning deaths and hospitalisations, football injuries, national leadership in injury prevention, news of the Australian Injury Prevention Network, serious transport-related injury, and using multiple causes of death for injury surveillance.

YOUTH CAMPAIGN FOCUSES ON INJURY PREVENTION
Manitoba's Workers' Compensation Board has launched an innovative SAFE Work media campaign targeting young workers. Unlike previous ad campaigns, the injury prevention message will reach youth through a medium they frequent: the Internet. The summer youth advertising campaign showcased three real-life workplace injury scenarios provided by Manitoba youth. Jason Croker's story is among them. "I worked in a fast food restaurant when I was 15," recalls Croker, "and I didn't receive any safety training. As a result, I was put in a dangerous situation. I'm glad the WCB is including my story in their campaign, because I don't want other young workers to go through the same thing." To ensure youth learn about workplace safety solutions, media components will drive people to www.safemanitoba.com where visitors will experience workplace safety and health solutions through an online quiz. The campaign features billboards, TV, radio, interactive webisodes and a presence on Facebook.com and YouTube.com. But as provocative as the new advertising tactics are, WCB's safety message remains the same: workplace injuries are preventable.

EUROPEAN BABY WALKER DEVELOPMENTS
At the European Commission’s committee responsible for issues associated with the General Product Safety Directive held in June, ANEC gave a presentation on baby walkers to convince EU Member States that the standard for baby walkers, EN 1273:2005, should become a so-called harmonised standard, having the effect of making it mandatory. Although most Member States gave their support in June 2007 to publish the references of the standard in the Official Journal, discussions took place at the February 2008 meeting on whether a ban would be the better option. ANEC would support a ban, but regards this as a long process. As none of the Member States had a fundamental objection against referencing the standard in the Official Journal of the European Union, hence making it a harmonised standard, the Commission is to plan a vote on the issue later this year.

CONSEQUENCES OF HELMET LAW REPEAL
In 2003, Pennsylvania legislators repealed a law requiring motorcycle riders to wear helmets. Researchers who studied deaths and injuries over the next two years say that decision had lethal, and expensive, consequences [1]. The researchers compared accident statistics from the two years before repeal with numbers from the two years after. After repeal, helmet use among riders in crashes decreased to 58 percent from 82 percent. At the same time, head injury deaths increased 66 percent and head injury hospitalizations increased 78 percent. Meanwhile, total acute-care hospital charges for motorcycle-related head injuries increased 132 percent in the latter period, compared with a 69 percent increase in other injury costs. Although motorcycle registrations also increased, the rate of crashes per 10 000 registrants remained the same, indicating that there was little change in driving habits, road conditions or the risk behavior of riders. "We hope that legislators take a look at the data," said the study’s lead author, Dr Kristen J Mertz, an assistant professor of epidemiology at the University of Pittsburgh, "and consider reinstituting universal mandatory helmet laws."

INTEGRIS
The further development and expansion of the European Injury Database (IDB) has received a positive boost in the form of INTEGRIS (Improved methodology for data collection on accidents and disabilities – Integration of European Injury Statistics), a new project co-funded under the Seventh Framework Programme of the European Community for research and technological development. The INTEGRIS project will run until early 2011. The expected impact of the project is the methodological improvement and increased efficiency in the recording and reporting of injuries in the network of IDB hospitals. This in turn should lead to an increased usability of existing hospital data for injury prevention and research. In the long-term, the creation of a representative and cost-efficient injury surveillance system in all EU Member States should be facilitated. The overall INTEGRIS goal is to develop and evaluate a data model for the integration of routine and more detailed hospital data on injuries, namely through linking the official Hospital Discharge Register (HDR) with the IDB. This integrated data model will enable IDB hospitals to generate a standard injury data set from the routinely collected information with minimal additional efforts. For further information, read the June 2008 issue of the Eurosafe newsletter, Alert: accessible via http://www.eurosafe.eu.com/. Regular INTEGRIS summaries will be available in the Research and Methodology section of the Eurostat home page http://epp.eurostat.ec.europa.eu/. The project is being led by Robert Bauer (robert.bauer{at}kfv.at).

ONTARIO HELPING KIDS PLAY SAFE
More than ten thousand low-income kids in the Canadian province of Ontario will now be able to play safe when participating in sport and recreation activities requiring helmets, including: biking, rollerblading and skateboarding. As part of Ontario's Injury Prevention Strategy, an investment of $500 000 is encouraging the use of helmets among children and youth, and providing helmets to kids in Ontario who could not otherwise afford them. The funding is part of a larger $1.2 million investment, through which the province’s Ministry of Health Promotion has partnered with the ThinkFirst Foundation of Canada to deliver the Ontario Safe Sport Helmet Initiative. Over the next few months ThinkFirst in collaboration with participating public health units and local community partners across Ontario will be distributing $25 helmet coupons that will go towards the purchase of sport helmets for kids in low-income communities, so that more kids will have equal access to participate safely in the sports that require helmets. Other components of this initiative include the youth-oriented "Buckle Your Bucket" public education campaign to enhance helmet safety awareness, and correct use and fitting of helmets; as well as a distribution of activity-specific helmets to community and recreation organizations for ongoing use in their programs.

SAFER TOYS IN THE US
The US House and Senate have passed the Consumer Product Safety Improvement Act of 2008. The bill has been sent to the President who is expected to sign it into law. Legislators have agreed on a unified bill that includes new limits for lead in children’s products; a lower limit for lead in paint and surface coatings; a ban on certain phthalates; mandatory third party testing; tracking labels and product registration cards; whistleblower protection; and increased civil penalties.

CONTRIBUTORS
Contributors to these News and Notes include Danilo Blank, Ian Scott and Brian Johnston. Mike Hayes has edited the contributions. Items for future issues, including calendar entries, should be sent to mike.hayes{at}capt.org.uk as soon as possible.

Reference
1. Mertz KJ, Weiss HB. Changes in motorcycle-related head injury deaths, hospitalizations, and hospital charges following repeal of Pennsylvania’s mandatory motorcycle helmet law. Am J Public Health 2008; 98:1464-1467

News and Notes submissions:

News items and calendar entries should be sent to:
Michael Hayes
The Child Accident Prevention Trust
22-26 Farringdon Lane, London EC1R 3AJ, UK 
Email: mhayes{at}capt.org.uk
Fax: +44 (0)20 7608 3674