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Randomised controlled trials in general practice: time for international collaboration
  1. Martin R Underwood,
  2. Yvonne H Carter
  1. Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College
  1. Correspondence and reprint requests to: Dr M R Underwood, St Bartholomew's and the Royal London School of Medicine and Dentistry, Department of General Practice and Primary Care, Medical Sciences Building, Queen Mary and Westfield College, University of London, Mile End, London E1 4NS. e-mail: M.Underwood{at}

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Unintentional injury to children aged under 5 caused 428 300 deaths globally in 1990. Not surprisingly, the majority are in the developing world, with 740 deaths annually per million of the population aged less than 5, compared with 249 per million a year in developed countries. However, injuries account for 15.6% of deaths after the perinatal period in this age group in the developed regions, compared with 4.1% in developing regions.1 Thus, although in absolute terms injuries are a problem that needs to be tackled worldwide, proportionally they are a greater problem in the developed world.

Either way, the size of the problem means there is a clear need for initiatives of proven value that can be used to reduce mortality.2 The greater prosperity and relative importance of childhood injury in the developed world mean that this is where robust research is most likely to be performed. However, studies that included developing countries could inform a global injury prevention strategy.

Young children, are less competent than adults in assessing and avoiding risk; thus society has an obligation to develop initiatives to reduce their injury rate. Such initiatives can be broadly divided into:

(1) Community based interventions, that affect mainly the environment outside the home, or safety of items brought into the home, such as encouraging (or enforcing), the use of child seats in cars or improving the safety of children's toys.

(2) Educational initiatives targeted at parents to improve safety behaviour such as avoidance of burns and scalds and the correct use of child seats in cars.

Although some public policy initiatives have been tested in a comparative manner either using historical data or similar areas with no intervention as controls, few such initiatives have been evaluated using randomised controlled designs.3 Subjecting the introduction of public policy …

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