Injuries in Skaraborg County, Sweden : surveillance, analysis, and evaluation of community intervention at municipal and county level

Abstract

The Falköping Accident Prevention Program (FAPP) is based in Skaraborg County, Sweden. An injury register was started in 1978, and intervention began in 1979. Three years later the rate of injuries had fallen by 23%. The Lidköping Accident Prevention Program (LAPP) was launched in 1984 as the result of a political decision by the County Council's Primary Health Care Committee. The background to the decision lay in positive experiences and results from the municipality of Falköping.

The primary objective of this study is to try to find answers to the questions when, where and how unintentional injuries have occurred in traffic and school environments, and also to depict some injury-prevention programs, their processes and their possible effects in three defined populations and geographical areas. Secondary objectives have been to study which individuals or groups are affected in the traffic environment (Paper I), to analyze the nature and scope of injuries that arose at school as a basis for counter-measures (Paper II), to discuss how the process of the injury program has affected injury incidence among children over a period of time (Paper III), to describe the changes in the organization and nature of the FAPP from 1983 and the changes in injury rates in subsequent years, and discuss possible implications (Paper IV), to examine the effects of a countywide bicycle-helmet initiative among children (Paper V), and to demonstrate the process through which a bicycle-helmet program can be built up and firmly established SO as to reduce bicycle-related head injuries (Paper Vl). There were 182 road- traffic injury events with 253 personal injuries, and 204 school-injury events with 222 personal injuries, recorded over the period of the study in Lidköping. All the injuries required medical or dental treatment.

Comparisons over the nine-year study period between Lidköping (with the LAPP) and four neighboring municipalities and the whole of Skaraborg County strengthen the impression that the program has had a positive effect. The decrease in the incidence of childhood injuries should be attributed to the interventions made in the LAPP. Evaluation of the FAPP revealed that the effect of the early phase of the program on injuries recorded at out-patient units (health centers and hospital emergency departments) was lasting, but for injuries involving hospital admissions, it was only temporary. In 1991, the local authorities in Falköping re-established a cross-sectoral organization and revitalized the program. In Skaraborg County, 90% of all preschool children now use bicycle helmets. For children under 15 there was an average annual decrease in all bicycle-related injuries of 3.1%, equivalent to a decrease of 48% over the study period, 1978-93 (for head injuries, 59%).

The elderly have not been targeted in helmet-wearing programs and showed a significant increase in their injury rate over the period (4.7% annually). The number of concussions sustained by helmet wearers is estimated to be one-third fewer than that of non-wearers. A countywide program is utilized to describe the processes and methods that have achieved attitudinal and behavioral changes resulting in increased helmet use. A conclusion drawn is that political and intersectoral support, and also the dissemination of information via the media, are important elements. Local political participation provides reinforcement and, alongside the involvement of committed individuals, has been decisive for success.