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Injuries
constitute one of the most significant and costly public health problems
in the European Union (EU) Region. Every year, more
than 235 000 EU citizens die as a result of an intentional or an
unintentional injury; this is the equivalent of more than 600 fatalities
per day. Despite downward trends noted in many EU countries, injury
still ranks first
in years of potential life lost and
fourth among all causes of death.
Nevertheless, unlike
researchers involved in the combat against chronic diseases, researchers
and practitioners in injury prevention and safety promotion face the
challenge of dealing with a highly predictable and preventable cause of
human death. The wide variation of injury mortality rates across
different regions of the world, or even different states within the same
region, implies that there is high potential for prevention. Indeed, in
the industrialized EU Region, where annual unintentional average
mortality rates range from 17/100 000 in
countries such as the United Kingdom and the Netherlands,
to 100/100 000 in Latvia and Estonia, it has been estimated that up to
50% of fatalities could have been avoided were all EU member states to
adopt existing effective injury prevention practices and policies.
EC
and WHO policy initiatives (Council Recommendation and WHO Resolution)
have rightfully emphasized injuries as a public health priority; the
respective initiatives, abide not legally binding, provide a policy
framework for a more systematic and coordinated approach in injury
prevention both at national and European levels. Apart from health care
delivery once the injury occurs, the health sector plays an important
facilitating role in injury prevention, along with different policy
sectors, which are also involved in delivering primary and mostly
passive prevention, such as the transport sector for road traffic
injury, the justice sector for the prevention of violence and bodies
responsible of building standards and manufacturers for domestic
injuries.
This Final Technical Implementation
report presents the achievements of the APOLLO project (Grant agreement:
2004119), which include two milestone deliverables:
  The
EU Hospital Discharge Data (HDD)
Web-Query System on injuries, providing the European citizens,
policy makers and experts with a user-friendly application of severe
injury, based on patient-level data from 18 EU countries. The system
relies on routinely collected data and therefore, necessitated a minimum
start off budget for the development of the infrastructure and
population with data across the member states, as contrasted to other EU
efforts relying on costly systems of new data collection and more
ambitious targets. It uses computerized algorithms to accommodate for
ICD-9-CM or ICD-10 coding and can be run with minimal maintenance costs.
The Web-query
can be freely assessed at:
https://www.unav.es/preventiva/apollo/asistente/index.php.
The
European Code Against Injuries
(ECAI), a simple and
comprehensive guide addressed to the European citizen
 and summarizing
the most effective available practices in reducing the major types of
unintentional injuries. The ECAI represents the first systematic
effort
to produce a tool through a consensus-building process aiming to raise
public awareness on injury prevention and safety promotion. Following
the successful example of the “European Code Against Cancer”,
developed in the context of a previous EU-funded project, it was made
possible to develop and evaluate the ECAI through a systematic process
aiming to incorporate common elements of available injury prevention
practices most likely to be adopted across the multi-cultural EU milieu.
The methodology is now in place and update can be done at minimum cost,
as new injury related risks emerge. Practically, injury prevention
practitioners and Non Governmental Organizations (NGOs) are now equipped
with an electronic version of the ECAI, currently available in 15
languages, spoken by ~90% of the European citizens. All translated
versions of the ECAI are available at: www.euroipn.org/apollo/WP3_ECAI.htm.
     
Two main injury prevention issues have also been
addressed, given the considerable lack of knowledge regarding: (1)
barriers to uptake on a personal level or apply on a community level
existing evidence-based good injury prevention practices and efficient
policies, and (2) specific indicators to follow up the progress of
injury prevention and safety promotion efforts on community, national
and EU level. In response, 4 reports were produced during the lifespan
of the project summarizing barriers and facilitating factors for the
implementation of injury prevention programs targeting different age
groups and recommendations on how to overcome barriers in injury
prevention, along with customization tips derived from already
successfully implemented prevention initiatives. More than 250
indicators aiming to assess exposure to injury risks, as well as the
burden and the economic consequences of injuries were also developed.
Most importantly, apart from the theoretical framework, actual figures
for the vast majority of these indicators across 18 EU countries are
currently available through the Web-Query system.
The implementation component of the project focused on
two major and costly injury fields, namely, how to address prevention
of falls among older people and injuries among vulnerable road users.
EU-wide applicable prevention computer based models, which can be
accustomed in individual member states, were also developed targeting
the prevention of injuries among pedestrian school age children and
adolescent two-wheel motorized vehicle users.
Dissemination activities were undertaken by both
individual work package leaders and in collaboration with the
dissemination package of the project. The former comprised mainly
preparation of over 20 scientific articles publishable in peer-reviewed
journals and acknowledging the contribution of the EC, out of which 15
have already been published or accepted for publication upon completion
of the project. Numerous opportunities for presenting the results in
scientific events, including conferences, meetings and seminars,
targeting both injury prevention experts and policy makers, were used,
while an effort is being made by the two APOLLO partners who sit on the
Executive Board of the International Society for Violence and Injury
Prevention (ISVIP) to disseminate the products to its world-wide
membership. Practitioners and individuals at risk were also reached
through various channels and platforms in order to ensure the broadest
possible support for change. A platform of EU NGOs was built aiming to endorse the EU-Recommendation on the
Prevention of Injury and the Promotion of Safety adopted by the
EU-Council and the European Parliament (May 2007), express NGOs’
commitment to align their actions in promoting health and safety in
Member States and at European level and undertake dissemination of the APOLLO products as the first
indication for testing their commitment.
Short
descriptions of the series of tools developed in the course of the
project are listed below in the interest of the reader:
 ATLAS
Report: It measures the burden of injuries in
terms of hospitalization episodes in eighteen countries of the EU. In
order to better approximate discharge events with incidence, a number of
indicators related to urgent hospital admissions due to injuries are presented. The report shows
what types of injuries derive from these data and shows the variability
between countries. The described data derived from the
web-query system for Hospital discharge
data
 Efficient strategies to reduce the burden of Injuries
in Europe and specific suggestions of policy measures to increase return
on the investments. The report aims to support EU
countries in calculating the economic consequences of injury for
purposes of priority setting in prevention.
 An
analysis on the best strategies to measure the severity of injuries. The report seeks to review state of the art in
injury severity assessment methods and contribute to the improvement of
the ICD9-AIS automatic conversion method (toward AIS/ISS based severity
scores) consisting
in an extension of its applicability towards
important body parts not yet fully considered in existing methods.
 Tools,
including software for computing direct costs of injuries.
The
web tools are SPSS scripts/syntaxes and have been developed to analyze,
harmonize, aggregate and merge hospital-based data for the calculation
of direct medical costs. A manual with guidelines is available
explaining the methods for data analysis of hospital-based surveillance
data, while giving a description of the collection, harmonization and
analysis of data on injury incidence and related healthcare consumption
and costs. Available
at:
http://www.eurosafe.eu.com/csi/eurosafe2006.nsf/wwwVwContent/l2apollo.htm
 Questionnaire
to collect data for a new indicator on exposure.
The report seeks to communicate information to all parties interested in
collecting information on exposure indicators, using the case of Road
Traffic Injuries and provides recommendations to assist decision-making.
Concurrently, it aims to explore whether in place systems can be used to
assess future trends in injury mortality and morbidity on the basis of
existing exposure indicators.
Success
Factors and Barriers to Implementation of Prevention Interventions. Th e
report aims to serve as a useful guide for those injury prevention
experts and safety practitioners who wish to implement effective
interventions for the prevention of: road traffic injuries,
alcohol-related injuries, drowning and occupational injuries.
 How
to overcome the barriers to implement recommendations for youth (<24
years) injury prevention. The report seeks to demonstrate perceived
barriers on the part of young people to the adopt safety measures and
provide the conceptual framework for guiding multidisciplinary campaigns
targeting adolescents and young adults.
 Strategy
and policy recommendations including feasibility for implementation of
effective policies and customization of good practices in various
settings.
The report aims to provide meaningful messages regarding ways to improve
implementability of effective policies and to customize successful
practices in injury prevention in diverse EU settings. Countries with
relatively small sized population, along with new and non-EU Member
States received high total feasibility scores even though in practice
they may face more difficulties in implementing effective policies.
 Feasibility
of large-scale interventions for preventing falls among older people in
the European Union - A
technical report on the methods and results of the studies conducted by
Work package 4 of the Apollo project.
This study aims to fill gaps in knowledge on specific aspects that
hinder the possibility of evaluating the feasibility of large-scale
interventions for the prevention of falls in older people.
 Recommendations
for promoting the prevention of falls in community dwelling older people.
These recommendations targeted EC and National/ local governments,
policy makers and all parties involved in initiating and developing
action plans for the prevention of falls in older people.
 Guide
for implementers of interventions to prevent falls in community-dwelling
older people. Material of strategic resources for parties involved.
The report expands and serves as a companion guide to the European Network
for Safety among Elderly (EUNESE) Guide, entitled: “Learn From The
Eunese Pilot Projects Experience: A 7-Step Guide to implement successful
interventions for injury prevention among elderly people (65+)”. It
provides invaluable information on the prevention of falls among older
people, while including materials on strategic resources & models
for parties involved.
 Good and promising interventions for the prevention
of injuries to pedestrians and two-wheelers-Inventory and guidebook for
the health sector. The aim of this report is to build common knowledge
on what is known to work in injury prevention when targeting vulnerable
road users and falls in pedestrians (“inventory”), and to guide
politicians, administrators and other stakeholders in the public health
sector in the implementation of policies and practices (“policy
guide”).
 Injuries
to vulnerable road users including falls in pedestrians in the EU-A data
report.
The first main aim of this study was to give a comprehensive view on
injuries to VRU including FiP in the EU and to identify data gaps
through the combination of different databases of data of the health and
traffic sector. Secondly, on behalf of tailor made injury prevention
measures injuries to two wheelers and pedestrians should be analysed in
regards to sex, age, injury mechanism and type of injury. Finally a
feasible method should be developed to improve the routine reporting on
injuries to VRU in the EU in the future.
 Safe
school ways by implementing school travel plans in primary schools in
Vienna-An evaluation report aims to evaluate an intervention on the
prevention of child pedestrian injuries in AT in order to show the
effect of the initiative of school travel plans in primary schools in
Vienna. A fundamental element in school travel safety planning is a
school travel plan. This is a map for pupils of primary schools showing
dangerous spots and recommended school travel routes in school
surroundings.
 ’Stick
it well on your head!’
Development, implementation and
evaluation of a school based helmet promotion program in Athens.
The report aims to present in a distinct and comprehensive way the
multi-faceted process of educational program planning. It is
specifically guided by results derived from qualitative research with
young two-wheel motorized vehicle users in Greece and applies the key
concepts of the Health Belief Model in the development and
implementation of a school-based helmet promotion program, targeting
eligible adolescent drivers.
   
 Traffic
and the Risk of Vehicle Pedestrian Injury: A Stochastic Mathematical
Model was developed to estimate the effect
of alternative transport scenarios on the risk of vehicle pedestrian
injury. The model comprises four sub- models: traffic dynamics,
pedestrian dynamics, collision incidence and injury severity. The model
was used to estimate the pedestrian injury rate for a baseline scenario,
corresponding to current traffic conditions in London, and three
alternative scenarios.
 A
mathematical modelling framework of motorized two-wheelers injury rate.
This study aimed to propose a modelling framework for evaluating the
impact of interventions on motorcyclist risk of injury. This resulted in
an extension of existing models for the simulation of traffic flow by
incorporating motorcycle crashes and injuries. This suite of models can
be used in practice as generic decision support tools by policy makers
to evaluate alternative transport policies in terms of their health
impact.
 Inventory
of European NGOs. The inventory is divided into six injury
domains: Consumer Safety, Suicide prevention, Transport, Violence
prevention, Work safety, other relevant organizations. Available also at:
www.eurosafe.eu.com:80/csi/eurosafe2006.nsf/wwwVwContent/l3results.htm?OpenDocument.
Network
of EU non governmental Organizations and, whenever applicable,
their national member organization that plays a role in implementing
injury prevention policies. Following personal contact and a series of
meetings, the network comprises the APOLLO work package leaders and
several NGOS as founding members, whereas key representatives of EU
Organizations, such as WHO, DG TREN and DG SANCO, played a major role in
its development.
 Declaration
on priorities in injury prevention safety promotion in the EU.
The first document singed by the APOLLO work package leaders and NGOs as
founding members during the 2nd Injury Prevention and Safety
Promotion Conference in Paris on October 2008 stating their consensus in
collaborating towards addressing all types of injuries in all age groups
according to the priorities set in the relevant documents of the
official EU and WHO documents and also the terms and conditions of this
collaboration.
Policy
briefings on the state of art in Public Health
actions on injury prevention and safety policies in Europe. Available
at
www.eurosafe.eu.com/csi/eurosafe2006.nsf/wwwVwContent/l4wp6results.htm?OpenDocument
   
In
conclusion, the tasks provisioned in the contract have been successfully
completed within the approved timeframe and budget.
APOLLO
Interim and Final Technical Implementation Reports
  
With
the collaboration of renowned injury prevention experts, the APOLLO
project managed to achieve its initial goal, namely to deliver a
pragmatic vision for implementation of successful and cost efficient
injury prevention and safety promotion activities in the EU. In
addition to the main and associated beneficiaries, numerous experts on
injury prevention and safety promotion deriving from 32 countries were
involved in the project, completed a variety of tasks over and beyond
contractual obligations and assumed wide dissemination of the APOLLO
products. The contribution of the EC has been acknowledged in more than
50 presentations of the results in International and National
Conferences as well as in the 15 scientific manuscripts, which until the
compilation of this report have been published or accepted for
publication in prestigious, peer reviewed journals.
More importantly, in the context of this project, the EC and EU
experts in injury prevention have contributed two sustainable and long
needed products, namely the development of a functioning hospital
discharge injury database and its query system, a set of populated
injury prevention indicators in order to monitor progress across EU and
a tool that summarizes the current state of the art in injury prevention
for the EU citizen, i.e. the European Code Against Injuries that can be
readily used by 90% of the EU population.
Center for
Research and Prevention of Injuries (CE.RE.PR.I)
Department
of Hygiene, Epidemiology and Medical Statistics
Medical School, University of Athens
75 Mikras Asias Street
Athens 115 27, Greece
Coordinating
Organization of APOLLO Project [2004119]
Eleni
Petridou,
E-mail:
epetrid@med.uoa.gr
Sakis
Ntinapogias
E-mail:
ntinap@med.uoa.gr
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