8. MARCO LEGAL
9.1 ANÁLISIS DEL PLAN DE GESTIÓN INTEGRAL DE RESIDUOS SÓLIDOS
The research questions addressed within six work streams in the KCS programme are outlined in the following sections and shown inFigure 1.
Work stream 1
This work stream addressed the question,‘What are the associations between modifiable risk and protective factors and medically attended injuries resulting from five common injury mechanisms in children under the age of 5 years?’This question was answered by a series of five case–control studies exploring risk and protective factors for each of the three most common types of medically attended falls (falls from furniture, stair falls and falls on one level), poisonings and scalds. These five studies are collectively referred to as study A. In addition, a study to validate the self-reported exposures was nested within the case–control studies in study A, and this is referred to as study B.
Work stream 2
This work stream addressed the question,‘What are the NHS and child and family costs of falls, poisonings and scalds?’This was answered by a cohort study measuring costs and injury outcomes nested within the case–control studies in study A. In addition, as there were no validated tools to measure health-related quality of life (HRQL) in the short term following a range of injuries in the under-fives, this study also validated the toddler version of the Pediatric Quality of Life Inventory (PedsQL™)43for this purpose.
These two studies are referred to as study C, with the costs study referred to as the study C costs substudy and the validation of the PedsQL study referred to as the study C HRQL substudy.
Work stream 3
This work stream addressed the question,‘What interventions are being undertaken by children’s centres to prevent thermal injuries, falls and poisonings?’. This question was answered by two national surveys of children’s centre managers and staff. These studies are referred to as study D.
Work stream 4
This work stream addressed the question,‘What are the barriers to, and facilitators of, implementing thermal injuries, falls and poisoning prevention interventions among children’s’centres, professionals and community members?’. This question was answered by three studies: first, a systematic review of the quantitative and qualitative evidence on barriers to, and facilitators of, injury prevention (study E); second, a qualitative study consisting of interviews with children’s centres managers and staff to explore their views on barriers to, and facilitators of, implementing injury prevention interventions in children’s centres (study F); and, third, a qualitative study of parents of injured and uninjured children to explore views on barriers to, and facilitators of, implementing home injury prevention nested in the case–control studies in study A (study G).
Work stream 1
Research question: What are the associations between modifiable risk and protective factors and medically attended injuries resulting from five common injury mechanisms in children under the age of 5 years?
• Case–control studies of falls, poisonings and scalds (study A)
• Validation of tools used to collect data (study B)
Work stream 5
Research question: How cost-effective are strategies for preventing falls, poisonings and scalds?
• Systematic overview of reviews and systematic review of evidence subsequent to latest review (study H)
• Systematic review and pairwise meta-analysis of home safety interventions (study I)
• Network meta-analyses of home safety interventions (study J)
• Decision analyses of home safety interventions (study K)
• Development of an IPB for thermal injuries, falls and poisonings
Work stream 6
Research question: How effective and cost-effective is implementing an IPB for one exemplar injury prevention intervention? • Review of facilitation of health promotion interventions (study L)
• Development of an IPB and randomised controlled trial evaluating implementation of the IPB in children’s centres with a nested cost-effectiveness analysis and qualitative study (study M)
Work stream 3
Research question: What interventions are being undertaken by children’s centres to prevent falls, poisonings and scalds? • National survey of children’s centres (study D)
Work stream 4
Research question: What are the barriers to, and facilitators of, implementing falls, poisoning and scald prevention interventions among children’s centres, professionals and community members? • Quantitative and qualitative systematic review (study E)
• Qualitative study of children’s centre managers/staff (study F)
• Qualitative study of parents (study G)
Work stream 2
Research question: What are the NHS and child and family costs of falls, poisonings and scalds? • Cohort study measuring costs and HRQL (study C)
FIGURE 1 The Keeping Children Safe programme of research.
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Work stream 5
This work stream addressed the question,‘How cost-effective are strategies for preventing thermal injuries, falls and poisonings?’. This question was answered by systematic overviews and systematic reviews of the literature on preventing falls, poisonings, fire-related injuries and scalds (study H), a systematic review and pairwise meta-analysis (PMA) of home safety interventions (study I), network meta-analyses (NMAs) of interventions to promote smoke alarm use and promote falls prevention practices, poison prevention practices and scalds prevention practices (study J) and decision analyses of interventions found to be effective in the NMAs (study K).
Work stream 6
This work stream addressed the question,‘How effective and cost-effective is implementing an IPB for one exemplar injury prevention intervention?’. This question was answered by a randomised controlled trial (RCT), set in children’s centres, which evaluated the effectiveness and cost-effectiveness of an IPB for the prevention of fire-related injury (study M). The trial was preceded by a review of the literature on the implementation and facilitation of health promotion interventions (study L) to inform the design of the intervention. Evidence from the trial was then incorporated into the development of a second IPB. This covered the prevention of fire-related injury, falls, poisonings and scalds, based on findings from studies A and D–M.