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Johns Hopkins International Injury Research Unit

A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

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Keyword: low- and middle-income countries

On Monday, May 16, 2011, the Unit was honored to welcome several guests from Duke University for a daylong meeting and special seminar which focused on trauma care in the developing world. Led by Dr. John Bartlett, director of the Program in International Research at Duke and a professor of medicine in the Division of Infectious Diseases and International Health at Duke University Medical Center, the Duke team included Dr. Anthony Roche, Dr. Robert Zura, Dr. William Richardson and Kelly Deal.

The special seminar, entitled “Surgical Capacity Building in East Africa through Twinning Training and Technology,” was led by Dr. Michael Haglund, professor of neurosurgery and neurobiology at Duke University and program director of the Duke Neurosurgery Training Program. Dr. Haglund is also the co-director of the Uganda East African Neurosurgery Training Program. Dr. Adnan Hyder, director of the Johns Hopkins International Injury Research Unit, moderated the seminar.

The Unit was pleased to have the opportunity to meet with fellow experts in the fields of trauma care and international health, and looks forward to future collaborations. For more information about partnering with the Johns Hopkins International Injury Research Unit, please contact us.


Dr. Michael Haglund presenting his seminar, “Surgical Capacity Building in East Africa through Twinning Training and Technology,” on May 16, 2011.

The Johns Hopkins International Injury Research Unit led a special seminar on December 3, 2010 that provided an in-depth look at trauma care and research in low and middle-income countries. The seminar, entitled “Trauma in the Developing World: Innovative Approaches to Research and Evaluation,” was co-presented by the Division of Acute Care Surgery in the Department of Surgery of Johns Hopkins Hospital, and was put on in collaboration with the Department of Surgery of the Virginia Commonwealth University Medical Center. The seminar attracted a large number of attendees from the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins Hospital and several organizations outside of the school.

Dr. Kent Stevens, the associate director of trauma and clinical services for the Johns Hopkins International Injury Research Unit, and a trauma surgeon at Johns Hopkins Hospital, delivered a powerful presentation on the use of data in improving care of the injured patient in developing countries. His talk was followed by Dr. Michel Aboutanos, the director of the International Trauma System Development Program in the Division of Trauma and Critical Care at Virginia Commonwealth University, who spoke specifically about trauma system development in the Latin American region.

Joined by Dr. Rao Ivatury, the director of the Division of Trauma and Critical Care at Virginia Commonwealth University, and also Dr. James Neifeld, the chair of the Department of Surgery at Virginia Commonwealth University, the group then formed an interactive panel moderated by Dr. Adnan Hyder, the director of the Johns Hopkins International Injury Research Unit. The discussion centered on increasing access to trauma care, evaluating existing programs and overall improving the trauma systems in low and middle-income countries.

The Johns Hopkins International Injury Research Unit was pleased to host this important seminar and looks forward to continued collaboration with Virginia Commonwealth University and others as we work together toward reducing the burden of trauma injuries around the world.

For more information, please contact the Johns Hopkins International Injury Research Unit. Presentations from the seminar will soon be available for download.


Dr. Kent Stevens, Associate Director of Trauma and Clinical Services, Johns Hopkins International Injury Research Unit, delivers his presentation.


Dr. Michel Aboutanos, Director, International Trauma System Development Program, Virginia Commonwealth University, delivers his presentation.


Dr. Adnan Hyder, Director, Johns Hopkins International Injury Research Unit, moderates the panel discussion.


Panel discussion featuring (from left to right) Dr. Kent Stevens, Dr. Michel Aboutanos, Dr. Rao Ivatury and Dr. James Neifeld.

Epidemiologic Reviews, a journal from Oxford Journals, today published recent work from Dr. Aruna Chandran, the International Injury Research Unit’s associate director of monitoring and surveillance. The paper, entitled “The Global Burden of Unintentional Injuries and an Agenda for Progress,” calls for improvements in injury research and prevention around the world, particularly in low and middle-income countries.

Dr. Chandran led the research project, along with Dr. Adnan Hyder of the International Injury Research Unit and Dr. Corinne Peek-Asa of the University of Iowa. Dr. Peek-Asa is the director of the University of Iowa’s Injury Prevention Research Center.

Using data from the 2004 World Health Organization (WHO) Global Burden of Disease Study, the researchers concluded that unintentional injuries pose a significant global health burden. According to the WHO, unintentional injuries were responsible for more than 3.9 million deaths in 2004. Road traffic injuries comprise the largest proportion of these (i.e., 33 percent).

Strikingly, more than 90 percent of the 3.9 million injury-related deaths occurred in low and middle-income countries. Many of these countries, especially those with poorly developed public health systems, have yet to prioritize injuries as a public health problem. Because 90 percent of the world’s population lives in low and middle-income countries, more research around injuries is needed so that governments can make informed, evidence-based decisions about the programs that work.

For more information about this research, or to download the full text, please click here.


Dr. Aruna Chandran, associate director of monitoring and surveillance for the International Injury Research Unit.

A global network conference of bone and joint decade was held on Oct 22-24 in Washington DC. The meeting, which is hosted by USBJD, highlighted the significance of musculoskeletal conditions and raised the awareness to advanced prevention and treatment. Dr. David Huang was present as the representative of International Injury Research Unit. Road traffic injury is the central focus of the trauma and injury strategic planning specialty group. In the panel discussion, Dr. Bruce Browner (Bone and joint decade) indicated the increasing burden of road traffic injuries in low- and middle-income countries where 90% of deaths due to RTIs occurred. Oman’s UN Permanent Ambassador Fuad Al-Hinai, who brought road safety into the fore of United Nations, said Member States had unanimously emphasized that road traffic injuries posted a global health crisis requiring “an urgent national and international action.” Ms. Nancy-Carter Foster, speaking for the U.S State Department called for the effort and international collaboration on road safety. She highlighted “Losses due to road traffic injuries are preventable- we should not take them for granted, and we should not accept road crashes and their costs in human lives as the price we pay for mobility or for economic growth and development.”

The Bone and Joint Decade trauma and injury strategic planning specialty group selected road traffic crashes as one of the priority issues to improve in trauma care and treatment capabilities through global collaborative programs. Lack of funding in WHO program, poor infrastructure, manpower shortages and insufficient emergency services in most LMICs are the major barriers to lessen the burden of RTIs. To maximize the efforts, BJD encouraged more surgeons involved at WHO level, UN and other international organizations so that appropriate attention is given to the trauma care of RTI victims. For more information, please visit BJD.

Many studies have offered recommendations on how to improve ancillary care in clinical settings but few have examined the role this crucial care plays in public health research. Ancillary care is care needed by research participants, but not necessary to ensure scientific validity, prevent study-related harms, or address study-related injuries. Researchers at the Johns Hopkins Bloomberg School of Public Health suggest that current literature and recommendations established to help researchers and sponsors act on ancillary care obligations often fail to consider studies in which the primary unit of research interest is a group. Their commentary is published in the July 22, 2009, issue of JAMA.

“Ancillary care applies to public health research, not only clinical research,” said Adnan Hyder, MD, PhD, MPH, lead author of the paper and an associate professor with the Bloomberg School’s Department of International Health and the Johns Hopkins Berman Institute of Bioethics. “After reviewing several of the larger and most widely accepted papers on ancillary care we noticed this disconnect, as none of the literature included public health research. In this commentary we began to examine how ancillary care might play out in public health research, especially in developing countries, and found that current research is constrained by several issues.”

Dr. Hyder, along with Maria Merritt, PhD, co-author of the paper and an assistant professor in the Bloomberg School’s Department of International Health and Johns Hopkins Berman Institute of Bioethics, outlined three limitations in current ancillary care research. Current research fails to examine ancillary care in dealing with groups as the unit of interest (existing accounts of the ancillary care obligation often assume that all relevant health needs are defined with respect to individuals only); the criteria for assessing the strength of ancillary care claims (international investigators and sponsors with access to external resources might have a stronger obligation to support local health systems where they are conducting research); and defining a process for consideration of ancillary care researchers (an operational approach to identifying candidate ancillary care needs outlined in a 10-step process).

To assess the strength of participant groups’ claims on researchers and sponsors to meet those needs and fulfill specified ancillary care obligations, Dr. Hyder and Dr. Merritt recommend the following:

* Understand the goals and objectives of the research study
* Understand the range of options that might be considered as ancillary care
* Assess the research-specific and context-specific factors influencing strength of participant group’s claims to options under consideration
* Rank options in order of greater to lesser strength of claim
* Identify costs, risks, and benefits of each option under consideration over specified period
* Engage in a locally driven deliberative process among concerned stakeholders, to include elicitation of participant group’s preferences
* Define the package of ancillary care that will be offered with rationale resulting from deliberative process
* Disseminate information about package of ancillary care and rationale widely to key stakeholders
* Monitor implementation and use of ancillary care over life of research study
* Analyze generalizeable lessons from experience of systematic provision of ancillary care

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