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Table 4 Sleeping position and sudden infant death syndrome

From: A translational framework for public health research

Case study
'Back to Sleep' campaigns to discourage the prone sleeping position are credited with having reduced the incidence of sudden infant death syndrome (SIDS) by 50–70%. The success of these campaigns reflects the effective translation of the findings of research in pathology and epidemiology into a comparatively simple intervention that was then effectively disseminated to health care professionals and parents.
However, the linear translational medicine pathway neither accounts for this success nor offers an obvious route to further reducing the impact of SIDS on the population. The case for 'Back to Sleep' was based not on clinical trials showing that the proposed intervention was effective, but on epidemiological evidence that the prone sleeping position was a risk factor for SIDS. The value of synthesising non-trial evidence is illustrated by the retrospective finding that this association could have been established by a meta-analysis of case-control studies as early as 1970, whereas many textbooks continued to recommend the prone sleeping position until the late 1980s. It has only been possible to demonstrate the effectiveness of the intervention after its widespread introduction and by using observational study designs. Meanwhile, continuing surveillance and observational epidemiology highlight possible side-effects such as an increase in plagiocephaly and show that SIDS is increasingly associated with deprivation, suggesting a need for action elsewhere in the public realm to reduce the risk among babies born into poor families [2225].