The political and social contexts of global road safety: challenges for the next decade.

The goal of this Series paper is to show how road safety has evolved as a global public health issue over the past two decades and to discuss the political and economic dynamics that led to this change. Specifically, the key stakeholders, influences, networks, issue framing, actor power, and synergistic interactions that have contributed to how road safety has evolved as a global public health issue will be discussed. In doing so, we capture the important chronology of events and discuss a set of challenges that highlight the complexity of road safety. We posit that the global road safety community needs to re-evaluate its role and strategy for the next decade and focus more on implementation and country action to achieve reductions in road traffic injuries. We call for an open and inclusive process to ensure that such a reflection occurs before the end of the current decade.

Lesiones no intencionales en México. Ensanut Continua 2022.

OBJETIVO: Estimar la prevalencia de lesiones no intencionales (LNI) y sus consecuencias no fatales en población mexicana. Material y métodos. Estudio transversal con la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022), diseñada con muestreo probabilístico, polietápico y estratificado. Se estimó la prevalencia de LNI, por grupo de edad, sexo, región, estrato de residencia e índice de bienestar. RESULTADOS: La prevalencia de LNI fue 5.74% (IC95%: 5.31,6.21); 30.5% reportó consecuencias permanentes en salud y 62% requirió atención en servicios de salud públicos. Las regiones Península, Pacífico-Sur y Pacífico-Centro presentaron prevalencias más altas (6.69, 6.43 y 6.36% respectivamente), en hombres (6.8%) y en población de 10-19 años (6.51%). Las caídas fueron la causa más frecuente con 57.6%; vía pública (39.5%) y hogar (29%) los principales sitios de ocurrencia. CONCLUSIONES: Las LNI no fatales afectan de manera diferenciada a hombres y población joven; caídas y lesiones de tránsito causan importante demanda en servicios de salud y discapacidad.

Impact of accidental and intentional injuries in Mexico. Findings of the Global Burden of Disease study for 1990 and 2021.

BACKGROUND: Previous analyses on the burden of disease in Mexico identified that injuries differentially affect young people, males and working-age people. OBJECTIVE: To analyze the burden of disease due to intentional and unintentional injuries in Mexico during 1990 and 2021, at the national and state levels. MATERIAL AND METHODS: The results of the Global Burden of Disease study for the 1990-2021 period were used to describe the burden of disease attributed to injuries in Mexico. The life years lost (YLL) due to premature mortality, years lived with disability (YLD) and disability-adjusted life years (DALY) were analyzed. RESULTS: The burden of disease related to intentional injuries has increased, as also have YLDs and DALYs associated with unintentional injuries. Men continue to have higher mortality and DALY rates compared to women. Interpersonal violence and suicide have steadily increased. The analysis by state showed patterns with important variations. CONCLUSIONS: Injuries generate catastrophic consequences in terms of mortality and disability in Mexico. It is necessary to promote and strengthen programs and policies in order to improve the data system and injury prevention.

ANTECEDENTES: Análisis previos sobre la carga de la enfermedad en México identificaron que las lesiones afectan de manera diferenciada a hombres, personas jóvenes y en edad productiva. OBJETIVO: Analizar la carga de la enfermedad por lesiones intencionales y no intencionales en México durante 1990 y 2021 en los ámbitos nacional y estatal. MATERIAL Y MÉTODOS: Se utilizaron los resultados del Global Burden of Disease respecto al período 1990-2021 para describir la carga de la enfermedad por las principales causas de lesiones en México; se analizaron los años perdidos por muerte prematura (APMP), los años vividos con discapacidad (AVD) y los años de vida saludable perdidos (AVISA). RESULTADOS: La carga de la enfermedad relacionada con lesiones intencionales se ha incrementado, al igual que los AVD y AVISA por lesiones no intencionales. Los hombres continúan presentando tasas de mortalidad y AVISA más altas comparados con las mujeres. La violencia interpersonal y el suicidio se han incrementado de manera sostenida El análisis por estados mostró patrones con variaciones importantes. CONCLUSIONES: Las lesiones generan consecuencias catastróficas en términos de mortalidad y discapacidad en México. Es indispensable impulsar y reforzar los programas y políticas para mejorar el sistema de datos y la prevención de lesiones.

Governance and injury prevention.

Urban governance implies that state authorities and other actors (including private and social sectors) work together with authentic community participation as needed to meet the challenges to achieve urban health. In this context, addressing the problem of injury is critical. In urban space, injuries can occur for various external causes (falls, burns, even interpersonal violence, etc). This paper includes a discussion and analysis of governance mechanisms on urban areas, in terms of the implementation of the safe system approach which has been proposed as the best preventive strategy, to assure road safety, mostly at urban spaces, for injury prevention. The existence of governance mechanisms needs to be considered as a primary issue to be included on injury research to evaluate the implementation for preventive programmes on the injury field in general, especially those occurred at urban spaces.

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.

[Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19]. / Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19.

OBJECTIVE: To estimate the prevalence of non-fatal uninten-tional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. MATERIALS AND METHODS: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. RESULTS: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depres-sion symptoms. CONCLUSIONS: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

OBJETIVO: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocu-rrencia. MATERIAL Y MÉTODOS: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. RESULTADOS: La pre-valencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. CONCLUSIONES: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

Desarrollo de la capacidad para la regulación en salud en México.

La Academia Nacional de Medicina es un espacio esencial para discutir la ciencia de la regulación en salud y posicionar su impacto en la salud y la economía. Enmarcada dentro de la función rectora de la autoridad sanitaria, la regulación en salud es la acción de proteger a la población de los peligros sanitarios involuntarios contra los cuales el individuo no puede protegerse; es una función esencial de la salud pública, componente institucional del sistema de salud y, por ende, vinculada a sus reformas y a la cobertura universal. La regulación tiene sustento en un cuerpo teórico epidemiológico, organizacional, legal, sociológico y económico. Tiene un cuerpo metodológico que sustenta su proceso en el análisis de riesgos y se traduce en normas, implementaciones, cumplimiento, monitoreo y evaluación de la regulación. Tiene una arquitectura profesional, financiera, organizacional, legal y de gobernanza. Dada su acción universal tiene un impacto generalizado en la población y un sustancial efecto económico, influyendo en al menos 17 % del comercio internacional regional. La salud a través de sus autoridades regulatorias debe ser parte del dialogo comercial internacional.The National Academy of Medicine is an essential space to discuss regulatory science in health, and to position its impact on health and economy. Framed within the stewardship role of the health authority, health regulation is the action of protecting the population against involuntary health hazards against which the individual cannot protect him/herself. It is an essential function of public health, an institutional component of the health system and, therefore, linked to its reforms and to universal coverage. Regulation has its support on an epidemiological, organizational, legal, sociological and economic theoretical body. It has a methodological body that supports its regulatory process based on risk analysis and that is translated into regulations, implementations, compliance, monitoring and evaluation of the regulation. It has a professional, financial, organizational, legal and governance architecture. Given its universal action, it has a widespread impact on the population and a substantial economic effect, influencing on at least 17% of regional international trade. Health through its regulatory authorities should be an early part of international trade discussions.

[Legislation on road safety in Mexico: a subnational analysisLegislação de segurança viária no México: uma análise subnacional]. / Legislación sobre seguridad vial en México: un análisis subnacional.

OBJECTIVE: Study federal and state regulations to determine to what extent road safety recommendations are followed with regard to different risk factors and protective factors. METHODS: A descriptive analysis was made of the legal frameworks for road safety at the federal level and in the 32 Mexican states, identifying those that had regulations respecting the main risk factors (speeding, drinking and driving, and cellphone use while driving) and the main protective factors against road injuries (helmet use, seat belt use, and use of child restraint systems). The adequacy of these regulations was analyzed on the basis of Pan American Health Organization/World Health Organization (PAHO/WHO) recommendations. The types of sanctions prescribed in these regulations are also described. RESULTS: Slightly less than 10% of the entities studied had specific regulations respecting the six protective and risk factors considered. It was noted that "drinking and driving" and "helmet use" are, respectively, the risk factor and protective factor most commonly included in state laws. Adequate regulations were found in only two states: Zacatecas (regarding speeding) and Jalisco (seat belts, child restraint systems, and helmet use). Monetary fines are the most frequently applied sanction. CONCLUSIONS: It is a key priority to promote comprehensive laws with provisions that adequately address technical and scientific criteria for protection and prevention, as well as appropriate mechanisms for monitoring, regulation, and sanctions.

OBJETIVO: Realizar un diagnóstico de la normativa federal y estatal para determinar en qué medida se siguen las recomendaciones en materia de seguridad vial para distintos factores de riesgo y factores protectores. MÉTODOS: Se realizó un análisis descriptivo de los distintos ordenamientos jurídicos federales y de las 32 entidades federativas de México en el tema de la seguridad vial. Se identificaron aquellas que tenían disposiciones sobre los principales factores de riesgo (exceso de velocidad, alcohol y conducción, uso de celular al conducir) y protectores de lesiones causadas por el tránsito (uso de casco, uso de cinturón de seguridad y uso de sistemas de retención infantil) y se analizó si estas eran adecuadas, con base en las recomendaciones de la Organización Mundial de la Salud/Organización Panamericana de la Salud (OMS/OPS). Además, se describen los tipos de sanciones empleados en dichos ordenamientos. RESULTADOS: Poco menos de 10% de las entidades analizadas cuentan con normatividad específica para los seis factores protectores y de riesgo analizados. Se observó que el factor de riesgo "alcohol y conducción" y el factor protector "uso de casco" son los que están más considerados en las leyes estatales. Solo en dos entidades federativas (estados) la normatividad es adecuada: en Zacatecas (en el tema de velocidad) y en Jalisco (cinturón de seguridad, sistemas de retención infantil y uso de casco). La sanción aplicada con mayor frecuencia es la multa económica. CONCLUSIONES: Es fundamental y prioritario impulsar leyes integrales que contemplen disposiciones adecuadas que aborden criterios técnicos y científicos de protección y prevención, así como los mecanismos apropiados para vigilar, regular y sancionar.

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

[Underestimation of mortality caused by traffic in Mexico: an analysis at the subnational level]. / Subestimación de la mortalidad causada por el tránsito en México: análisis subnacional.

OBJECTIVE: To estimate the potential underestimation of mortality from traffic injuries at the subnational level in Mexico for a period of 15 years and to identify social and economic variables at the state level that could potentially be associated with the quality of statistical classification of deaths. MATERIALS AND METHODS: Secondary analysis of validated mortality databases for the period 1999-2013 was conducted. Using multiple imputation models, registries that could potentially be attributed to road traffic deaths were estimated and the potential underestimation of mortality due to this external cause was quantified. A simple correlation analysis was carried out. RESULTS: The potential underestimation of deaths from traffic injuries during the period was 18.85% at the national level, with significant variations by state. From the data analyzed, there was no statistical evidence of any association of the percentage of road traffic deaths underestimation with the variables analyzed. CONCLUSIONS: Performance in terms of mortality classification is different at the state level in Mexico. This information is useful for targeting interventions to improve the recording of deaths in the country.

[Prevalence and factors associated with intimate partner abuse in female users of public health services in Mexico: a comparative analyses]. / Prevalencia y factores asociados a violencia de pareja en usuarias de servicios de públicos de salud en México: un análisis comparativo.

OBJECTIVE: To analyze the evolution of the prevalence in intimate partner violence during the years 2003 and 2006 in Mexico, identifying factors associated with its severity, comparing our results with findings from 2003. MATERIAL AND METHODS: Data from the Encuesta Nacional de Violencia contra las Mujeres (ENVIM 2006) was used; it has urban-rural national representation of female users of Mexican public health services. A total of 22,318 women above 14 years of age were interviewed. A multinomial logistic regression model was adjusted. The dependent variable was the Index of Intimate Partner Abuse. RESULTS: Intimate partner abuse increased 17% in comparison to the year 2003. Women's personal history of childhood abuse (ORA= 5.12, 95% CI4.15-6.30) and rape (ORA = 3.5, 95% CI = 2.66-4.62) were the most important women's factors that were found associated with severe violence. Male partner's daily alcohol consumption increased eleven fold the possibility of severe violence; higher disagreement with traditional female gender roles and higher education of both partners were protective factors. Factors associated with violence and their severities were consistent with findings reported in 2003. CONCLUISIONS: Intimate partner violence is a highly prevalent social problem which requires comprehensive strategies supporting empowerment of women through higher education, early detection and care of those battered, as well as structured interventions to prevent violence in future generations.

Distracted driving: mobile phone use while driving in three Mexican cities.

Mexico has a significant road traffic injury and mortality burden, and several states/municipalities have begun passing legislation restricting mobile phone use while driving (MPUWD). Little information is available about the prevalence of MPUWD in Mexico. This study measures the prevalence of mobile phone talking and texting among drivers in three cities, and identifies associated demographic and environmental factors. Two rounds of roadside observations from a group of randomly selected automobile drivers were conducted during 2011-2012 in Guadalajara-Zapopan, León and Cuernavaca. The overall prevalence of MPUWD was 10.78%; it was highest in Guadalajara-Zapopan (13.93%, 95% CI 12.87 to 15.05), lowest in Cuernavaca (7.42%, 95% CI 6.29 to 8.67), and remained stable over two rounds of observations, except for León, where the prevalence increased from 5.27% to 10.37% (p=0.000). Driving alone on major roads in non-taxi cars during the weekdays was associated with MPUWD. Results highlight the importance of studying the risk of mobile phone use, and designing and evaluating specific preventive interventions to address this problem in Mexico.

[Indicators to measure the performance of emergency trauma care]. / Principales indicadores para medir el desempeño de la atención de emergencias traumatológicas.

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.

El objetivo del presente trabajo fue identificar los principales indicadores utilizados para medir el desempeño en la atención de emergencias traumatológicas. Se realizó una revisión de la literatura de tipo narrativa en las bases de datos: PubMed, LILACS y Epistemónikos, se incluyeron publicaciones entre enero de 2011 y el 31 diciembre 2021, en español, inglés y portugués. Se identificaron 962 publicaciones. Tras revisar el texto completo, 48 artículos fueron incluidos. Los indicadores se clasificaron en las dimensiones de proceso y resultado. Se identificaron 100 diferentes indicadores para analizar el desempeño de la atención de emergencias traumatológicas. 71% fueron indicadores de proceso, entre ellos el tiempo de atención y el triaje. En la dimensión de resultados se identificaron 29 indicadores; la mortalidad fue el indicador mayormente analizado así como el periodo de estancia hospitalaria. Se identificaron seis indicadores sobre la discapacidad de las personas lesionadas y 14 indicadores relacionados con la satisfacción, el más frecuente fue quejas. Diversos indicadores han sido utilizados para evaluar el desempeño de la atención de emergencias traumatológicas. En la dimensión de resultados, los indicadores relacionados con la satisfacción y discapacidad han sido poco explorados. Los responsables de la atención de emergencias traumatológicas deben impulsar ejercicios de evaluación del desempeño para conocer su situación actual a través de indicadores sensibles y acordes con los datos disponibles.

Road safety legislation in the Americas.

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

[Comparing pedestrian injury mortality in Mexico City: ¿have changes occurred over a decade?]. / Comparación de datos sobre mortalidad por atropellamientos en la Ciudad de México: ¿se han presentado cambios en una década?

OBJECTIVE: To compare and analyze the main characteristics associated with pedestrian injuries mortality in Mexico City. MATERIAL AND METHODS: A crossectional design was done using the mortality database related with pedestrian fatality during the periods 1994-1997 and 2004-2007. Variables as sex, age, residence, education and place of evento ccurrence were analyzed. Standardized mortality ratios by delegation were used to the analysis. RESULTS: There was a reduction during 2004-2007 at least 17.5% in deaths by pedestrian injuries and mortality rate of 1.9/100.000 inhabitants on the first period.The high decrease was in men (4,6/100.000) than in women (1,2/100.000). (p<0,05). Four delegations presented the highest risk of pedestrian injuries death during both periods. CONCLUSIONS: Results show significant changes among both periods. Differences by sex pointed out the need of a differential analysis of the problem. Contribute to elaborate new research questions to be addressed in the future to work on the prevention of this public health problem.

Impact of Mexican Road Safety Strategies implemented in the context of the UN's Decade of Action.

OBJECTIVE: To evaluate advancements in the prevention of road traffic injuries (RTI) in Mexico in the context of the United Nation's Decade of Action for Road Safety. METHODS: An analysis of the trend and age-period-cohort effects of RTI mortality from 1999 to 2018 was conducted. Mortality figures were age-standardized using the direct method and population estimates of 2018 as the standard. To evaluate whether advancements might be attributed to higher levels of death misclassification, we conducted sensitive analysis using multiple imputation to redistributed deaths allocated to non-specific ICD-10 codes. Non-fatal RTI from four nationally representative health surveys (2000, 2006, 2012 and 2018) were analyzed. FINDINGS: Implementation of Mexico's National Road Safety Strategy 2011-2020 was associated with an average annual percentage change reduction in the age-standardized RTI mortality rate of 1.3% (95%-CI: -1.8,-0.9). Reductions are more evident in pedestrians and four + wheelers (-6.7% and -5.3%, respectively, from 2011 to 2018); mortality trend in motorcyclists increased from 1999 to 2018 an average of 12.8% annually (95%-CI: 9.9, 15.9). Potential underestimation of mortality due to death misclassification decreased from 22.7% in 1999 to 16.4% in 2018; sensitive analysis showed that reductions might not be attributed to death misclassification. Non-fatal injuries decreased in four + wheelers but increased in motorcyclists. The number of individuals suffering permanent consequences from RTI increased. CONCLUSIONS: Results showed some potential gains of Mexico's road safety strategies: RTI in four + wheelers decreased. Efforts should be put in place urgently to prevent the growing number of RTI in motorcyclists.

[Use and non-use of pedestrian bridges in Mexico City. The pedestrian perspective]. / Motivos de uso y no uso de puentes peatonales en la Ciudad de México. La perspectiva de los peatones.

OBJECTIVE: To analyze the motives for using and not using pedestrian bridges (PB). MATERIAL AND METHODS: A cross-sectional survey was conducted of a sample of pedestrian users and non-users of PB; a logistic regression model was used to analyze the motives for use and non-use. RESULTS: The prevalence of non-use was 50.5 % of 813 surveyed pedestrians; the principal reason to use a PB was safety, and not to use it was "laziness". There were significant differences when analyzing the reason of non-use in the age groups 19 to 36 years, adjusted for education and physical characteristics of the PB ([aOR=1.7; 95 % CI=1.06-2.86] and [ORa.1.9; 95 % CI=1.14-3.33], respectively). CONCLUSIONS: The results of this study allow us to identify important aspects to consider--from the perspective of the pedestrians--when constructing new PB and improving existing PB to increase use in areas with a high risk of pedestrian injuries.

Factors associated with severity of intimate partner abuse in Mexico: results of the first National Survey of Violence Against Women.

OBJECTIVE: To identify factors associated with the severity of intimate partner abuse (IPA) in Mexico. METHODS: Data were gathered from the National Survey of Violence Against Women (November 2002-November 2003), a nationwide study in which 18,902 women over the age of 14 participated. Subjects were recipients of national public health care services. The severity of IPA was measured using a 27-item scale. Multinomial logistic regression analyses were performed to explore significant factors associated with partner violence. RESULTS: One in four participants reported experiencing IPA. This model showed that younger and less educated women had a higher risk of IPA. Working out of the home (OR [odds ratio] 1.3, 95% confidence interval [CI] 0.99-1.72), two or more children in the household (OR 1.44, CI 1.18-1.77), alcohol consumption (OR 2.51, CI 1.63-3.90) and history of childhood abuse (OR 3.7, CI 3.03-4.52) increased the possibility of severe violence. The most important predictor of severe IPA was the partner's alcohol consumption (daily or almost daily, OR 14.7, 95% CI 13.25-16.46). CONCLUSIONS: Awareness about the risk factors associated with IPA will help identify populations at greater risk of severe injury and could orient the health sector to direct actions toward this vulnerable population.

[Road traffic injuries among youth: measuring the impact of an educational intervention]. / Accidentes de tránsito de vehículos de motor en la población joven: evaluación de una intervención educativa en Cuernavaca, Morelos.

OBJECTIVE: To analyze the impact of an educative intervention intended to increase the knowledge of causes and risk factors associated with road traffic iinjries in the city of Cuernavaca. MATERIAL AND METHODS: A quasi-experimental study design was administered to students from 16 to 19 years old in colleges and universities in the city of Cuernavaca. The educative intervention included radio spots, banners, pamphlets, posters and cards. The measure of impact was established as changes in knowledge about speed, alcohol and the use of seat belts, using factor analysis methodologies. RESULTS: A significant change in the level of knowledge (p= 0.000) was observed in 700 students from 16 institutions. CONCLUSIONS: Educative interventions represent an initial strategy for changes in knowledge and population behaviours. The present study offers an appropriate methodology to measure short-term changes in knowledge about risk factors associated with a significant problem affecting Mexican youth.

Advances in Mexico in the middle of the Decade of Action for Road Safety 2011-2020.

OBJECTIVE: To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states. METHODS: This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states. RESULTS: Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions. CONCLUSIONS: The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.