Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Assessment of the impact of Uber system implementation on mortality from traffic injuries in Brazilian capital cities.

The rapid expansion of Uber Technologies, Inc.'s ride-sharing, courier service, and food delivery system and e-hailing applications has been transforming the logistics network and urban mobility around the world. We aimed to evaluate the impact of the Uber system on traffic injury (TI) mortality during its implementation in Brazilian capital cities. A quasiexperimental design of interrupted time series was used. The monthly mortality rates for TI standardized by age were analyzed. The date of availability of the Uber app, specific to each capital, was considered the start date. Data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics were used. For the data analysis, from an interrupted time-series design, autoregressive integrated moving average (ARIMA) models with a transfer function were fitted. In 92.6% (n = 25) of Brazilian capitals, there was no impact of Uber system implementation, 12 months after the start of its activities, on TI mortality. A reduction in mortality from this cause was observed after the system was implemented in Belo Horizonte and Rio de Janeiro. The impact on TI mortality was progressive and continuous in both. More studies are needed to establish the factors associated with the inequalities observed in the impact of Uber system implementation between different locations and the heterogeneity of effects.

Magnitude and factors associated with motor road traffic injuries in Brazil: Results from the National Health Survey, 2019.

OBJECTIVE: To estimate the magnitude and factors associated with self-reported road traffic injuries (RTI) in Brazil. METHODS: Cross-sectional study conducted using data from individuals aged 18 years or older, participants in the 2019 National Health Survey, a population-based conducted on 88,531 adult individuals in Brazil. Three indicators were analyzed: (i) Proportion (%) of individuals aged 18 years or older who were involved in RTI in the past 12 months; (ii) Proportion (%) of car drivers who were involved in RTI in the past 12 months; and (iii), Proportion (%) of motorcycle drivers who were involved in RTI in the past 12 months. In the inferential analysis, multiple Poisson regression was used to analyze the association between demographic and socioeconomic variables and RTI, stratified for the general population, population of car and motorcycle drivers. RESULTS: The estimated prevalence of self-reported RTI in the past 12 months was 2.4%. The South, Southeast, Northeast, Central-West, and North regions of Brazil had prevalences of 2.0%, 2.1%, 2.7%, 3.2%, and 3.4%, respectively. The results also show that most developed regions (South and Southeast) showed the lowest prevalence's, the highest frequencies were observed in those with lower socioeconomic development levels (Central-West, North, and Northeast). The prevalence was also higher in the subgroup of motorcyclists when compared to car drivers. In the general sample, the Poisson model showed an association between male sex, younger age, low level of education, residing outside capitals and metropolitan regions, in the North, Northeast and South regions and the prevalence of RTI. In car drivers, similar associations were found, except for area of residence. In motorcycle drivers, young age, low level of education, living in urban areas were associated with increased prevalence of RTI. CONCLUSION: The prevalence of RTI is still high within the country, with disparities between regions, affecting more motorcyclists, young people, males, individuals with low education, and residents of the countryside.

10 city analysis of child passenger helmet use.

INTRODUCTION: Road traffic injuries are the leading cause of death in children over age five. Most of these deaths occur in low- and middle-income countries. Vulnerable road users, such as motorcyclists and their passengers, are at higher risk. Helmets have significantly decreased morbidity and mortality for motorcyclists; however, they are often unused. The second phase of the Bloomberg Philanthropies Initiative for Global Road Safety was launched in 2015 to improve road safety in 10 cities. This study focuses on child passenger helmet use data from that study to understand the prevalence of helmet use and factors that are associated with helmet use. METHODS: The 10 cities selected were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai, Sao Paulo, and Shanghai. Eight rounds of roadside observational data were collected from February 2015 to April 2019. Observers noted correct child motorcycle passenger helmet use and other site observations including weather patterns, traffic volume, and road surface conditions. A multivariable Poisson regression model was used to examine correct helmet use trends over time. A multivariable logistic regression model was fitted for correct child passenger helmet use in all cities controlling for weather, observation time, number of passengers, and driver's correct helmet use. RESULTS: This dataset contained 99,846 motorcycle child passenger observations across the 10 cities. The highest prevalence of correct child passenger helmet use was in Sao Paulo at 97.33%. Six cities had under 25% correct helmet use for child passengers. Examining helmet use over time, only five cities had a significant increase, four cities had no change, and Ho Chi Minh City demonstrated a decrease. In the multivariable regression model, child passengers had higher odds of wearing helmets in adverse weather conditions, early mornings, if the driver wore a helmet, and if there were fewer passengers. CONCLUSIONS: The prevalence of correct child passenger helmet utilization shows large variation globally and is concerningly low overall. Enhanced enforcement in combination with media campaigns may have contributed to increasing helmet use prevalence over time. Further research is needed to understand reasons for low child passenger helmet use in most cities.

Road traffic injuries and substance use in Latin America: A systematic review.

OBJECTIVE: The aim of the study is to identify and report the epidemiological patterns of substance use on fatal and non-fatal road traffic injuries (RTIs) in Latin America. METHODS: A systematic review identified all published studies from January 2010 through October 2020. Twenty-eight studies were included from PubMed and SciELO databases. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies. RESULTS: The prevalence of alcohol consumption in fatal RTIs in studies where 100% of the target population were tested varies from 15.3% up to 55% in Brazil; with respect to non-fatal RTIs, it varies from 9.1% in car drivers in Brazil to 24.1% in emergency patients in Argentina. The most studied drug other than alcohol was cannabis, present in 6.5% up to 20.8% of non-fatal RTIs cases, but lower rates of testing for drugs was reported. Few studies reported epidemiological association measures. CONCLUSIONS: This article shows that scientific production on substance use and RTIs in the region is limited and reports the prevalence of substance use, with few estimates of the relative risk of drug use and RTIs.

Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities.

BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

The relationships between correct helmet use, enforcement presence, and mortality in a Latin-America city: The case study of Bogotá, Colombia.

OBJECTIVE: In Bogotá, Colombia, motorcyclists represent a concern as the proportion of motorcycle users between 2013 and 2018 has increased from 18% to 35%. Despite available risk reduction strategies, the fatality rates are also growing, notably in young adults (15-29 years old). This study aims at identifying correct helmet use patterns and its relationship with official records of injuries and casualties in the city over time. METHODS: Between 2015 and 2018, semiannual observational studies of motorcycle users in six randomly selected sites in Bogotá were conducted. Data was collected and analyzed on the number of occupants per vehicle (driver and passengers), gender, approximate age, type of helmet, and whether it was correctly used (strapped) or not. Bivariate and multivariate analyses were performed to identify the determinants of correct helmet use. Additionally, a spatial analysis was conducted to estimate the relationship between motorcycle's casualties and correct use of the helmet (full-face helmet use) prevalence. RESULTS: A total of 77,932 motorcycles were observed, showing a high prevalence of helmet use (99% for drivers and passengers), but only 88% use it correctly (89% drivers and 82% passengers). The presence of enforcement (camera or police personnel) increases the correct use of the helmet, especially in principal roads. Female, adults, and single riders are more likely to correctly wear the helmet. Finally, there is a relationship between the concentration of the fatalities and the incorrect helmet use in 80% of the observational sites. CONCLUSIONS: Incorrect helmet use has been found by the study to be related to higher mortality among motorcycle occupants in Bogotá. Our data shows that enforcement increases correct helmet use with the potential to reduce deaths among motorcycle occupants.

Análisis geográfico de la mortalidad de diferentes usuarios de vías de tránsito y factores de área asociados en Argentina / Geographic analysis of the mortality of different road users and associated area factors in Argentina

Resumen Introducción Las muertes por lesiones de tránsito son la principal causa de muerte por lesiones en la población de 5-64 años en Argentina. Objetivo Describir las variaciones espaciales del riesgo de mortalidad de diferentes tipos de usuarios de vías de tránsito y analizar factores de área asociados con el riesgo de mortalidad en Argentina durante los períodos 1999-2003 y 2008-2012. Método Se realizó un estudio ecológico espacial utilizando los departamentos/partidos como unidades de análisis. Se consideraron las muertes de peatones, usuarios de bicicleta, motocicleta y automóvil y usuarios no especificados de vías de tránsito. Como variables independientes se seleccionaron variables sociodemográficas y variables de patentamiento automotor. Resultados El riesgo de mortalidad de los usuarios de vías de tránsito se concentró espacialmente durante los dos períodos en Argentina. El nivel socioeconómico bajo a nivel departamental estuvo relacionado a un riesgo alto de mortalidad en peatones y usuarios de bicicleta. En áreas con mayor patentamiento de nuevos automóviles se observó un mayor riesgo de mortalidad en usuarios de bicicletas durante 1999-2003. Conclusión Las grandes disparidades en la distribución geográfica del riesgo de mortalidad de diferentes usuarios de vías de tránsito indican la adopción de políticas regionales de seguridad vial diferenciales en Argentina.

Abstract Background Traffic injury deaths are the leading cause of injury death in the 5-64-year-old population in Argentina. Objective To describe the spatial variations of the risk of mortality of different types of road users and to analyze area factors associated with the risk of mortality in Argentina during the periods 1999-2003 and 2008-2012. Method A spatial ecological study was carried out using the departments/parties as spatial units of analysis. The deaths of pedestrians, bicycle, motorcycle, and automobile users, and unspecified road users were considered. Sociodemographic characteristics of area and variables related to automotive patenting were the independent variables. Results The mortality risk of road users was spatially concentrated during the two periods in Argentina. The low socioeconomic level at the departmental level was related to a high risk of mortality in pedestrians and bicycle users. In areas with higher patenting of new cars, a higher risk of mortality was observed in bicycle users during 1999-2003. Conclusion The great disparities in the geographical distribution of the mortality risk of different road users indicated the adoption of different regional road safety policies at the national level.

Austerity policies in Brazil may affect violence related outcomes / Políticas de austeridade no Brasil podem afetar os desfechos relacionados à violência

Abstract Economic crisis is often managed with austerity policies. These measures seem to burden the population disproportionately, with the poorer being more affected. This paper aims to investigate health outcomes performance after the recent Brazilian crisis and gauge whether that pattern also emerged. Public domain data from 2010 to 2017 was used, and it was found that suicide and homicide rates increased after 2014, while mortality by road traffic injuries decreased at the same time. Furthermore, these trends were exacerbated in the North and Northeast regions and in the municipalities with the poorest quintiles of Human Development Index (HDI). The austerity policies followed by the Brazilian economic crisis may have influenced the mortality trends due to external causes, with a possible stronger impact in the North and Northeast regions and among less developed municipalities.

Resumo Crises econômicas são comumente administradas com políticas de austeridade. Estas medidas atingem a população de modo desproporcional, sendo os mais pobres os mais afetados. Este artigo pretende investigar a performance dos desfechos de saúde após a crise econômica recente e avaliar se o padrão de desproporcionalidade também ocorreu no Brasil. Dados públicos de 2010 a 2017 foram utilizados e encontramos que suicídios e taxas de homicídios aumentaram depois de 2014, enquanto mortalidade por acidentes de trânsito diminuíram. Além disto, estas tendências foram exacerbadas no Norte e no Nordeste e em municípios no quintil mais pobre em termos de Índice de Desenvolvimento Humano (IDH). As políticas de austeridade que se seguiram à crise econômica brasileira podem ter influenciado a tendência de mortalidade por causas externas, com um possível maior impacto no Norte e no Nordeste e em municípios menos desenvolvidos.

Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions.

Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.

Building Road Safety Institutions in Low- and Middle-Income Countries: The Case of Argentina.

Traffic injuries remain a leading health concern in most low- and middle-income countries (LMICs). However, most LMICs have not established institutions that have the legislative mandate and financial resources necessary to coordinate large-scale interventions. Argentina provides a counterexample. Argentina is a federal country where the decentralization of authority to provincial governments was a key barrier to effective national interventions. In 2008, Argentina passed a law establishing a national road safety agency and subsequently received a World Bank loan to build the agency's capacity to coordinate actions. Although traffic injuries in Argentina have not yet begun to decline, these developments raise important questions:Why did Argentina come to view road safety as aproblem?Why was institutional reform the chosen solution? What was the political process for achieving reform? What are the broader implications for institutional reform in LMICs?We explore these questions using a descriptive case study (single-case, holistic design) of Argentina. The case illustrates that focusing events, like the Santa Fe tragedy that killed nine children, and advocacy groups are important for raising political attention and creating an opportunity for legislative reform. It highlights the importance of policy entrepreneurs who used the opportunity to push through new legislation. Though the political dynamic was predominantly local, international actors worked with local advocates to build demand for safety and develop solutions that could be deployed when the opportunity arose. Most important, the case emphasizes the importance of developing institutions with the resources and authority necessary for managing national road safety programs.

Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study.

OBJECTIVES: We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chile's regions. METHODS: An interrupted time-series design was used to measure the effect of CRL and the National Decree on two dependent variables-number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002-2005) nationally and by region, controlling for several confounders. RESULTS: Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. CONCLUSION: In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chile's northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.

Estimating the drink driving attributable fraction of road traffic deaths in Mexico.

AIM: To estimate the Drink Driving Attributable Fraction (DDAF) of road traffic injury mortality in car occupants in Mexico during 2010-13. DESIGN: A case-control study was conducted to examine the presence of alcohol in analysed body fluids of car occupants killed in fatal crashes (cases) compared with car drivers tested in alcohol-testing checkpoints who were not involved in a fatal collision (controls). Two data sets were used for the period 2010-13: the forensic module of the Epidemiological Surveillance System on Addictions that included car occupants killed in a collision (cases) and a data set from alcohol-testing at police checkpoints available for matching municipalities (controls). SETTING: Mexico. PARTICIPANTS: The analysed study sample included 1718 car occupants killed in a traffic collision and 80 656 drivers tested at alcohol police checkpoints, all from 10 municipalities. MEASUREMENTS: Unadjusted and adjusted odds ratios (OR) of presence of alcohol in body fluids were obtained stratified by sex and age groups and the interaction with these two variables were assessed. The ORs were used to calculate the DDAF. FINDINGS: It was estimated that 19.5% of car occupants' deaths due to road traffic injuries were attributable to alcohol consumption [95% confidence interval (CI) = 19.1-19.9]. The adjusted OR of presence of alcohol was 6.84 (95% CI = 6.06-7.71) overall. For males it was 7.21 (95% CI = 6.35-8.18) and for females it was 4.45 (95% CI = 3.01-6.60). The ORs were similar across younger age bands (10-19 years: 9.61, 95% CI = 6.72-13.73; 20-29 years: 7.70, 95% CI = 6.28-9.4; and 30-49 years: 7.21, 95% CI = 5.98-8.70); and lower but still elevated among older people (50+ years: 3.19, 95% CI = 2.19-4.65). CONCLUSIONS: An estimated 19.5% of car occupant deaths in Mexico may have been caused by alcohol in 2010-13.

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

Resumen: Objetivo: Estimar la potencial subestimación de la mortalidad por lesiones de tránsito en las entidades federativas de México para un periodo de 15 años. Se buscó identificar variables sociales y económicas de cada entidad federativa que pudieran estar potencialmente asociadas con la calidad de la clasificación estadística de las defunciones. Material y métodos: Análisis secundario de bases de mortalidad, periodo 1999-2013. Mediante modelos de imputación múltiple, se identificaron los registros que pudieran ser muertes atribuidas al tránsito y se realizó un análisis de correlación simple. Resultados: La subestimación de defunciones por lesiones de tránsito durante el periodo fue de 18.85%, con importantes variaciones por entidad federativa. No hubo evidencia de que existiera asociación de alguna variable con el porcentaje de subestimación de la mortalidad. Conclusiones: La clasificación de la mortalidad es diferente en las entidades federativas. Esta información es de gran utilidad para focalizar intervenciones que permitan mejorar el registro de las defunciones en el país.

Abstract: 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.

Challenges associated with drunk driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil.

BACKGROUND: Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. OBJECTIVE: To compare the prevalence of drunk driving gathered from police reports to the prevalence gathered from self-reported questionnaires administered at police sobriety roadblocks in two Brazilian capital cities, and to estimate a more accurate prevalence of drunk driving utilizing three correction techniques based upon information from those questionnaires. METHODS: In August 2011 and January-February 2012, researchers from the Centre for Drug and Alcohol Research at the Universidade Federal do Rio Grande do Sul administered a roadside interview on drunk driving practices to 805 voluntary participants in the Brazilian capital cities of Palmas and Teresina. Three techniques which include measures such as the number of persons reporting alcohol consumption in the last six hours but who had refused breath testing were used to estimate the prevalence of drunk driving. RESULTS: The prevalence of persons testing positive for alcohol on their breath was 8.8% and 5.0% in Palmas and Teresina respectively. Utilizing a correction technique we calculated that a more accurate prevalence in these sites may be as high as 28.2% and 28.7%. In both cities, about 60% of drivers who self-reported having drank within six hours of being stopped by the police either refused to perform breathalyser testing; fled the sobriety roadblock; or were not offered the test, compared to about 30% of drivers that said they had not been drinking. DISCUSSION: Despite the reduction of the legal limit for drunk driving stipulated by the "Zero Tolerance Law," loopholes in the legislation permit many drivers under the influence of alcohol to act with impunity. In this context the police/traffic officers are often powerless to enforce the law and thus drunk driving continues to go unchecked. CONCLUSION: Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.

Análise das ocorrências das lesões no trânsito e fatores relacionados segundo resultados da Pesquisa Nacional por Amostra de Domicílios (PNAD) Brasil, 2008 / Analysis of the occurrence of traffic injuries and related factors according to the National Household Sample Survey (PNAD) Brazil, 2008

O objetivo foi descrever as estimativas de ocorrência de lesões decorrentes do trânsito e os fatores relacionados à população brasileira a partir dos dados obtidos na Pesquisa Nacional por Amostra de Domicílios (PNAD). Trata-se de amostra probabilística em três estágios: municípios, setores censitários e domicílios. Foram entrevistadas 391.868 pessoas. As variáveis acidente de trânsito (AT) e uso de cinto de segurança foram descritas segundo dados sociodemográficos e de região de residência. Calcularam-se as proporções, intervalos de confiança de 95 por cento, teste c2 e valor de p. 2,5 por cento (IC95 por cento 2,4-2,6) da população relataram a ocorrência de AT, com maior acometimento da população masculina (3,5 por cento; IC95 por cento: 3,4-3,6), jovens (4,4 por cento; IC95 por cento: 4,2-4,6) e residentes da região Centro-Oeste (3,3 por cento; IC95 por cento: 3,0-3,6). Os AT predominaram entre condutores ou ocupantes de automóveis/vans (53,9 por cento) e de motocicletas (30,1 por cento), seguidos de ciclistas (7,6 por cento) e pedestres (5,2 por cento). O uso de cinto de segurança dianteiro foi relatado por 73,2 por cento (IC95 por cento: 72,2-74,2) e o cinto traseiro por 37,4 por cento (IC95 por cento 36.6-38,2). O AT determinou o afastamento das atividades habituais em 30,7 por cento dos acometidos. A magnitude das lesões no trânsito justifica avançar em medidas preventivas e legislativas para a redução dos eventos.

The study describes the estimates of occurrence of injury due to traffic accidents among the Brazilian population based on data obtained from the National Household Sample Survey (PNAD). It is a probabilistic sample, in which 391,868 people were interviewed. in three stages, namely municipalities, census sectors and households. The traffic accident (TA) and the safety belt usage variables were described according to socio-demographic variables and region of residence. Proportions, 95 percent confidence intervals, c² tests and p values were calculated. 2.5 percent (CI95 percent 2.4-2.6 percent) of the population reported higher traffic accident (TA) incidence among males (3.5 percent; CI95 percent: 3.4-3.6), youths (4.4 percent; CI95 percent: 4.2-4.6) and residents in the Central-West region (3.3 percent CI95 percent3.0-3.6). Most of the events involved drivers or passengers of cars or vans (53.9 percent), followed by motorcyclists or pillion passengers (30.1 percent), cyclists (7.6 percent) and pedestrians (5.25 percent). The front seat safety belt is used by 73.2 percent (CI95 percent 72.2-74.2) and the rear seat safety belt is only used by 37.4 percent (CI95 percent 36.6-38.2). Traffic accidents led to the abandonment of their habitual activities by 30.7 percent of those involved. The severity of injuries in traffic accidents demands further preventive and legislative measures to reduce such incidents.

Fatores de risco para acidentes de transporte terrestre entre adolescentes no Brasil: Pesquisa Nacional de Saúde do Escolar (PeNSE) / Risk factors for road traffic injury among adolescents in Brazil: National Adolescent School-based Health Survey (PeNSE)

Os acidentes de transporte terrestre (ATT) causam expressivo número de mortes e hospitalizações entre jovens no mundo, sendo no Brasil responsável por 17,1 por cento dos óbitos entre 10 e 14 anos. Este artigo apresenta resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE), inquérito realizado em uma amostra probabilística de escolares do 9º ano do ensino fundamental de escolas públicas e privadas das capitais brasileiras, em 2009. Foram estimadas as prevalências (e IC95 por cento) das situações de risco para acidentes de transporte. Os 60.973 entrevistados indicam que (nos últimos trinta dias): 26,3 por cento (IC95 por cento 25,5 por cento-27,0 por cento) referiram nunca ter usado cinto de segurança; 18,5 por cento (IC95 por cento 18,0 por cento-19,1 por cento) dos menores de 18 anos referiram ter dirigido veículo motorizado (>1 vez); 18,7 por cento (IC95 por cento 18,1 por cento-19,2 por cento) referiram ter sido transportados em veículo conduzido por alguém que consumiu bebida alcoólica (>1 vez) e 35 por cento (IC95 por cento 33,8 por cento-36,2 por cento) referiram não ter usado capacete pelo menos uma vez quando andava de motocicleta. Os resultados estão de acordo com as elevadas taxas de morbimortalidade de jovens no país por ATT, o que reforça a importância de ações educativas para adolescentes e a necessidade de ações intersetoriais integradas, além de legislação específica e fiscalização rigorosa.

Road traffic injuries are the cause of an expressive number of deaths and hospitalizations among young people in the world. In Brazil, it is responsible for 17.1 percent of all deaths among adolescents aged 10 to 14 years. This article presents the results of the National Adolescent School-based Health Survey (PeNSE), using a probabilistic sample of students in the 9th grade of high schools (public and private) of the Brazilian capitals in 2009. The prevalence (and 95 percentCI) of risk factors for road traffic injury among adolescents were estimated. Main results from the 60,973 interviews were: in the last 30 days, 26.3 percent (25.5 percent to 27.0 percent 95 percentCI) reported no use of seat-belts while riding in a moving vehicle; 18.5 percent (18.0 percent to 19.1 percent 95 percentCI) of youths younger than 18 years reported driving a motor vehicle (> once); 18.7 percent (18.1 percent a 19.2 percent 95 percentCI) reported a history of being driven by a driver who had been drinking (> once); and 35.0 percent (33.8 percent to 36.2 percent 95 percentCI) reported no use of helmets while riding a motorcycle (> once). The results are in accordance with the high rates of morbidity and mortality from traffic injury among youths, reinforcing the need of integrated intersectoral actions, specific legal measures and strict control.

Prevalencia de accidentes de tránsito no fatales en México: resultados de la ENSANUT 2006 / Prevalence of non-fatal road traffic injuries in Mexico: results from ENSANUT 2006

OBJETIVO: Determinar la prevalencia y distribución de los accidentes de tránsito no fatales (ATNF) en México. MATERIAL Y MÉTODOS: Se utilizaron datos de la ENSANUT 2006. En los hogares visitados se seleccionó a un adulto, un adolescente y un niño, hasta conformar una muestra de 94197 sujetos que representa a la N de 102 886 482 individuos. La variable dependiente fue la prevalencia de ATNF en los 12 meses anteriores a la encuesta. RESULTADOS: La prevalencia de accidentes (de tránsito o no) fue de 6.0 por ciento y de esa cifra 16.7 por ciento correspondió a ATNF. Los hombres del grupo de 20 a 44 años, los habitantes de áreas urbanas y los de mejor nivel socioeconómico (NSE) presentaron mayor prevalencia (p<0.05). Jalisco, Aguascalientes y Sonora registraron la mayor prevalencia y Guerrero, Michoacán y Oaxaca la menor. CONCLUSIONES: Los ATNF en México se concentran en hombres de edad productiva en zonas urbanas y se relacionan con el NSE individual y el desarrollo económico de cada estado.

OBJECTIVE: To determine non-fatal road traffic injuries (NFRTI) prevalence and its distribution in Mexico. MATERIAL AND METHODS: Data from ENSANUT Survey 2006 were used. Using simple random sampling, one adult, one adolescent and one child were selected in each household, constituting a final sample of 94 197 representing an N of 102 886 482 people. The dependent variable was the prevalence of road traffic injuries (RTI) during the 12 months prior to the survey. RESULTS: The general accident prevalence was 6.0 percent; 16.7 percent corresponded to NFRTI. Men in the 20 to 44 age group living in urban areas and with high socioeconomic status had a higher RTI prevalence (p<0.05). Jalisco, Aguascalientes and Sonora were states with the highest prevalence of RTI, while Guerrero, Michoacan and Oaxaca were those with the lowest. CONCLUSIONS: NFRTI are frequent in Mexico and they are concentrated among men in productive ages in urban areas; they are associated with socioeconomic status at the individual level and with the state's development at the population level.