How has research on the effectiveness and safety of COVID-19 vaccination been evaluated: a scope review with emphasis on CoronaVac.

Introduction: The control of the COVID-19 epidemic has been focused on the development of vaccines against SARS-CoV-2. All developed vaccines have reported safety and efficacy results in preventing infection and its consequences, although the quality of evidence varies depending on the vaccine considered. Different methodological designs have been used for their evaluation, which can influence our understanding of the effects of these interventions. CoronaVac is an inactivated vaccine, and it has been assessed in various studies, including clinical trials and observational studies. Given these differences, our objective was to explore the published information to answer the question: how has the efficacy/effectiveness and safety of CoronaVac been evaluated in different studies? This is to identify potential gaps and challenges to be addressed in understanding its effect. Methods: A scoping review was carried out following the methodology proposed by the Joanna Briggs Institute, which included studies carried out in humans as of 2020, corresponding to systematic reviews, clinical trials, analytical or descriptive observational studies, in which the effectiveness and/or safety of vaccines for COVID19 were evaluated or described. There were no age restrictions for the study participants. Results: The efficacy/effectiveness and safety of this vaccine was assessed through 113 studies. Nineteen corresponded to experimental studies, 7 of Phase II, 5 of Phase IV, and 4 were clinical trials with random assignment. Although some clinical trials with random assignment have been carried out, these have limitations in terms of feasibility, follow-up times, and with this, the possibility of evaluating safety outcomes that occur with low frequencies. Not all studies have used homogeneous methods of analysis. Both the prevention of infection, and the prevention of outcomes such as hospitalization or death, have been valued through similar outcomes, but some through multivariate analysis of dependencies, and others through analysis that try to infer causally through different control methods of confounding. Conclusion: Published information on the evaluation of the efficacy/effectiveness and safety of the CoronaVac is abundant. However, there are differences in terms of vaccine application schedules, population definition, outcomes evaluated, follow-up times, and safety assessment, as well as non-standardization in the reporting of results, which may hinder the generalizability of the findings. It is important to generate meetings and consensus strategies for the methods and reporting of this type of studies, which will allow to reduce the heterogeneity in their presentation and a better understanding of the effect of these vaccines.

COVID-19 mortality in two waves of the pandemic in Cali, Colombia, before and during vaccination roll-out.

Objective: To describe the variation in COVID-19 mortality among residents of Cali, Colombia, in the second wave of the pandemic, before vaccines, and in the fourth wave, with vaccination roll-out in process, taking into account variables of sex, age group, comorbidities, and interval between onset of symptoms and death, and to estimate the number of deaths averted by vaccination. Methods: A cross-sectional study of second wave and fourth wave deaths and vaccination coverage. The frequencies of attributes of deceased population in the two waves were compared, including comorbidities. Machado's method was used to calculate an estimate of the number of deaths averted in the fourth wave. Results: There were 1 133 deaths in the second wave and 754 deaths in the fourth wave. It was calculated that approximately 3 763 deaths were averted in the fourth wave in Cali in the context of vaccination roll-out. Conclusions: The decline in COVID-19-associated mortality observed supports the continuation of the vaccination program. Given the lack of data to explain other possible reasons for this decline, such as on the severity of novel viral variants, the limitations of the study are discussed.

COVID-19 mortality in two waves of the pandemic in Cali, Colombia, before and during vaccination roll-out

[ABSTRACT]. Objective. To describe the variation in COVID-19 mortality among residents of Cali, Colombia, in the second wave of the pandemic, before vaccines, and in the fourth wave, with vaccination roll-out in process, taking into account variables of sex, age group, comorbidities, and interval between onset of symptoms and death, and to estimate the number of deaths averted by vaccination. Methods. A cross-sectional study of second wave and fourth wave deaths and vaccination coverage. The frequencies of attributes of deceased population in the two waves were compared, including comorbidities. Machado’s method was used to calculate an estimate of the number of deaths averted in the fourth wave. Results. There were 1 133 deaths in the second wave and 754 deaths in the fourth wave. It was calculated that approximately 3 763 deaths were averted in the fourth wave in Cali in the context of vaccination roll-out. Conclusions. The decline in COVID-19-associated mortality observed supports the continuation of the vac- cination program. Given the lack of data to explain other possible reasons for this decline, such as on the severity of novel viral variants, the limitations of the study are discussed.

[RESUMEN]. Objetivo. Describir la variación en la mortalidad por COVID-19 en los residentes de Cali, Colombia, en la segunda ola de la pandemia (antes de las vacunas) y en la cuarta ola (durante el despliegue de las vacunas). Se tomaron en cuenta las variables referidas al sexo, grupo de edad, comorbilidades e intervalo entre el inicio de los síntomas y la muerte y se estimó el número de muertes evitadas por la vacunación. Métodos. Estudio transversal sobre las muertes en la segunda y cuarta olas de la pandemia de COVID-19 y la cobertura de vacunación. Se compararon las frecuencias de los atributos correspondientes a la población fallecida durante las dos olas, incluidas las comorbilidades. Se utilizó el método de Machado para estimar el número de muertes evitadas en la cuarta ola. Resultados. Se registraron 1 133 muertes en la segunda ola y 754 en la cuarta. Se calculó que, en el contexto del despliegue de las vacunas, en la cuarta ola se evitaron aproximadamente 3 763 muertes en Cali. Conclusiones. La disminución observada en la mortalidad asociada a la COVID-19 respalda la continuación del programa de vacunación. Dada la falta de datos para explicar otras posibles causas de esta disminución, como puede ser la gravedad causada por las nuevas variantes virales, se analizan las limitaciones del estudio.

[RESUMO]. Objetivo. Descrever a variação da mortalidade por COVID-19 entre residentes de Cali, Colômbia, na segunda onda da pandemia (antes das vacinas) e na quarta onda (com a implantação da vacinação já em anda- mento), considerando as variáveis sexo, faixa etária, comorbidades e intervalo entre início dos sintomas e óbito, bem como estimar o número de óbitos evitados pela vacinação. Métodos. Estudo transversal de mortes e cobertura vacinal na segunda e quarta ondas da pandemia. Foram comparadas as frequências dos atributos da população que foi a óbito durante as duas ondas, incluindo comorbidades. Foi utilizado o método de Machado para estimar o número de mortes evitadas na quarta onda. Resultados. Houve 1.133 mortes na segunda onda e 754 mortes na quarta onda. Calcula-se que cerca de 3.763 mortes foram evitadas na quarta onda em Cali, no contexto da disponibilização das vacinas. Conclusões. A queda observada na mortalidade associada à COVID-19 apoia a continuidade do programa de vacinação. Considerando a falta de dados para explicar outros possíveis motivos para esta queda, como a gravidade das novas variantes do vírus, discutem-se as limitações do estudo.

COVID-19 mortality in two waves of the pandemic in Cali, Colombia, before and during vaccination roll-out / Mortalidad por COVID-19 en dos olas de la pandemia en Cali, Colombia, antes y durante el despliegue de las vacunas / Mortalidade por COVID-19 em duas ondas da pandemia em Cali, Colômbia, antes e durante a disponibilização das vacinas

ABSTRACT Objective. To describe the variation in COVID-19 mortality among residents of Cali, Colombia, in the second wave of the pandemic, before vaccines, and in the fourth wave, with vaccination roll-out in process, taking into account variables of sex, age group, comorbidities, and interval between onset of symptoms and death, and to estimate the number of deaths averted by vaccination. Methods. A cross-sectional study of second wave and fourth wave deaths and vaccination coverage. The frequencies of attributes of deceased population in the two waves were compared, including comorbidities. Machado's method was used to calculate an estimate of the number of deaths averted in the fourth wave. Results. There were 1 133 deaths in the second wave and 754 deaths in the fourth wave. It was calculated that approximately 3 763 deaths were averted in the fourth wave in Cali in the context of vaccination roll-out. Conclusions. The decline in COVID-19-associated mortality observed supports the continuation of the vaccination program. Given the lack of data to explain other possible reasons for this decline, such as on the severity of novel viral variants, the limitations of the study are discussed.

RESUMEN Objetivo. Describir la variación en la mortalidad por COVID-19 en los residentes de Cali, Colombia, en la segunda ola de la pandemia (antes de las vacunas) y en la cuarta ola (durante el despliegue de las vacunas). Se tomaron en cuenta las variables referidas al sexo, grupo de edad, comorbilidades e intervalo entre el inicio de los síntomas y la muerte y se estimó el número de muertes evitadas por la vacunación. Métodos. Estudio transversal sobre las muertes en la segunda y cuarta olas de la pandemia de COVID-19 y la cobertura de vacunación. Se compararon las frecuencias de los atributos correspondientes a la población fallecida durante las dos olas, incluidas las comorbilidades. Se utilizó el método de Machado para estimar el número de muertes evitadas en la cuarta ola. Resultados. Se registraron 1 133 muertes en la segunda ola y 754 en la cuarta. Se calculó que, en el contexto del despliegue de las vacunas, en la cuarta ola se evitaron aproximadamente 3 763 muertes en Cali. Conclusiones. La disminución observada en la mortalidad asociada a la COVID-19 respalda la continuación del programa de vacunación. Dada la falta de datos para explicar otras posibles causas de esta disminución, como puede ser la gravedad causada por las nuevas variantes virales, se analizan las limitaciones del estudio.

RESUMO Objetivo. Descrever a variação da mortalidade por COVID-19 entre residentes de Cali, Colômbia, na segunda onda da pandemia (antes das vacinas) e na quarta onda (com a implantação da vacinação já em andamento), considerando as variáveis sexo, faixa etária, comorbidades e intervalo entre início dos sintomas e óbito, bem como estimar o número de óbitos evitados pela vacinação. Métodos. Estudo transversal de mortes e cobertura vacinal na segunda e quarta ondas da pandemia. Foram comparadas as frequências dos atributos da população que foi a óbito durante as duas ondas, incluindo comorbidades. Foi utilizado o método de Machado para estimar o número de mortes evitadas na quarta onda. Resultados. Houve 1.133 mortes na segunda onda e 754 mortes na quarta onda. Calcula-se que cerca de 3.763 mortes foram evitadas na quarta onda em Cali, no contexto da disponibilização das vacinas. Conclusões. A queda observada na mortalidade associada à COVID-19 apoia a continuidade do programa de vacinação. Considerando a falta de dados para explicar outros possíveis motivos para esta queda, como a gravidade das novas variantes do vírus, discutem-se as limitações do estudo.

Homicide Epidemic in Cali, Colombia: A Surveillance System Data Analysis, 1993‒2018.

Objectives. To examine homicide rates in Cali, Colombia, during the 1993-2018 period, using information derived from an interagency surveillance system. Methods. We used homicide data from Cali's Epidemiological Surveillance System to examine homicide trends by victim's age and sex, time, and type of method used. We estimated trend changes and the annual percentage changes using joinpoint regression analyses. Results. Homicide rates per 100 000 inhabitants dropped from 102 in 1993 to 47.8 in 2018. We observed reductions in homicide rates across age and sex groups. Most homicide victims were men aged 20 to 39 years from poor, marginalized areas. Firearms were used in 84.9% of all cases. The average annual percentage change for the entire period was -3.6 (95% confidence interval = -6.7, -0.4). Conclusions. Fluctuations in homicide rates in Cali show a clear epidemic pattern, occurring concurrently with the "crack epidemic" in different countries. Reliable and timely information provided by an Epidemiological Surveillance System allowed opportune formulation of public policies to reduce the impact of violence in Cali.

AfroColombian ethnicity, a paradoxical protective factor against Dengue.

INTRODUCTION: Dengue is a priority public health problem. During epidemics in Cuba and Haiti, ethnic African descendant population had lower risk of dengue, and the ethnic factor was proposed as a protective one. OBJECTIVE: To determine the relation between the Dengue's cumulative incidence and the Afro-Colombian proportion in communities of Cali, during the epidemic of 2013. METHODS: This study was conducted in Cali, Colombia. The design was ecological, using information from the National Census 2005 projected to 2013, from the National Administrative Department of Statistics (DANE), and the National Epidemiological Surveillance System. It was obtained the Pearson´s correlation coefficient between cumulative incidence and the proportion of Afro-Colombian population by communities. Additionally, the cumulative incidences of dengue were evaluated in two zones with different proportion of Afro-Colombian population. The association was also evaluated for aggregation bias, confounding by social variables, and interaction by area of ​​residence. RESULTS: Dengue´s cumulative incidence was significantly lower for Afro-Colombians regardless of the proportion of Afro-Colombian population in the area of residence. The relative risk of dengue between non-Afro-Colombians and Afro-Colombians was 9.4 (95% CI=8.4-10.6) in zones with high proportion of Afro-Colombian population, while the relative risk of dengue was 4.0 (95% CI :3.6 - 4.4) in the zone with lower proportion of Afro-Colombian population. There was no evidence of aggregation bias or confounding in the association by social variables. CONCLUSIONS: The Afro-Colombian population had a significantly lower risk of getting dengue and its complications, compared with the non-Afro-Colombian population. The non-Afro-Colombian populations living in areas with a high proportion of Afro-Colombians increase their risk of dengue more than double, suggesting an asymptomatic viremic environment. INTRODUCCIÓN: el dengue es un problema prioritario en salud pública. Durante epidemias en Cuba y Haití, la población étnica afro-descendiente tuvo menor riesgo de dengue. Por ello, se propuso el factor étnico como protector. OBJETIVO: Determinar la relación entre la incidencia acumulada de dengue y la proporción de población Afrocolombiana de Cali, durante la epidemia de 2013. MÉTODOS: Este estudio se realizó en Cali, Colombia. El diseño fue ecológico, con información del Censo Nacional 2005 y su proyección a 2013 del DANE y del Sistema de entre las incidencias acumuladas de dengue y la proporción de afrocolombianos, según comunidades. Adicionalmente, fueron evaluadas las incidencias acumuladas de dos zonas con diferente proporción de habitantes afrocolombianos. También se evaluó la presencia del sesgo de agregación, de confusión por variables sociales y de interacción según la zona de residencia. RESULTADOS: Para afrocolombianos, la incidencia acumulada de dengue fue significativamente menor, independientemente de la proporción de población afrocolombiana en la zona de residencia. El riesgo relativo de dengue entre no-afrocolombianos y afrocolombianos fue 9.4 (IC 95%= 8.4-10.6) en la zona con más alta proporción de población afrocolombiana, mientras que el riesgo relativo fue 4.0 (IC 95%= 3.6-4.4) en la zona de más baja proporción de población afrocolombiana. No se evidenció sesgo de agregación ni confusión de la asociación por variables sociales. CONCLUSIONES: La población afrocolombiana presentó un riesgo significativamente menor de enfermar por dengue y sus complicaciones en comparación con no-afrocolombianos. La población no-afrocolombiana que reside en zonas con alta proporción de población afrocolombiana aumenta el riesgo de dengue a más del doble, lo cual sugiere un entorno virémico asintomático.

AfroColombian ethnicity, a paradoxical protective factor against Dengue / La etnia afrocolombiana, factor protector paradójico contra el Dengue

Abstract Introduction: Dengue is a priority public health problem. During epidemics in Cuba and Haiti, ethnic African descendant population had lower risk of dengue, and the ethnic factor was proposed as a protective one. Objective: To determine the relation between the Dengue's cumulative incidence and the Afro-Colombian proportion in communities of Cali, during the epidemic of 2013. Methods: This study was conducted in Cali, Colombia. The design was ecological, using information from the National Census 2005 projected to 2013, from the National Administrative Department of Statistics (DANE), and the National Epidemiological Surveillance System. It was obtained the Pearson´s correlation coefficient between cumulative incidence and the proportion of Afro-Colombian population by communities. Additionally, the cumulative incidences of dengue were evaluated in two zones with different proportion of Afro-Colombian population. The association was also evaluated for aggregation bias, confounding by social variables, and interaction by area of ​​residence. Results: Dengue´s cumulative incidence was significantly lower for Afro-Colombians regardless of the proportion of Afro-Colombian population in the area of residence. The relative risk of dengue between non-Afro-Colombians and Afro-Colombians was 9.4 (95% CI=8.4-10.6) in zones with high proportion of Afro-Colombian population, while the relative risk of dengue was 4.0 (95% CI :3.6 - 4.4) in the zone with lower proportion of Afro-Colombian population. There was no evidence of aggregation bias or confounding in the association by social variables. Conclusions: The Afro-Colombian population had a significantly lower risk of getting dengue and its complications, compared with the non-Afro-Colombian population. The non-Afro-Colombian populations living in areas with a high proportion of Afro-Colombians increase their risk of dengue more than double, suggesting an asymptomatic viremic environment...(AU)

Resumen Introducción: el dengue es un problema prioritario en salud pública. Durante epidemias en Cuba y Haití, la población étnica afro-descendiente tuvo menor riesgo de dengue. Por ello, se propuso el factor étnico como protector. Objetivo: Determinar la relación entre la incidencia acumulada de dengue y la proporción de población Afrocolombiana de Cali, durante la epidemia de 2013. Métodos: Este estudio se realizó en Cali, Colombia. El diseño fue ecológico, con información del Censo Nacional 2005 y su proyección a 2013 del DANE y del Sistema de entre las incidencias acumuladas de dengue y la proporción de afrocolombianos, según comunidades. Adicionalmente, fueron evaluadas las incidencias acumuladas de dos zonas con diferente proporción de habitantes afrocolombianos. También se evaluó la presencia del sesgo de agregación, de confusión por variables sociales y de interacción según la zona de residencia. Resultados: Para afrocolombianos, la incidencia acumulada de dengue fue significativamente menor, independientemente de la proporción de población afrocolombiana en la zona de residencia. El riesgo relativo de dengue entre no-afrocolombianos y afrocolombianos fue 9.4 (IC 95%= 8.4-10.6) en la zona con más alta proporción de población afrocolombiana, mientras que el riesgo relativo fue 4.0 (IC 95%= 3.6-4.4) en la zona de más baja proporción de población afrocolombiana. No se evidenció sesgo de agregación ni confusión de la asociación por variables sociales. Conclusiones: La población afrocolombiana presentó un riesgo significativamente menor de enfermar por dengue y sus complicaciones en comparación con no-afrocolombianos. La población no-afrocolombiana que reside en zonas con alta proporción de población afrocolombiana aumenta el riesgo de dengue a más del doble, lo cual sugiere un entorno virémico asintomático...(AU)

Geographic distribution of risk of death due to homicide in Puerto Rico, 2001–2010 / Distribución geográfica del riesgo de muerte por homicidio en Puerto Rico,2001–2010

Objective. To raise awareness of the impact of homicides in Puerto Rico based on the findings of the spatial and temporal distribution of homicides and the use of firearms, by age and gender, using reports of interpersonal violent deaths from the Institute of Forensic Science (IFS) headquartered in San Juan, Puerto Rico. Methods. This was a descriptive study of all homicide incidents in Puerto Rico reported by the IFS for the period 2001–2010. For each of the 8 542 cases, data analyzed included age, sex, municipality of incident, date of death, and mechanism. Crude sex- and age-specific mortality rates for Puerto Rico and for each municipality per year and for the 10-year period were calculated. Cumulative rate and cumulative risks were estimated and defined as lifetime risk. The relative distribution of cumulative rates for each municipality was categorized into quartiles of highest to lowest risk and displayed as a map. Results. The risk of homicide death among males is 13 times greater than among females. The highest rates were observed among males 20–24 years of age (198.4 homicides per 100 000). In any given year, firearms were used in at least 80% of homicides. The average lifetime risk of homicide death for males is 1 in 34. Conclusions. Young adult males with access to firearms are at greatest risk of homicide in Puerto Rico. Also, highly urbanized municipalities are at highest risk; however, certain nonurban municipalities along the coast also have a very high homicide risk. Top priorities should be applying the WHO “ecological model” for violent injury prevention and establishing a surveillance system that will assist in identifying the role that socioeconomics, illegal firearms trade, and drug trafficking are playing.

Objetivo. Concientizar sobre la repercusión de los homicidios en Puerto Rico con base en los resultados de la distribución espacial y temporal de los homicidios y el uso de las armas de fuego, según la edad y el sexo, a partir de los informes del Instituto de Ciencias Forenses (ICF), con sede en San Juan, Puerto Rico, sobre defunciones por violencia interpersonal. Métodos. Estudio descriptivo de todos los incidentes de homicidio ocurridos en Puerto Rico informados por el ICF durante el período del 2001 al 2010. La edad, el sexo, el municipio del incidente, la fecha de muerte y el mecanismo fueron los datos analizados en cada uno de los 8 542 casos. Se calcularon las tasas brutas de mortalidad específicas de cada sexo y edad en Puerto Rico y en cada municipio, por año y durante el período de 10 años. Se calcularon también las tasas y los riesgos acumulados y se definieron como riesgo durante toda la vida. La distribución relativa de las tasas acumuladas para cada municipio se clasificó en cuartiles, del riesgo más alto al más bajo, y se ilustró en un mapa. Resultados. El riesgo de muerte por homicidio en varones es 13 veces mayor que en mujeres. Las tasas más elevadas se observaron en hombres de 20 a 24 años de edad (198,4 homicidios por 100 000). Cualquiera que fuera el año escogido, en al menos 80% de los homicidios se utilizaron armas de fuego. En varones, el riesgo promedio de morir por homicidio durante toda la vida es de 1/34. Conclusiones. Los jóvenes varones adultos con acceso a las armas de fuego están sometidos a un mayor riesgo de homicidio en Puerto Rico. Además, en los municipios muy urbanizados el riesgo es más alto; sin embargo, en ciertos municipios no urbanos de la costa también hay un riesgo de homicidio muy alto. Las máximas prioridades deben ser aplicar el “modelo ecológico” de la OMS para prevenir las lesiones violentas y establecer un sistema de vigilancia que ayude a determinar la función que desempeñan las condiciones socioeconómicas, el comercio ilegal de armas de fuego y el tráfico de drogas.

Geographic distribution of risk of death due to homicide in Puerto Rico, 2001-2010.

OBJECTIVE: To raise awareness of the impact of homicides in Puerto Rico based on the findings of the spatial and temporal distribution of homicides and the use of firearms, by age and gender, using reports of interpersonal violent deaths from the Institute of Forensic Science (IFS) headquartered in San Juan, Puerto Rico. METHODS: This was a descriptive study of all homicide incidents in Puerto Rico reported by the IFS for the period 2001-2010. For each of the 8 542 cases, data analyzed included age, sex, municipality of incident, date of death, and mechanism. Crude sex- and age-specific mortality rates for Puerto Rico and for each municipality per year and for the 10-year period were calculated. Cumulative rate and cumulative risks were estimated and defined as lifetime risk. The relative distribution of cumulative rates for each municipality was categorized into quartiles of highest to lowest risk and displayed as a map. RESULTS: The risk of homicide death among males is 13 times greater than among females. The highest rates were observed among males 20-24 years of age (198.4 homicides per 100 000). In any given year, firearms were used in at least 80% of homicides. The average lifetime risk of homicide death for males is 1 in 34. CONCLUSIONS: Young adult males with access to firearms are at greatest risk of homicide in Puerto Rico. Also, highly urbanized municipalities are at highest risk; however, certain non-urban municipalities along the coast also have a very high homicide risk. Top priorities should be applying the WHO "ecological model" for violent injury prevention and establishing a surveillance system that will assist in identifying the role that socioeconomics, illegal firearms trade, and drug trafficking are playing.

The establishment of injury surveillance systems in Colombia, El Salvador, and Nicaragua (2000-2006) / Establecimiento de sistemas de vigilancia de lesiones en Colombia, El Salvador y Nicaragua (2000-2006)

La Organización Panamericana de la Salud (OPS), en colaboración con los Centros para el Control y la Prevención de Enfermedades (CDC) de los Estados Unidos de América, estableció en 2000 sistemas para la vigilancia de lesiones en Colombia, El Salvador y Nicaragua. Estos sistemas, basados en los servicios hospitalarios de emergencia, formaron parte de un proyecto piloto fundamentado en las guías para la vigilancia de lesiones, desarrolladas por la Organización Mundial de la Salud (OMS) y los CDC. Los objetivos de este proyecto eran evaluar la utilidad de las guías de la OMS/CDC, crear mecanismos apropiados para la vigilancia de lesiones en los tres países, promover intervenciones preventivas adecuadas e integrar la prevención y el control de lesiones en proyectos nacionales de salud pública. En este artículo se describe el proyecto piloto de la OPS/CDC y se resaltan los principios más importantes y las lecciones aprendidas durante sus seis años de funcionamiento (2000-2006). Entre las principales recomendaciones se encuentran la integración de la vigilancia de las lesiones en las unidades de epidemiología e información existentes en los ministerios de salud, la recogida de los datos importantes exclusivamente, la garantía de monitoreos y evaluaciones adecuados y la adopción de las prácticas que han demostrado ser más efectivas para el entrenamiento de personal y la diseminación de información.

Sistema de Información de Lesiones de Causa Externa (SILEX): un proyecto exitoso en El Salvador / An information system for injuries from external causes (SILEX): a successful project in El Salvador

This article examines the stages in developing an information system for injuries from external causes (Sistema de Información de Lesiones de Causa Externa-SILEX), as well as its limitations and achievements. SILEX is a Web-based application for collection, quality control, presentation, and analysis of data available from the hospital system for surveillance of injuries from external causes created by Ministry of Health of El Salvador with data from the hospital emergency services. This system maintains comprehensive information on the injured person-type of injury, intention, injury site, activity being performed at the time of injury, risk factors, etc.-in the form of tables, graphs, and maps, which streamlines the development of intervention plans and prevention initiatives for these types of injuries in El Salvador. This experience is an example of what can be done to close the information gap on injuries by external causes in the Region of the Americas.

Understanding the uneven distribution of the incidence of homicide in Latin America.

BACKGROUND: Throughout the final years of the twentieth century and into the beginning of the twenty-first, violence has been one of the main public health issues in Latin America, a region which has some of the highest mortality rates due to violence in the world. However, there seems to be an uneven geographical distribution of such instances. METHODS: We reviewed epidemiological data on violence globally and in Latin America, and here, we discuss differences between the Latin American countries in the context of a sociological framework as well as from a public health perspective. RESULTS: Our results indicate marked differences by country in terms of rates of violence. Countries such as Argentina, Chile, Costa Rica, and Uruguay, have low violence mortality rates; Peru, Nicaragua, Ecuador, Dominican Republic, Panama, and Paraguay have moderate rates, and Brazil, Mexico, Colombia, El Salvador, Honduras and Venezuela have high to extremely high mortality rates. Factors related to violence include social inequalities, lack of employment opportunities, urban segregation, a culture of masculinity, local drug markets, and the availability of firearms and widespread use of alcohol. CONCLUSION: The observed homicide variability between Latin American countries can be explained largely by differences in the countries' social contexts and political models. In those countries where homicide rates are extremely high, governments should review their current policies and take preventive actions. Fortunately increasingly nowadays there are promising advancements in that direction.

[Impact of interventions directed toward motorcyclist death prevention in Cali, Colombia: 1993-2001]. / Efectos de las intervenciones diseñadas para prevenir las muertes de motociclistas en Cali, Colombia (1993-2001).

OBJECTIVE: Describe the impact of interventions focused on decreasing deaths by motorcycle crash. MATERIAL AND METHODS: We analyzed variations in deaths by motorcycle crash in Cali when the interventions were implemented and the statistical significance of changes between 1993 and 2001. RESULTS: The rate of motorcyclist deaths per 100,000 inhabitants decreased from 9.7 in 1995 to 3.6 in 2001. The greatest reduction was observed after the introduction of the helmet law for motorcycle drivers in 1996 (12.3%). Other interventions-such as a helmet law for passengers, a reflective safety vest, a circulation ban for motorcyclists in December, and compulsory courses for all motorcyclists-produced a greater decrease in mortality; meanwhile, a lack of law enforcement increased it. CONCLUSIONS: The establishment and implementation of a combination of prevention strategies was more effective than a single or non-articulated strategy.

[An information system for injuries from external causes (SILEX): a successful project in El Salvador]. / Sistema de Información de Lesiones de Causa Externa (SILEX): un proyecto exitoso en El Salvador.

This article examines the stages in developing an information system for injuries from external causes (Sistema de Información de Lesiones de Causa Externa-SILEX), as well as its limitations and achievements. SILEX is a Web-based application for collection, quality control, presentation, and analysis of data available from the hospital system for surveillance of injuries from external causes created by Ministry of Health of El Salvador with data from the hospital emergency services. This system maintains comprehensive information on the injured person-type of injury, intention, injury site, activity being performed at the time of injury, risk factors, etc.-in the form of tables, graphs, and maps, which streamlines the development of intervention plans and prevention initiatives for these types of injuries in El Salvador. This experience is an example of what can be done to close the information gap on injuries by external causes in the Region of the Americas.