The Invisible Burden of Violence Against Girls and Young Women in Mexico: 1990 to 2015.

The increasing burden of interpersonal violence in women in Mexico is a neglected social and health problem that competes with other leading causes of premature death, disability, and health losses in young women. In this article, we focus on revealing the burden of violence in girls and young women and its implications for public policy. This study presents the subnational analysis of Mexico from the Global Burden of Disease study (1990-2015). The global study harmonized information of 195 countries and 79 risk factors. The study analyzed the deaths, years of life lost to premature death (YLL), years lived with disability (YLD), and the healthy years of life lost or disability-adjusted life year (DALY) related to violence. Nationwide, violence in young women accounts for 7% of all deaths in the 10 to 29 years age group and arises as the second most important cause of death in all age groups, except 10 to 14 years old, where it stands in the seventh position from 1990 to 2015. The health losses and social impact related to violence in young women demands firm actions by the government and society. It is urgent for health institutions to focus on the health of girls and young women because gender inequities have an enormous effect on their lives. Girls and women are nearly universally less powerful, less privileged, and have fewer opportunities than men.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Medidas de prevención primaria para controlar lesiones y muertes en peatones y fomentar la seguridad vial / Primary prevention measures for controlling pedestrian injuries and deaths and improving road safety

Dentro de las lesiones causadas por el tránsito (LCT) los atropellamientos representan a nivel mundial al menos la tercera parte de éstas; son eventos que habitualmente generan lesiones corporales incapacitantes e incluso pueden provocar la muerte. En Latino-América las personas afectadas, en general, son hombres entre 20 y 45 años, en edad productiva, jefes de hogar, personas que sostienen sus familias, su ausencia genera gran impacto en la economía de sus hogares. Se realizó una revisión sistemática sobre la carga que representan las LCT, en especial los atropellamientos y sobre las medidas de prevención primaria diseñadas e implementadas para el control de lesiones fatales y no fatales en peatones a través del mejoramiento de procesos de seguridad vial. En Latino- América los atropellamientos han sido poco estudiados; el grueso de intervenciones para reducir las LCT se han orientado hacia el conductor y ocupantes de vehículos y poco hacia los demás actores del tránsito, incrementando la desigualdad y vulnerabilidad de peatones; existe consenso mundial entre expertos, que es necesario investigaciones rigurosas, en especial en países de bajos y medianos ingresos orientados a evaluar la efectividad de intervenciones focalizadas hacia otros actores del tránsito; en la presente revisión se expone una variedad de estrategias de prevención primaria diferentes a puentes peatonales que según la evidencia disponible debe empezar a implementarse. Varias de éstas incluyen modificaciones al medio ambiente físico, educación, control de la velocidad, cumplimiento de la legislación y respeto por el peatón, valorando sus limitantes y vulnerabilidad.

At least 30 percent of traffic-related injuries involve pedestrians. These events typically result in incapacitating physical injury and may even cause death. Productive-agedmen, aged 20 to 45, represent the people generally affected in Latin-America. They tend to be heads of household supporting their families and whose absence greatly affects the home's financial situation. A systematic review was conducted of the burden represented by traffic-related injuries, especially those involving pedestrians, and of the primary preventative measures designed and implemented for controlling fatal and non-fatal injuries to pedestrians by improving road safety. There have been few studies in Latin-America regarding these types of accidents and most interventions aimed at reducing traffic-related injuries have been directed towards vehicle drivers and passengers, little attention being focused on other traffic-related actors. This increases pedestrian inequality and vulnerability. There is a consensus among experts worldwide that rigorous investigation is needed (especially in low- and middle-income countries) to evaluate the effectiveness of interventions focused on other traffic-related actors. This review presents a variety of primary prevention strategies, other than pedestrian bridges, which (according to the available evidence) should start to be implemented. These would include modifying the physical environment, education, speed controls, enforcing legislation and imposing respect for pedestrians, valuing their limitations and vulnerability.

[Primary prevention measures for controlling pedestrian injuries and deaths and improving road safety]. / Medidas de prevención primaria para controlar lesiones y muertes en peatones y fomentar la seguridad vial.

At least 30 % of traffic-related injuries involve pedestrians. These events typically result in incapacitating physical injury and may even cause death. Productive-aged men, aged 20 to 45, represent the people generally affected in Latin-America. They tend to be heads of household supporting their families and whose absence greatly affects the home's financial situation. A systematic review was conducted of the burden represented by traffic-related injuries, especially those involving pedestrians, and of the primary preventative measures designed and implemented for controlling fatal and non-fatal injuries to pedestrians by improving road safety. There have been few studies in Latin-America regarding these types of accidents and most interventions aimed at reducing traffic-related injuries have been directed towards vehicle drivers and passengers, little attention being focused on other traffic-related actors. This increases pedestrian inequality and vulnerability. There is a consensus among experts worldwide that rigorous investigation is needed (especially in low- and middle-income countries) to evaluate the effectiveness of interventions focused on other traffic-related actors. This review presents a variety of primary prevention strategies, other than pedestrian bridges, which (according to the available evidence) should start to be implemented. These would include modifying the physical environment, education, speed controls, enforcing legislation and imposing respect for pedestrians, valuing their limitations and vulnerability.

Determinants of vaccination after the Colombian health system reform.

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Determinants of vaccination after the Colombian health system reform

OBJETIVO: Analisar o efeito das características do indivíduo carente, da família e do próprio sistema de atendimento com a utilização da vacinação infantil, após a reforma do sistema de saúde, na Colômbia. MÉTODOS: Os dados foram colhidos numa amostra aleatória de assegurados em agregados familiares de baixo rendimento, em Bogotá, em 1999. O padrão analítico e conceitual utilizado baseou-se no Modelo Comportamental de Utilização de Serviços de Saúde de Andersen. Este considera duas unidades de análise para avaliar a vacinação e seus determinantes: 1) a população carente assegurada, inclusive características das crianças e suas famílias; e 2) o sistema de saúde. As análises estatísticas incluíram o teste do qui-quadrado com intervalo de confiança de 95%, modelos de regressão multivariada e coeficiente alfa de Cronbach. RESULTADOS: A análise de regressão mostra que a vacinação esteve relacionada com o tamanho da família (OR=4,3), a área da residência (OR=1,7), a idade da criança (OR=0,7) e os anos de escolaridade do chefe de família (OR=0,5). Também esteve relacionada com as características do sistema de saúde, tais como a disponibilidade de posto de atendimento (OR=6,0), e a informação sobre os programas e horários dos serviços de saúde (OR=2,1). CONCLUSÕES: Os baixos níveis de vacinação e a importante relação que existe com o sistema de atendimento mostram barreiras que devem ser avaliadas e resolvidas. A inexistência de postos com atendimento regular e a deficiente informação à população são fatores que podem limitar a utilização dos serviços.