Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

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.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

Facial trauma in the largest city in Latin America, São Paulo, 15 years after the enactment of the compulsory seat belt law

Traffic accidents are a reality throughout Brazil. The face is one of the anatomic parts most affected by these accidents, especially when a seat belt is not used. These accidents are costly for the public health system and have a significant impact on society and the lives of families involved. The compulsory use of seat belts in Brazil, especially in São Paulo, has decreased the rate of facial trauma. This suggests that the public health policies and measures adopted by the Brazilian authorities have benefited the population 15 years after the enactment of the law of compulsory seat belts in the city of São Paulo.

El respeto a las normas de tránsito en la cuidad de Santa Fe, Argentina / Traffic law compliance in the city of Santa Fe, Argentina

Se realizó un estudio de campo observacional descriptivo para evaluar el cumplimiento de algunas normas de tránsito en la ciudad de Santa Fe, Argentina, y comparar los resultados con mediciones realizadas anteriormente. Para ello, entre el 2 y el 4 de enero de 2006, se verificó en 13 sitios de la ciudad el cumplimiento de las normas que obligan a los automovilistas a usar cinturón de seguridad y a llevar a los menores de 10 años en el asiento trasero, y a los motociclistas, a conducir con casco y a no transportar menores. Las observaciones abarcaron 4 173 automóviles y 1 013 motocicletas. Solo 9 por ciento de los conductores de automóviles usaban el cinturón de seguridad. En 56 por ciento de los 246 automóviles que transportaban menores, estos se hallaban en el asiento delantero. En cuanto a los motociclistas, solo 12 por ciento usaba casco y 6,7 por ciento transportaba niños. Al comparar estas observaciones con cinco registros anuales anteriores, se comprobó que en los últimos tres años disminuyeron los porcentajes de acatamiento de estas normas de tránsito. Los resultados de este estudio sugieren que la mayoría de los conductores de vehículos de la ciudad argentina de Santa Fe viola las normas de tránsito consideradas. Para lograr disminuir la elevada mortalidad por accidentes viales no basta con contar con leyes de tránsito y organizar campañas de información, sino que, además, es necesario implementar sistemas que vigilen el cumplimiento de las normas.

An observational, descriptive study was conducted to evaluate compliance with certain traffic regulations in city of Santa Fe, Argentina, and compare these with measurements taken in prior years. During January 2-4, 2006, at 13 sites across the city, compliance with the following traffic rules was measured: for car drivers: seat belt use and restricting minors to the rear seat; and for motorcycle drivers: helmet use and not carrying a minor on board. At total of 4 173 cars and 1 013 motorcycles were observed. Only 9 percent of the car drivers wore seatbelts. Of the 246 cars carrying minors, 56 percent had a minor in the front seat. Regarding the motorcycles drivers, only 12 percent wore a helmet and 6.7 percent had a child on board. When these observations were compared with those of the previous five years, findings showed that over the past three years compliance rates had decreased. The results of this study suggest that most drivers in city of Santa Fe do not obey the stated traffic laws. In order to reduce the high rate of mortality from traffic accidents, in addition to legislation and public-awareness campaigns, a system for enforcing compliance is needed.

Association between exposure/non-exposure to the mandatory seat belt law with regards to compliance in vehicle accident victims a hospital review / Asociación entre exposición/no exposición a la ley obligatoria de cinturón de seguridad en relación con su cumplimiento en el caso de víctimas de accidentes vehiculares ­ un estudio basado en datos de hospital

OBJECTIVE: Injuries sustained in motor vehicle accidents (MVAs) are a major challenge to the Jamaican healthcare system. In November 1999, Jamaica enacted legislation to make seat belt usage in motor vehicles compulsory. The effect of this policy change on seat belt usage is unclear. This study therefore sought to determine the prevalence of seat belt usage and to determine the association between exposure/non-exposure to the mandatory seat belt law and seat belt use in subjects who presented to the Accident and Emergency Department (A&E) of the University Hospital of the West Indies (UHWI) as a result of motor vehicle accidents. METHODS: Subjects were recruited from June to November 2003, post-seat belt law (POBL) period, and May to October 1999, pre-seat belt law (PRBL) period. Data collected included demographic variables, seat belt use and position of the occupants in the vehicle. RESULTS: Of the 277 patients who were eligible for inclusion, data were complete in 258 subjects, 87 in the PRBL period and 171 in the POBL period. The prevalence of seat belt use was 47% (PRBL) and 63% (POBL) respectively. There was no significant gender difference at each period. The odds of wearing seat belt in the rear of a motor vehicle were significantly lower than that of a driver (Table 3, OR 0.19, 95% CI 0.07, 0.48). Adjusting for age, gender and position in vehicle exposure, there was about 100% increase in the odds of seat belt use during the post seat belt law era (OR = 2.09, 95% CI 1.21, 3.61). CONCLUSION: It is concluded from this hospital-based study that the mandatory seat belt law legislature was associated with increased seat belt use in motor vehicle accident victims. However, current data from the Road Traffic Agency indicate that there is still an alarming number of fatalities. This clearly suggests that additional public health measures are needed to address the epidemic of motor vehicle trauma in Jamaica.

Objetivo: Las heridas producidas en accidentes en vehículos motorizados (AVM) constituyen uno de los principales desafíos para el sistema de atención a la salud en Jamaica. En noviembre de 1999, Jamaica aprobó una legislación que obligada al uso del cinturón de seguridad en vehículos motorizados. El efecto de este cambio de política sobre el uso del cinturón de seguridad no está claro. Por lo tanto, este estudio busca determinar la prevalencia del uso del cinturón de seguridad y determinar la asociación entre exposición/no exposición a la ley obligatoria de cinturón de seguridad y el uso del cinturón de seguridad en sujetos que acudieron al Departamento de Accidentes y Emergencia (A&E) del Hospital Universitario de West Indies (HUWI) como resultado de un accidente vehicular. Métodos: Los sujetos fueron reclutados de junio a noviembre de 2003, período posterior a la ley de cinturón de seguridad (PLCS), y de mayo a octubre de 1999, período anterior a la ley de cinturón de seguridad (ALCS) Los datos recopilados incluyeron las variables demográficas, el uso de cinturón de seguridad, y la posición de los ocupantes del vehículo. Resultados: De los 277 pacientes que eran elegibles para ser incluidos, se completaron los datos de 258 sujetos, 87 en el período ALCS y 717 en el período PLCS. La prevalencia del uso del cinturón de seguridad fue 47% (ALCS) y 63% (PLCS) respectivamente. No hubo diferencia significativa de género en ninguno de los períodos. Las probabilidades de uso del cinturón de seguridad fueron significativamente más bajas para los ocupantes del asiento trasero que para el conductor del auto (Tabla 3, OR 0.19, 95% CI 0.07, 0.48). Ajustando por edad, género y posición en exposición vehicular, hubo un aumento de alrededor del 100% en las probabilidades de uso del cinturón de seguridad durante la era posterior a la ley del uso del cinturón de seguridad (OR = 2.09, 95% CI 1.21, 3.61). Conclusión: A partir de este estudio basado en datos de hospital, se llegó a la conclusión de que la legislación de la ley del uso obligatorio del cinturón de seguridad, estuvo asociada con el aumento del uso del cinturón de seguridad en víctimas de accidentes con vehículos motorizados. Sin embargo, los datos actuales de la Agencia del Tráfico de Carreteras, indican que existe todavía un número alarmante de casos fatales. Esto sugiere a todas luces la necesidad de medidas de salud pública adicionales para abordar la epidemia de traumas por accidentes de vehículos en Jamaica

Normas de segurança para o transporte de crianças em automóveis / Safety strategies for traveling children in cars

Objetivo: revisar as normas de segurança para transporte de crianças em automóveis, abordando aspectos práticos de utilização dos sistemas de retenção infantil para cada faixa etária...

Objective: to review the safety strategies concerning car transportation of children, focusing practical points about usage of child restraint car seats at any age...

The prevalence of seat belt use in Kingston, Jamaica: a follow-up observational study five years after the introduction of legislation / Prevalencia del uso del cinturón de seguridad en Kingston, Jamaica: un estudio observacional de seguimiento, cinco años después de introducida la legislación

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0. 001) and as front seat passengers (79.9% vs 66.3%; p < 0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p < 0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized

Un estudio transversal observacional llevado a cabo en Kingston en el año 2004 mostró que los cinturones de seguridad eran usados por el 81.2% de los conductores de vehículos motorizados privados, y el 74.0% de los pasajeros del asiento delantero. Esto representa una mejoría significativa en comparación con el 21.1% y el 13.6% respectivamente en 1996 antes de que se introdujera la legislación en 1999 (p < 0.001). Las tendencia de las mujeres a usar cinturones de seguridad fue significativamente mayor que la de los hombres, tanto al conducir (92.5% vs 77.3%; p < 0.001) como al viajar como pasajeras en el asiento delantero (79.9% vs 66.3%; p < 0.001). De los 2289 vehículos motorizados examinados, todos – excepto uno – estaban equipados con cinturones de seguridad. No se examinó la utilización de los cinturones de seguridad por parte de los pasajeros en los asientos traseros. Los conductores de vehículos nuevos mostraron una tendencia mayor que los otros conductores a usar cinturones de seguridad (p < 0.001). Los conductores varones, los conductores de vehículos más viejos, y todos los pasajeros puede que requieran ser objeto específico de una campaña destinada a educarlos o a hacer cumplir la ley si se desea maximizar los beneficios del uso del cinturón de seguridad.

O pediatra e a segurança no trânsito / The pediatrician and traffic safety

OBJETIVO: Através de revisão bibliográfica, orientar o transporte seguro da criança e do adolescente e o seu comportamento como ciclista e pedestre. FONTES DOS DADOS: Revisão bibliográfica através do banco de dados MEDLINE e LILACS, utilizando os seguintes termos: acidentes de trânsito, criança, adolescente, morbidade, mortalidade, faixas etárias e gênero, no período de 1995 a 2005. Foram selecionados artigos científicos que relataram estudos de morbimortalidade por acidentes de trânsito, criança na situação de pedestre, ciclista e passageira de veículo a motor. SíNTESE DOS DADOS: Foram encontrados mais de 300 artigos científicos, sendo selecionados aqueles que tratassem dos assuntos em questão de forma mais geral. CONCLUSÕES: A mortalidade no trânsito ainda é muito alta e mostra a necessidade de intensificar investimentos em medidas efetivas de segurança para pedestres, passageiros e condutores de veículos, reforço das leis e de controle ambiental, além de campanhas e ações educativas continuadas de conscientização da comunidade. O pediatra pode colaborar nesse processo por meio da orientação e educação, no âmbito clínico e na comunidade.

Compliance with the law on car seat-belt use in four cities of Thailand.

Surveys to determine the scope of compliance with the law requiring seat-belt use in Thailand were conducted by observation and interviews with drivers in four cities: namely, Bangkok Metropolis, Chiang Mai, Phuket and Nakhon Ratchasima. The work was carried out in two separate sessions: during the first month following enactment of the law, and six months after its enactment. The sample comprised 46,949 vehicles in the first session (January 1996) and 76,188 vehicles in the second session (July 1996). The results showed that 42.7 per cent of drivers used seat-belts in January and 30.7 per cent in July. When the data were disaggregated according to cities, it was found that more Bangkok drivers complied with the seat-belt law than in Phuket, 24.6 per cent; Chiang Mai, 22.1 per cent; and Nakhon Ratchasima, 18.3 per cent relatively low compliance rate was encountered among drivers of pick-up trucks (including those with modified roofs) and vans, particularly farmers and the self-employed. Women drivers tended to abide by the law more often than men (OR = 1.7, 95% CI = 1.12, 1.23). Inter-city travelers wore seat-belts more than those traveling in the city (OR = 1.74, 95% CI = 1.68, 1.80). About one-fifth of non-users or those who rarely used seat-belts were unsure of the effectiveness of seat-belts in preventing serious injury or death in the case of an accident. Discomfort associated with using seat-belts and the perception that they were rendered unnecessary because of slow traffic in cities were other reasons for non-compliance in 50.6 per cent and 43.9 per cent of cases, respectively. The decline in compliance with the law six months after its enactment indicates that there may be a problem with uniform and consistent enforcement of the law.

O uso de cinto de segurança em pessoas envolvidas em acidentes automobilísticos com trauma crânio facial / Utilization of seat belt in people involved in automobilistic accidents with skull facial trauma

Os autores realizaram um estudo prospectivo fazendo entrevistas e exames nos pacientes com trauma crânio-facial, atendidos no Hospital de Pronto Socorro de Porto Alegre. Foi utilizado um questionário pre-determinado com o propósito de trazer os padroes do uso do cinto de segurança e as características sócio-demográficas dos acidentados. Comparando os usuários e os nao-usuários de cinto de segurança, os primeiros foram significativamente mais velhos, viajaram com uma velocidade menor, se acidentaram numa regiao mais distante do domicílio ou destino e os traumas ocorridos foram menores em extensao e gravidade. Uma diferença estatística a respeito dos parâmetros de sexo, estado civil e evidência de consumo de álcool nao foi detectada. Comparando-se esses dados com experiências de outros países, os autores acentuaram a necessidade de adoçao de leis que imponham de maneira rigorosa o uso do cinto de segurança.