Políticas públicas basadas en evidencia científica: el caso de la seguridad vial infantil / Public policies based on scientific evidence: child road safety

Los accidentes de tránsito son un problema de salud pública global. En América Latina, la tasa de mortalidad por accidentes de tránsito en niños es casi el doble que el promedio mundial. Se presenta nuestra experiencia en la formulación de una política pública de seguridad vial infantil en Panamá, basada en la evidencia científica generada por nuestro grupo de investigación. Además, se propone un modelo para la formulación de políticas públicas que podría usarse en otros países latinoamericanos. Se trata de un vector de formulación que es parte del ciclo de las políticas públicas e incluye la identificación de un problema público, la ejecución de la investigación científica, la publicación y la socialización de los productos científicos para la formulación de la política pública con la participación incluyente de los científicos, la sociedad civil y los tomadores de decisiones cuando estos comparten espacios de diálogo.

Road traffic accidents are a global public health problem. In Latin America, the mortality rate among children due to road traffic accidents almost doubles the global average. We describe our experience formulating a public policy on child road safety in Panama, based on the scientific evidence produced by our research group. Moreover, we propose a model for public policy-making that may be used in other Latin American countries. It is a formulation vector that is part of the public policy-making cycle and entails identifying a public problem, conducting scientific research, publishing and disseminating scientific products for public policy-making with the participation of scientists, the civil society, and decision-makers by sharing spaces for dialog.

Sociedad y cuidado desde la perspectiva de niños sin cuidado parental (NSCP) / Society and care from the perspective of children without parental care / Sociedade e cuidado desde a perspectiva de crianças sem cuidado parental (CSCP)

Objetivo: Comprender los significados que otorgan niños y niñas sin cuidado parental, a las condiciones de vida, relaciones que establecen y formas como negocian o recrean su situación en los lugares en que crecen, reconociéndolos como interlocutores necesarios para el análisis de las circunstancias en que tiene lugar su crecimiento. Materiales y métodos: Investigación multisituada por el carácter transitorio de sus vidas, se fundamenta epistemológicamente en el perspectivismo, abordando treinta niños y niñas en contextos de calle, treinta y cinco niños y niñas en instituciones educativas y veintiuno en centros de protección, en ciudades y municipios que conforman el corredor industrial de Boyacá. Para ello se implementaron estrategias cualitativas como relatos de vida, entrevistas en ocasiones realizadas por los niños y niñas participantes; también estrategias participativas tales como observación participante y talleres. Resultados: Las relaciones con vecinos o cercanos, funcionarios del estado y maestros, quienes ejercen acciones transitorias de cuidado como una excepción a la regla general de indiferencia, adquieren para los participantesotros sentidos en cuanto a posibilidades de vínculos afectivos que, no obstante, se pierden por razones personales o sociales que no los favorecen, generando interrogantes sobre el papel que podría desempeñar la sociedad como corresponsable de su crecimiento. Conclusiones: El conocimiento basado en la experiencia de niños y niñas sin cuidado parental fue fundamental para comprender que la construcción de sociedad ha ido abandonando el cuidado como su eje central en el crecimiento y la formación de los seres humanos y para encontrar otras formas de interpretar la niñez en cuanto categoría social.

Objective: Understand the meanings given by children without parental care to living conditions, relationships established and how they negotiate or recreate their situation in the places where they grow, recognizing them as necessary interlocutors for the analysis of the circumstances of their place of growth. Materials and Methods: Multi-sited research for the transitory character of their life, it is epistemologically based on perspectivism, addressing thirty street children, thirty-five children in educational institutions and twenty-one in child protection centres in cities and municipalities within the industrial corridor of Boyacá, Colombia. Qualitative strategies such as life stories, interviews (occasionally made by the participant children) were implemented for this research; also, participative strategies such as participant observation and workshops. Results: Relationships with neighbors, close relatives or friends, government officials or teachers who practice transitory care actions as an exception to the general rule of indifference, acquire for the participants other feelings regarding possibilities of emotional ties that, however, are lost due to personal or social reasons and are not favorable for them, generating open questions about the role society could play as co-responsible of their growth. Conclusions: The knowledge based on experience of children without parental care was fundamental to understand that the construction of society has abandoned care as the main focus in the growth and the training of human beings, and to find other ways of interpreting childhood regarding social status.

Objetivo: Compreender os significados que outorgam crianças sem cuidado parental, às condições de vida, relações que estabelecem e formas como negociam ou recriam sua situação nos locais em que crescem, reconhecendo-os como interlocutores necessários para a análise das circunstancias em que tem lugar seu crescimento. Materiais e métodos: Pesquisa em foco múltiplo pelo carácter transitório de suas vidas, fundamentada epistemologicamente no perspectivismo, abordando trinta (30) crianças em contextos de rua, trinta e cinco (35) crianças em instituições educativas e vinte e um em centros de proteção, em cidades e municípios que conformam o corredor industrial do estado Boyacá. Por isso, se implementaram estratégias qualitativas como relatos de vida, entrevistas em ocasiões realizadas pelas crianças participantes; também estratégias participativas tais como: observação participante e oficinas. Resultados: As relações com vizinhos ou próximos, funcionários do estado e mestres, quem exercem ações transitórias de cuidado como uma exceção à regra geral de indiferença, adquirem para os participantes outros sentidos em quanto a possibilidades de vínculos afetivos que, não obstante, se perdem por razões pessoais ou sociais que não os favorecem, gerando interrogantes sobre o papel que poderia desempenhar a sociedade como corresponsável de seu crescimento. Conclusões: O conhecimento baseado na experiencia de crianças sem cuidado parental foi fundamental para compreender que a construção de sociedade tem ido abandonando o cuidado como seu eixo central no crescimento e a formação dos seres humanos e para encontrar outras formas de interpretar a infância em quanto categoria social.

Safety awareness and use of child safety seats among parents after the legislation in Shanghai / 中华创伤杂志(英文版)

PURPOSE@#To investigate the changes and underlying mechanisms in parents' safety awareness and the use of child safety seats after the mandatory legislation in Shanghai city, China.@*METHODS@#This study was carried out by Shanghai Key Laboratory of Environment and Children's Health using a multi-stage, simple random sampling method. Volunteers with children aged 0-12 months were recruited. Child safety seats were sent to each volunteer's family. Telephone encounters and/or on-site visits were used to collect data from parents using a phased survey on children's safety during car use.@*RESULTS@#Among all respondents, 91.2% had heard of motor vehicle accidents involving children, and 97.2% could describe the appropriate use of a safety seat to minimize the risk of child injury in a collision. Among 1078 families with newborns, awareness of child safety seats was 91.9%. There were 86% patients aware that new laws and regulations have been released regarding the use of child safety seats, and 98.5% of them plan to comply with the new laws. Moreover, 61% patients think that taxis should be routinely equipped with child safety seats.@*CONCLUSION@#The parents in Shanghai obtained a high level of awareness of children's traffic safety after the introduction of child safety seats legislation, and had a positive experience related to the use of child safety seats. Taxi may be an important area of focus for implementation of child traffic safety. Traffic safety laws and regulations with further impact should be continuously studied.

Medicina de tráfego: transporte seguro de crianças em veículos automotores / Traffic medicine: safe transport of children in motor vehicles

Saber que as tragédias no trânsito continuam sendo as principais causas de morte e ferimentos graves em crianças nos deixa inconformados. Ao mesmo tempo, ficamos estimulados ao saber que podemos reduzir as consequências dos acidentes de trânsito. As evidências científicas comprovam a eficácia do uso correto dos dispositivos de retenção para crianças em veículos automotores, por isso precisamos disseminar essas orientações para que a segurança no transporte veicular de crianças faça parte do aconselhamento médico. Com a cartilha Medicina de tráfego: transporte seguro de crianças em veículos automotores, o Conselho Federal de Medicina (CFM) pretende estimular os médicos para que recomendem, apropriadamente, os dispositivos de retenção veicular disponíveis para crianças e alertem a comunidade e as autoridades sobre esta importante causa evitável de morbimortalidade.

Current use of safety restraint systems and front seats in Korean children based on the 2008–2015 Korea National Health and Nutrition Examination Survey / 소아과

PURPOSE: The use of proper safety restraint systems by children is vital for the reduction of traffic accident-related injury and death. This study evaluated the rates of use of safety restraint systems and front seats by Korean children. METHODS: Based on data from the National Health and Nutrition Examination Survey from 2008 to 2015, I investigated the frequencies of safety restraint systems and front seat use by children under six and 12 years of age, respectively. RESULTS: The percentage of respondents who said they always use safety restraint systems increased from 17.7% in 2008 to 45.0% in 2015. The rate of children who did not use the front seats at all was 47.3 % in 2008 compared to 33.4% in 2015. Multivariate logistic regression analysis showed a decrease in safety-restraint-system use as age increased (odds ratio, 0.63; 95% confidence interval [CI], 0.51–0.77). The use rate of front-passenger seat belts by the mother is significantly correlated with the safety-restraint- system use rate by children (odds ratio, 2.14; 95% CI, 1.12–4.06). CONCLUSION: Although the rate of safety-restraint-system use for children is increasing annually, it remains low. Additionally, the use rate of front passenger seats for children is high. To reduce the rates of injury and death of children from traffic accidents, it is necessary to educate on the appropriate use of safety restraint systems according to age and body size and to develop stronger regulations.

Use of child safety seats during transportation of newborns / 소아과

PURPOSE: Child safety seats (CSS) are critical for the protection of children, in case of motor vehicle accidents. Although the national legislation mandates that all newborns must be placed in an appropriately installed CSS during transportation, people often do not perceive the importance of CSS and do not use it as recommended. The purpose of this survey was to understand the use of CSS for the safe transport of newborns from hospital to home. METHODS: We interviewed parents of newborn infants, using a structured questionnaire, at the time of their discharge from Cheil General Hospital & Women’s Health Care Center, between May 2014 and July 2014. RESULTS: A total of 403 participants were interviewed. The rate of CSS use was only 14.9%. Overall, 76.4% of the families interviewed were not aware about the recommendations on CSS use for newborns when travelling in a car. The provision of education on using CSS significantly influenced their rate of use. Parents who were educated about mounting the CSS in a car used it more as compared with others (25.7% vs. 12.2%) (P=0.002). Furthermore, if parents had heard about the importance or necessity of CSS, they used it more than others did (19.5% vs. 10.6%, P=0.032). CONCLUSION: Despite the legal regulation, most parents transport their newborn infants without a CSS while traveling from hospital to their home. The rate of CSS use was influenced by parental education and their knowledge about its necessity. Education programs for parents must be reinforced to increase the CSS use.

Drivers’ Knowledge And Attitudes Towards Child Restraint System (Crs) Usage

@#Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.

Viagem com crianças: segurança "além da cadeirinha" / Traveling with children: beyond car seat safety

Resumo Objetivo Proporcionar conhecimento e instigar o profissional de saúde a fornecer uma orientação aprimorada quanto aos cuidados com crianças em viagens, além de orientar o seu transporte seguro. Fontes dos dados Revisão bibliográfica nas bases de dados Lilacs e Medline® de artigos com os termos viagem, segurança, equipamentos de proteção, criança e medicina preventiva e publicados nos últimos 21 anos. Síntese dos dados Foram analisados 93 artigos e66 atenderam aos critérios de inclusão após a leitura dos resumos. Para a construção do artigo propôs-se a definição dos subtemas: preparar a viagem com as crianças, conhecer alguns riscos do translado (transporte aéreo, transporte terrestre e aquático), explorar o destino com as crianças (exposição solar, hospedagem, altitude, alimentação, diarreia do viajante, picada de insetos) e retorno de viagem com crianças. Conclusões Ao longo dos anos houve um aumento do número de crianças que viajam pelo mundo. Entretanto, essa população não está isenta de apresentar problemas de saúde durante a viagem e pode ser até mais suscetível do que a faixa etária adulta. Esses surgem a partir de uma variedade de fatores, incluindo a exposição a organismos infecciosos, o uso de certos tipos de transporte e a participação em algumas atividades, como caminhadas para altas altitudes, entre outros. Porém, quando se viaja com crianças esses fatores de risco podem ser negligenciados e uma viagem considerada segura para um adulto pode não ser uma boa opção para os infantes. A consulta pediátrica deve ser uma boa oportunidade para aprimorar as orientações preventivas no planejamento pré-viagem.

Abstract Objective To spread knowledge and instigate the health professional to give advice on childcare during travels and on child transport safety. Sources of data Literature review through the LILACS and MEDLINE® databases, using the terms: travel, safety, protective equipment, child, preventive medicine, retrieving articles published in the last 21 years. Summary of the findings The authors analyzed 93 articles, of which 66 met the inclusion criteria after summaries were read. For drafting this article, the following sub-themes were proposed: getting ready to travel with children; knowing some of the transfer risks (air, land and water transportation) and exploring the destination with children (sun exposure, accommodations, altitude, food, traveler's diarrhea, insect bites) and return from the trip with children. Conclusions Over the years, there has been an increase in the number of children who travel around the world. However, this population is still subject to health problems while traveling and may be even more susceptible than the adult age group. These problems arise from a variety of factors, including exposure to infectious organisms, the use of certain types of transportation, and participation in some activities, such as hiking at high altitudes, among others. However, when traveling with children, these risk factors can be overlooked; a trip that is considered safe for an adult might not be a good choice for this age group. The pediatric consultation should be a good opportunity to optimize preventive guidelines at the pre-trip planning.

Correct use of safety belts and child restraint devices in cars among children in Goiânia / Uso correto do cinto de segurança e dos dispositivos de restrição infantil em automóveis de Goiânia

Objective: to conduct an observational study, by means of campaigns, regarding the use of child restraint devices in cars in Goiânia. Methods: this was a cross-sectional study using a convenience sample built up as cases arose. The data were gathered into an Excel spreadsheet and were analyzed descriptively and statistically (SPSS 16.0), using chi-square and taking p < 0.05 as significant. Results: in 2006, 410 cars were evaluated, and in 2010, 544 cars were evaluated. Around 85% of the occupants were using seat belts correctly at both times (p = 0.650). In 2006, it was observed that a total of 273 passengers were occupying the rear seats, while in 2010 there were 226. Among these, 178 and 170 were using seat belts, respectively, i.e. 65.2% and 75.22% (p = 0.001). In 2006, five children were occupying the front seat without using the seat belt, while in 2010, this number was 42 (p < 0.001). In 2010, it was observed that 458 vehicles were transporting children on the rear seats, and this was being done correctly in 214 vehicles, i.e. 46.72%. In 2006, of the 410 vehicles analyzed, only 90 of them (21.95%) were transporting children correctly (p < 0.001). In addition, there was a difference in the variables within the year evaluated, in which transportation done correctly in the front seat was much more frequent than transportation done correctly in the rear seats, in both years (p < 0.001). Cars transported one to four children, while vans transported one to nine children. In 2006, one van transporting children irregularly was observed, while in 2010 it was done correctly in all cases. Conclusion: comparing these two years (2006 and 2010) in which data were gathered, we can conclude that changes in behavior among drivers in Goiânia have begun, with regard to safety when transporting children in vehicles, with an improvement of 25% (p < 0.001). A large part of this has come through changes in knowledge among ...

Objetivo: Fazer um estudo observacional, por meio de campanhas, sobre o uso dos dispositivos de restrição infantil em automóveis de Goiânia. Métodos: Estudo transversal por amostra de conveniência conforme surgimento dos casos. Os dados foram coletados em uma tabela Excel, analisados de forma descritiva e estatística (SPSS 16.0), com o uso do qui-quadrado, com p < 0,05 como significativo. Resultados: Em 2006, foram avaliados 410 automóveis, enquanto que em 2010 foram avaliados 544, nos quais cerca de 85% das pessoas usavam o cinto de forma correta nos dois períodos (p = 0,650). Em 2006, foram observados 273 passageiros no banco dianteiro e em 2010, 226. Usavam cinto de segurança 178 e 170, respectivamente, ou 65,2 e 75,22% (p = 0,001). Em 2006, cinco crianças ocupavam o banco da frente sem o uso do cinto de segurança. Em 2010, esse número foi de 42 (p < 0,001). Em 2010, foram observados 458 veículos que transportavam crianças no banco traseiro, 214 de maneira correta, ou 46,72%. Em 2006, dos 410 veículos analisados, apenas 90 (21,95%) transportavam crianças de maneira correta (p < 0,001). Além disso, houve diferença entre as variáveis dentro do ano avaliado, no qual o transporte correto no banco da frente foi bem mais frequente do que o no banco de trás, nos dois anos (p < 0,001). Carros transportavam de uma a quatro crianças e as vans, de uma a nove crianças. Em 2006 foi observada uma van que transportava crianças de maneira irregular, enquanto que em 2010 todas estavam corretas. Conclusão: Na comparação desses dois períodos, podemos avaliar que houve um início de mudança no comportamento do motorista goianiense no que tange à segurança no transporte de crianças em automóveis, com melhoria de 25% (p < 0,001). Grande parte disso decorreu da mudança ...

Effects of Pre-discharge Education for the Correct Use of Child Occupant Restraints

PURPOSE: To determine the effects of pre-discharge education for the correct use of child occupant restraints (CORs). METHODS: Between January and August 2012, education for the correct use of CORs was provided to parents at the time of discharge of their newborns from our neonatal intensive care unit. A cross-sectional survey using self-report questionnaires or telephone interviews was conducted when the children were 6 to 12 months of age, and the acquired data were compared with data from a control group. RESULTS: The overall percentage of children using CORs was 73.4% for the COR educated group and 69.9% for the control group. However, the percentage of children who correctly used CORs was 42.2% for COR educated group and 44.3% for the control group. There was no statistically significant difference in parental awareness and perception of the correct use of CORs between the two groups. CONCLUSION: The correct use rate of CORs in our community is still low, and no difference in the correct use of CORs was observed between parents who were educated before discharge of their newborns and those who were not. Therefore, an alternative strategy, such as a strong enforcement program, is needed to increase the correct use of CORs.

Sujeción gentil en el lactante mayor / Gentile holding of the nursing infant high", "_i": "

El uso de la sujeción gentil es un procedimiento utilizado para inmovilizar a las personas hospitalizadas y de esta manera prevenir caídas y lesiones, así como para evitar la interrupción de tratamientos. Sin embargo, es de resaltar que se utiliza como último recurso para controlar situaciones que pongan en riesgo a la persona. El presente manuscrito se realiza para dirigir la práctica clínica del profesional de enfermería en la sujeción gentil del lactante mayor, con el objetivo de mantener la seguridad en todo momento. Se incluyen apartados sobre el concepto del procedimiento, objetivo, población a quien está dirigida, principios y políticas, indicaciones, material y equipo. El procedimiento está enfocado a tres tipos de sujeción gentil: restricción para lactantes con intubación endotraqueal, de tipo momia con y sin acceso vascular.

The use of gentle subjection is a procedure used to immobilize people hospitalized and thus prevent falls, injury and/or avoid interruption of treatments. However, it is pointed out that you used as a last resort to control situations that put at risk the person. The present manuscript is performed to direct clinical practice of the nurse in gentil’s highest infant attachment with the objective of maintaining the security at all times. Include paragraphs from the concept of procedure, objective, population to whom it is directed, principles and policies, instructions, material and equipment. The procedure is focused on three types of gracious restraint: for infants with endotracheal intubation and mummy type with and without vascular access restriction.

¿Qué deben saber los pediatras sobre las sillitas para autos?: Sistemas de retención infantil para automóviles / What pediatricians should know about car seats?: Car safety seats

En la Argentina mueren más de 7000 personas por año debido a lesiones de tránsito. Es una endemia y un serio problema de salud pública. Existen recomendaciones basadas en la evidencia sobre cómo deben viajar los niños en los automóviles; los menores de 8 años o de 150 cm de altura no pueden ser sujetados por el cinturón de seguridad y deben viajar en un sistema de retención infantil. Estos dispositivos disminuyen significativamente las probabilidades de sufrir lesiones y muerte en una colisión. Si bien en nuestro país aún no está legislada la obligatoriedad de su uso, los pediatras deben recomendar a los padres cómo y por qué utilizarlos.

In Argentina more than 7,000 people die each year due to traffic injuries. It is an endemic disease, a serious public health problem. There are evidence-based recommendations about how children should ride safety in cars; children through 8 years or 4 feet 9 inches cannot be fastened by the seat belt so they should ride in a child restraint system. These devices significantly reduce the chances of suffering serious injuries and fatalities. Although in our country the use of car safety seats is not yet legislated nor compulsory, pediatricians should recommend parents how and why to use them.

Sentimentos de pais de crianças acidentadas em automóveis sem uso de assento de segurança infantil / The feelings of parents of children victims of accidents in automobiles without child restraint systems / Sentimientos de padres de niños accidentados en automóviles sin utilizar el asiento de seguridad infantil

Os acidentes se configuram em um problema de saúde pública no Brasil. O objetivo deste estudo foi compreender a experiência de pais de crianças vítimas de acidentes automobilísticos sem a utilização de Assento de Segurança Infantil (ASI) ocorridos em Londrina, Paraná, de 2008 a 2011. Estudo exploratório de abordagem qualitativa. Os participantes foram 17 pais de crianças de zero a oito anos, atendidas pelo Sistema Integrado de Atendimento ao Trauma de Emergência (SIATE) e encaminhadas a hospitais. A análise dos dados se deu através da análise de conteúdo, resultando em duas categorias: Acidente de trânsito: quem está a salvo?; Sentimentos no momento do acidente. Concluiu-se que as pessoas não acreditam que acidentes possam acontecer consigo ou com pessoas próximas. Sentimentos de nervosismo são os observados no momento do acidente. A educação se mostra como ponto de partida para o uso do ASI, daí a importância do enfermeiro como profissional educador.

Accidents are a public health problem in Brazil. The objective of this study was to understand the experience of parents of children victims of automobile accidents without a child restraint systems (CRS) taken place in Londrina, Paraná, from 2008 to 2011. This exploratory study was performed with a qualitative approach. The participants were 17 parents of children of ages zero to eight years, seen by the Integrated Emergency Trauma Care Service and referred to hospitals. The data analysis was performed using content analysis, which revealed two categories: Traffic accidents: who is safe?; Feelings at the time of the accident. In conclusion, people do not believe that accidents may happen with them or with close ones. Feelings of nervousness are observed at the time of the accident. Education is a starting point for using the CRS, thus the importance of nurses as educators.

Los accidentes constituyen un problema de salud pública en Brasil. Se objetivó comprender la experiencia de padres de niños víctimas de accidentes automovilísticos sin utilización de Asiento de Seguridad Infantil (ASI) sucedidos en Londrina-PA, de 2008 a 2011. Estudio exploratorio de abordaje cualitativo. Participaron 17 padres de niños de 0 a 8 años, atendidos por el Sistema Integrado de Atención del Trauma de Emergencia (SIATE) y derivados a hospitales. Datos analizados por análisis de contenido, resultando dos categorías: "Accidente de tránsito, ¿quién está a salvo?"; "Sentimientos al momento del accidente". Se concluye en que las personas no creen que puedan ocurrir accidentes a sí mismos o a personas próximas. Se observan sentimientos de nerviosismo al momento del accidente. La educación se muestra como punto de partida para el uso del ASI, de allí la importancia del enfermero como educador.

La seguridad en el transporte de los niños: ¿Qué responsabilidad tenemos los pediatras? / Safe transportation of children: what is our responsability as pediatricians?

En 2009 murieron en la Argentina 564 niños de 0 a 14 años en accidentes de tránsito, cuya tasa de mortalidad es de 56/100 000 habitantes, el 858% con respecto a Suecia, el país con menor tasa. El 50% viajaban en automóviles; el 30%, en vehículos pesados; el 16,3% murieron en vuelcos, y el 4,5%, en vehículos de dos ruedas. Las lesiones graves y la muerte son más frecuentes en los bebés menores de 1 año. Las sillas de seguridad adecuadas evitan la muerte del 71% de los niños menores de 1 año y del 54% de los de 1 a 6 años. Motivar un mayor uso requiere un trabajo interdisciplinario entre el obstetra y el pediatra para asesorar a la familia. El Estado y las instituciones deben acompañar esta campaña para disminuir los accidentes mortales y sus secuelas.

During 2009, 564 children died in Argentina from 0 to 14 in traffic accidents. The mortality rate for road accidents is 56/100 000 inhabitants and is 858% when compared to Sweden, the country with the lowest rate. Fifty percent were children transported in cars, 30% in heavy duty vehicles, 16.3% died when the vehicle overturned and 4.5% died in two wheeled vehicles. Serious injuries and death are more frequent in babies less than a year old. Seventy one per cent of children under 1 year old and 54% of those between 1 and 6 years old would avoid death in an accident if transported in adequate safety seats. This requires a joint effort between obstetricians and pediatricians to inform the family about the right type of safety seat. The State and other institutions should accompany this campaign to reduce the number of fatal accidents and their consequences.

Erros de utilização de assentos de segurança infantil por menores de 4 anos / Child safety seat usage errors in under-4s

OBJETIVO: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. MÉTODOS: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. RESULTADOS: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). CONCLUSÃO: Os dados são coerentes com publicações internacionais.

OBJECTIVE: To analyze child safety seat usage errors among children enrolled at daycare. METHODS: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. RESULTS: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). CONCLUSION: The results of this study are in line with findings reported in international publications.

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.

Pediatric trauma due to motor vehicle accidents on high traffic roadway / Trauma pediátrico devido a acidente veicular em via de grande tráfego

Objective: To outline a profile of pediatric trauma victims and verify the likelihood of trauma in children on a high traffic roadway. Methods: A descriptive cohort study of the records of emergency medical service activations on the Rio-Niterói Bridge, a high traffic roadway in Rio de Janeiro, Brazil. Descriptive statistics were expressed as absolute and relative frequencies. The estimated risk of trauma in children aged < 12 years was calculated by means of odds ratios, with a 95% confidence interval. Results: Trauma accounted for 514 of 1,244 activations (41.31%) of the Rio-Niterói Bridge emergency medical service between March 2002 and March 2003. Response to incidents involving children aged < 12 years accounted for 52 of these (4.18%). Half of victims were between the ages of 6 and 12 years (n = 26), and 55.76% were male (n = 29). Of the 52 victims, 37 (71.15%) were involved in motor vehicle accidents (OR: 3.70; 95%CI: 1.94-7.13; p < 0.0001). Of these, 28 were vehicle?vehicle collisions (75.67%). The most common sites of injury were the extremities (n = 12; 32.43%), face (n = 10; 27.02%), and head (n = 9; 24.32%). Pre-hospital procedures were performed on 23 of the 37 patients (62.16%), and 44.23% (n = 23/52) required hospital transportation. There were no deaths during the study period. Conclusions: In this study, children were at significantly higher odds of being treated for trauma while on a highway with heavy traffic flow. The most common sites of injury in this sample were the lower extremities and the head, face, and neck complex.

Objetivo: Caracterizar o perfil dos atendimentos pediátricos por trauma e verificar a chance de ocorrência de trauma em uma rodovia de alto fluxo de veículos. Métodos: Estudo de coorte descritivo dos dados armazenados nos boletins de atendimentos realizados por grupo de resgate pré-hospitalar da Ponte Rio-Niterói, uma via de grande tráfego, no Rio de Janeiro. Estatística descritiva foi aplicada utilizando-se a frequência simples e percentual, verificando-se o risco estimado de "trauma" em crianças < 12 anos, por meio de odds ratio, com intervalo de confiança de 95%. Resultados: Em 1.244 atendimentos, entre março de 2002 e março de 2003, trauma representou 41,31% (n = 514), 76% do sexo masculino dos casos. O atendimento a crianças de até 12 anos correspondeu a 4,18% (n = 52) e metade das vítimas tinha entre 6 e 12 anos (n = 26), sendo 29 (55,76%) do sexo masculino. Entre as 52 vítimas, 71,15% (n = 37) estavam envolvidas em acidente de trânsito (OR: 3,70; IC95%: 1,94-7,13; p < 0,0001), sendo 28 (75,67%) colisões. Os locais mais frequentes de lesões foram extremidades (n = 12; 32,43%), face (n = 10; 27,02%) e cabeça (n = 9; 24,32%). Os procedimentos pré-hospitalares foram realizados em 23 dos 37 pacientes (62,16%) e 44,23% (n = 23/52) necessitaram de remoção hospitalar. Não houve óbito pediátrico durante o período analisado. Conclusões: Neste estudo as crianças apresentaram maior probabilidade de serem tratadas para traumatismo nessa rodovia de intenso fluxo de veículos. Os locais mais frequentes de lesões foram membros inferiores e o complexo cabeça, face e pescoço.