ABSTRACT
OBJECTIVE: Traffic accidents (TA) are a global problem with mortality of 1.25 million each year. The objective of this study was to compare adjusted mortality rates (AMR) by AT of Colombia, with Spain and the United States (US). The selection is justified because Colombia is a country with less development in road safety, Spain a nation that has adhered to European guidelines and US for having little adherence to international guidelines. METHODS: A descriptive cross-sectional study was carried out for five-year periods, by calculating the AMRs by the direct method of standardization according to sex and age groups, as well as the adjustment of the motorization index. The mean values, the 95% confidence interval for each country and the relative change between the periods studied were calculated. RESULTS: The AMR of periods P1 and P2 in all countries decreased significantly (p <0.005). In periods P2 and P3 also decreased significantly in Spain, by 52.0% (p = 0.010), and in the US, by 23.6% p = 0.001), while in Colombia the difference of 4.0% it was not significant (p = 0.724). Spain stood out for the reduction in mortality (P1-P3), by 69.0%. CONCLUSIONS: Colombia presented a less favorable evolution of mortality due to AT than Spain and the US. Men aged 15 to 44, motorcyclists and cyclists were the most committed. The TAs are a public health problem that Colombia has raised and must adapt to its reality those successful measures in other countries.
OBJETIVO: Los accidentes de tráfico (AT) son un problema mundial con mortalidad de 1,25 millones cada año. El objetivo de este estudio fue comparar tasas ajustadas de mortalidad (TAM) por AT de Colombia, con España y Estados Unidos (EEUU). La selección se justifica por ser Colombia un país con menor desarrollo en seguridad vial, España una nación que se ha adherido a directrices Europeas y EEUU por tener poca adherencia a directrices internacionales. METODOS: Se realizó un estudio descriptivo de corte trans- versal por quinquenios, mediante el cálculo de las TAM por el método directo de estandarización según sexo y grupos de edad, así como el ajuste del índice de motorización. Se calcularon los valores medios, el intervalo de confianza al 95% por cada país y el cambio relativo entre los períodos estudiados. RESULTADOS: Las TAM de los períodos P1 y P2 en todos los países disminuyeron significativamente (p <0.005). En los períodos P2 y P3 también disminuyeron significativamente en España, en un 52,0% (p=0,010), y en EU, en un 23,6% p=0,001), mientras que en Colombia la diferencia de 4,0% no fue significativa (p=0,724). Destacó España por la reducción de su mortalidad (P1-P3), en un 69.0%. CONCLUSIONES: Colombia presentó una evolución menos favorable de mortalidad por AT que España y EEUU. Los hombres de 15 a 44 años, motociclistas y ciclistas fueron los más comprometidos. Los AT son un problema de salud pública que tiene planteado Colombia y debe adaptar a su realidad aquellas medidas exitosas en otros países.
Subject(s)
Accidents, Traffic/mortality , Safety , Adolescent , Adult , Colombia/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Public Health , Spain , United States , Young AdultABSTRACT
STUDY DESIGN: Systematic review. OBJECTIVE: To compare the effectiveness of surgery versus conservative treatment on pain, disability, and loss of quality of life caused by symptomatic lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: LSS is the most common reason for spine surgery in persons older than 65 years in the United States. METHODS: Randomized controlled trials (RCTs) comparing any form of conservative and surgical treatment were searched in CENTRAL, MEDLINE, EMBASE, and TripDatabase databases until July 2009, with no language restrictions. Additional data were requested from the authors of the original studies. The methodological quality of each study was assessed independently by two reviewers, following the criteria recommended by the Cochrane Back Review Group. Only data from randomized cohorts were extracted. RESULTS: A total of 739 citations were reviewed. Eleven publications corresponding to five RCTs were included. All five scored as high quality despite concerns deriving from heterogeneity of treatment, lack of blinding, and potential differences in the size of the placebo effect across groups. They included a total of 918 patients in whom conservative treatments had failed for 3 to 6 months, and included orthosis, rehabilitation, physical therapy, exercise, heat and cold, transcutaneous electrical nerve stimulation, ultrasounds, analgesics, nonsteroidal anti-inflammatory drugs, and epidural steroids. Surgical treatments included the implantation of a specific type of interspinous device and decompressive surgery (with and without fusion, instrumented or not). In all the studies, surgery showed better results for pain, disability, and quality of life, although not for walking ability. Results of surgery were similar among patients with and without spondylolisthesis, and slightly better among those with neurogenic claudication than among those without it. The advantage of surgery was noticeable at 3 to 6 months and remained for up to 2 to 4 years, although at the end of that period differences tended to be smaller. CONCLUSION: In patients with symptomatic LSS, the implantation of a specific type of device or decompressive surgery, with or without fusion, is more effective than continued conservative treatment when the latter has failed for 3 to 6 months.
