[Challenges in care of trauma patient in Spain. The need for implementation of scientific evidence including secondary prevention]. / Retos asistenciales en la atención al paciente traumatizado en España. La necesidad de implementación de la evidencia científica incluyendo la prevención secundaria.

The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role. The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement. The application of diagnostic or therapeutic actions with scientific evidence is associated with lower mortality, but as in other areas of medicine, the application of scientific evidence in trauma patients is barely 50%. Moreover, nearly 90% of trauma deaths occur in the crash site or in the first 72h of hospitalization, the vast majority as a result of injuries incompatible with life. In these circumstances it is clear that prevention is the most cost-effective activity. As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma.

Lesiones infantiles por accidente de tráfico en España: magnitud de un problema prevenible / No disponible

Las lesiones constituyen la principal causa de muerte infantil en Europa, con una incidenciados veces superior a la muerte por cáncer y ocho veces a las producidas por enfermedadesrespiratorias. En España, las lesiones por accidente de tráfico son la primera causa demortalidad entre los 5 y los 14 años, aunque el número de accidentes con víctimas infantilesha disminuido casi un 25% en los últimos 10 años. Este artículo expone las características dela accidentalidad infantil por tráfico, los aspectos más relevantes relacionados con el problemay las intervenciones preventivas más efectivas: el uso de dispositivos de retención infantil(DRI), el casco en bicicletas y ciclomotores, el diseño de vías específicas para usuarios vulnerablesy el diseño de “zonas de tráfico no agresivo”. Finalmente, se señalan las recomendacionesque se deben incluir en el consejo pediátrico y sanitario, consejo que se ha demostradoeficaz en la promoción del uso de DRI cuando se asocia a intervenciones de distribuciónde éstos

Injuries are the main cause of child death in Europe. The mortality rate is twice the cancer’smortality, and eight times higher than respiratory diseases’. Although it remains themain cause of mortality in Spain, the trend of traffic accidents involving children has descendedduring the recent past years. The number of accidents involving children has fallenby 25% in the last 10 years. This review describes the characteristics of traffic related childfatality, the main factors related to the problem and the most effective preventive measures:the correct use of child restraints systems (CRS) and helmets and the construction ofspecific lanes and “traffic-calming areas” for vulnerable road users. Finally, we describe someuseful recommendations for use in child health counselling, which has been shown efficientto promote the use of CRS when it is associated with free-distribution interventions

Alcohol-related problems and fitness to drive.

This paper analyses the alcohol consumption patterns in Spanish drivers, the incidence of alcohol-related problems and attempts to ascertain whether, in the end, drivers with alcohol-related problems are considered fit or unfit to drive. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from alcohol-related problems. A medical, psychological and eyesight evaluation was performed to test the driving fitness of 8043 drivers attending 25 Medical Driving Test Centres on a national scale. Among other things, information was collected on the patterns of alcohol consumption, the AUDIT and CAGE tests, the incidence of alcohol-related problems (DSM-IV criteria for abuse, dependence and alcohol-induced disorder), as well as an evaluation of their fitness to drive. In all, 60.3% of drivers drink alcohol on a regular basis; 7.3% of drivers scored > or = 8 points in the AUDIT test, and 2% met criteria for DSM-IV alcohol abuse, dependence or induced disorder. Drivers with alcohol-related problems have been involved in traffic accidents (23.2%) and have infringed driving regulations (18.7%) more frequently (P < 0.0001) than those without alcohol-related problems. Of those with alcohol-related problems, 72.2% were considered fit to drive. The study reveals that alcohol consumption is common among drivers, that a significant number of drivers have alcohol-related problems, and that three in four of the latter were considered fit to drive.

The relationship of different socioeconomic variables and alcohol consumption with nighttime fatal traffic crashes in Spain: 1978-1993.

This paper identifies the variables associated with alcohol-related fatal traffic crashes (AFTC) in Spain. In addition, and for the first time in this country, these variables are used to describe the trend in AFTC, and to study the relationship between AFTC and alcohol consumption over the period 1976-1993. To this end, official data were obtained from the Traffic Department (Dirección General de Tráfico), the National Statistics Institute (Instituto Nacional de Estadística), and from international publications on trends in alcohol consumption. Nighttime fatal crashes (NFC) and male-driver single-vehicle nighttime fatal crashes (MNFC) were strongly associated with AFTC rates in Spain. A further finding was the decrease in NFC and MNFC rates during the period 1978-1993, though this decrease proved of a lower magnitude than that observed for daytime crashes. No relationship was observed between alcohol consumption at the population level and NFC or MNFC rates. The fatal crash rate, particularly the daytime rate, showed a rise with wealth level, as measured by gross domestic product and national private consumption, and an inverse relationship with the unemployment rate. The relationship between the fatal crash rate and economic variables was due, in most part, to changes in vehicle-km travelled.