Lesiones por tráfico: un ejemplo en la salud pública / Road traffic injuries: an example of public health

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[Definition of hospital discharge, serious injury and death from traffic injuries]. / Definición de alta hospitalaria, lesión grave y muerte por lesiones por tráfico.

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) "Hospital discharge for traffic injuries", b) "Person with severe traffic injury", and c) "Death from traffic injuries" in order to homogenize the use of these sources.

Association between cannabis and cocaine use, traffic injuries and use of protective devices.

The effect of cannabis and cocaine use on non-fatal traffic injuries and use of motorcycle helmets or car seatbelts was assessed in a nationwide sample of 17,484 car or motorcycle drivers surveyed in 2005 in Spain. Logistic regression was used to adjust for distance driven and potential confounders. Cocaine use ≥ 1 day/week and cannabis use >4 days/week were associated with more traffic injuries. A positive dose-response relationship was found between frequency of cocaine use and lack of consistent use of protective devices. Interventions to avoid driving under the influence of drugs and to increase use of protective devices among drug users are needed.

Impact of the demerit point system on road traffic accident mortality in Spain.

BACKGROUND: To assess the effect of the Demerit Point System (DPS), introduced in Spain on 1 July 2006, on the number of fatalities due to road traffic accidents, using a methodology that controls for the seasonal variation and trend in the data series. METHODS: Time-series analysis by ARIMA models of 29 113 fatalities in road traffic accidents (at the accident scene or within 24 h thereafter), between January 2000 and December 2007. The model permitted estimation of an intervention parameter, together with its 95% CI, to calculate the number of fatalities that would have occurred if the DPS had not been implemented, after controlling for the effect of other measures introduced in 2004. RESULTS: It was estimated that 618 persons (95% CI 259 to 977) would have died in traffic accidents in the 18 months after implementation of the DPS had it not been in effect, which represents a reduction of 14.5% (95% CI 6.1% to 23.0%) from a total of 4252 deaths. CONCLUSION: Implementation of the DPS in Spain has led to a significant reduction in the number of traffic accident deaths in the context of a downward trend after the implementation of the 2004 measures.

Organochlorine pesticide exposure in children living in southern Spain.

Despite the prohibition of most persistent organochlorine (OC) pesticides in Spain, their presence has been widely documented in adult human tissues. However, scarce information is available on the exposure of children. The aim of the present study was to investigate the presence of 16 OC pesticide residues in 52 fat samples collected from boys with a mean age of 7yr (0-15yr) living in Southern Spain and to assess the association between OC pesticide levels and child characteristics. No pesticide was found in more than 50% of samples, except for p,p'-DDE (79% of samples; median, 710ng/g lipid). After this compound, the most frequent pesticides were o,p'-DDT (17%; median, 330ng/g lipid) and o,p'-DDD (15%; median, 1510ng/g lipid). No statistically significant association was found between p,p'-DDE or SigmaDDTs and the birth year, birth weight, gestational age, infant feeding history or the age, weight, height or Quetelet Index at the time of sampling. The lack of correlation between the presence of the main metabolite p,p'-DDE and that of the parent compounds, o,p'-DDT and p,p'-DDT, suggests that children were exposed mainly to the metabolite rather than to the commercial pesticide, which was banned 30yr ago. In contrast, among currently used OCs, endosulfan was positively correlated with the presence of its metabolites, suggesting exposure to the commercial products. Further research is warranted to investigate the health consequence in children resulting from exposure to chemicals suspected of endocrine-disrupting effects.

Evaluating trihalomethane content in drinking water on the basis of common monitoring parameters: regression models.

The presence of trihalomethanes (THMs) in potable-water sources is an issue of great interest because of the negative impact THMs have on human health. The objective of this study was to correlate the presence of trihalomethanes with more routinely monitored parameters of water quality, in order to facilitate THM control. Water samples taken at various stages of treatment from a water treatment plant were analyzed for the presence of trihalomethanes with the Fujiwara method. The data collected from these determinations were compared with the values obtained for free-residual-chlorine and combined-residual-chlorine levels as well as standard physico-chemical and microbiological indicators such as chemical oxygen demand (by the KMnO4 method), total chlorophyll, conductivity, pH, alkalinity, turbidity, chlorides, sulfates, nitrates, nitrites, phosphates, ammonia, calcium, magnesium, heterotrophic bacteria count, Pseudomonas spp., total and fecal coliforms, and fecal streptococci. The data from these determinations were compiled, and statistical analysis was performed to determine which variables correlate best with the presence and quantity of trihalomethanes in the samples. Levels of THMs in water seem to correlate directly with levels of combined residual chlorine and nitrates, and inversely with the level of free residual chlorine. Statistical analysis with multiple linear regression was conducted to determine the best-fitting models. The models chosen incorporate between two and four independent variables and include chemical oxygen demand, nitrites, and ammonia. These indicators, which are commonly determined during the water treatment process, demonstrate the strongest correlation with the levels of trihalomethanes in water and offer great utility as an accessible method for THM detection and control.