Substance use and type of Road Traffic Injury in Mexico City.

Limited data are available in Mexico on the prevalence of alcohol and drug use and the possible differences in their effects on types of road traffic injury (RTI), such as those involving pedestrians, drivers or passengers of motorcycles or other motor vehicles, and the association between substance use and driving behaviors, for preventive purposes. The sample comprised 433 adult RTI patients, admitted to the emergency department (ED) of a public hospital in Mexico City (January to April 2022). Breath Alcohol Concentration (BAC) was measured using a breath tester, and six types of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine) were assessed using a saliva screen test. RTI patients also self-reported their alcohol and drug use in the six hours prior to the accident. Approximately 62% of respondents had been involved in a motorcycle crash. One in three patients self-reported or had traces of a substance in their saliva or breath. The most common substance was alcohol (23.6%), followed by cannabis and stimulants (10.9%). One in five patients reported having used a cell phone ten minutes before the injury. One in three had not been using any safety device, the only behavior exacerbated by substance use. We found a high prevalence of substance use in the sample of RTI patients admitted to the ED, regardless of the type of the RTI, together with high cell phone rates. Motorcycle passengers under the influence were particularly likely not to have been wearing a helmet.

[Indicators to measure the performance of emergency trauma care]. / Principales indicadores para medir el desempeño de la atención de emergencias traumatológicas.

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.

El objetivo del presente trabajo fue identificar los principales indicadores utilizados para medir el desempeño en la atención de emergencias traumatológicas. Se realizó una revisión de la literatura de tipo narrativa en las bases de datos: PubMed, LILACS y Epistemónikos, se incluyeron publicaciones entre enero de 2011 y el 31 diciembre 2021, en español, inglés y portugués. Se identificaron 962 publicaciones. Tras revisar el texto completo, 48 artículos fueron incluidos. Los indicadores se clasificaron en las dimensiones de proceso y resultado. Se identificaron 100 diferentes indicadores para analizar el desempeño de la atención de emergencias traumatológicas. 71% fueron indicadores de proceso, entre ellos el tiempo de atención y el triaje. En la dimensión de resultados se identificaron 29 indicadores; la mortalidad fue el indicador mayormente analizado así como el periodo de estancia hospitalaria. Se identificaron seis indicadores sobre la discapacidad de las personas lesionadas y 14 indicadores relacionados con la satisfacción, el más frecuente fue quejas. Diversos indicadores han sido utilizados para evaluar el desempeño de la atención de emergencias traumatológicas. En la dimensión de resultados, los indicadores relacionados con la satisfacción y discapacidad han sido poco explorados. Los responsables de la atención de emergencias traumatológicas deben impulsar ejercicios de evaluación del desempeño para conocer su situación actual a través de indicadores sensibles y acordes con los datos disponibles.

Riesgos de accidentes en el hogar: factores asociados y su efecto sobre la ocurrencia de accidentes en grupos vulnerables.

OBJETIVO: Estimar el nivel de exposición a riesgos de ac-cidentes en hogares vulnerables, identificando sus factores asociados y analizar su relación con la ocurrencia de acciden-tes en México. Material y métodos. Estudio transversal que analiza una submuestra de información del Secretariado Técnico del Consejo Nacional para la Prevención de Acci-dentes, recolectada durante 2016-2019. Se utilizó regresión Poisson para estimar factores asociados con el número de riesgos presentes en hogares donde residía población infantil (<5) y adulta mayor (75+) y regresión logística para analizar la ocurrencia de accidentes. RESULTADOS: En hogares con <5 hubo en promedio seis riesgos; 2.9 donde residían 75+. La prevalencia de lesiones accidentales el año previo fue 3.1% (IC95%=2.0,4.6) en <1 año, 7.6% (IC95%=6.9,8.4) en 1-4 años y 17.1% (IC95%=15.6,18.7) en 75+. Las caídas fueron la principal causa. CONCLUSIONES: Existe un elevado número de riesgos en hogares con población vulnerable; es necesario fortalecer las estrategias de prevención, educación y promoción de la salud.

Riesgos de accidentes en el hogar: factores asociados y su efecto sobre la ocurrencia de accidentes en grupos vulnerables / Risks of unintentional injuries at home: associated factors and their relation on the occurrence of injuries in vulnerable populations

Resumen: Objetivo: Estimar el nivel de exposición a riesgos de accidentes en hogares vulnerables, identificando sus factores asociados y analizar su relación con la ocurrencia de accidentes en México. Material y métodos: Estudio transversal que analiza una submuestra de información del Secretariado Técnico del Consejo Nacional para la Prevención de Accidentes, recolectada durante 2016-2019. Se utilizó regresión Poisson para estimar factores asociados con el número de riesgos presentes en hogares donde residía población infantil (<5) y adulta mayor (75+) y regresión logística para analizar la ocurrencia de accidentes. Resultados: En hogares con <5 hubo en promedio seis riesgos; 2.9 donde residían 75+. La prevalencia de lesiones accidentales el año previo fue 3.1% (IC95%=2.0,4.6) en <1 año, 7.6% (IC95%=6.9,8.4) en 1-4 años y 17.1% (IC95%=15.6,18.7) en 75+. Las caídas fueron la principal causa. Conclusiones: Existe un elevado número de riesgos en hogares con población vulnerable; es necesario fortalecer las estrategias de prevención, educación y promoción de la salud.

Abstract: Objective: To estimate level of exposure to different risks of unintentional injuries (UI) at home, identifying factors associated, and to analyze its relation to the occurrence of injuries in Mexican vulnerable populations. Materials and methods: A crossover study design analyzed secondary information from the leading agency for UI prevention (Ministry of Health) collected during 2016-2019. Using Poisson regression, factors associated to the number of risks present at home were analyzed in households with children (<5) and elders (75+); logistic regression analyzed factors associated with the occurrence of UI. Results: Households with <5 had an average of six risks; 2.9 where 75+ lived. Prevalence of UI the previous year was 3.1% (95%CI=2.0,4.6) in <1 year, 7.6% (95%CI=6.9,8.4) in 1-4 years and 17.1% (95%CI=15.6,18.7) in 75+. Falls were the main cause. Conclusions: There is a high number of risks in households with vulnerable populations; it is necessary to strengthen prevention, education and health promotion strategies.

Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities.

BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

Speeding in the city of Xalapa, Mexico: Prevalence and associated factors.

OBJECTIVE: To estimate the prevalence of speeding in the city of Xalapa, Veracruz, in Mexico and to identify factors potentially associated to this risk behavior. METHODS: A cross-sectional study was conducted on December 2019 in Xalapa, Veracruz. Speed measurement was conducted in a random sample of 10% of all the main roads in the urban area (n = 12). Observations were conducted over the course of one week at different times spending no more than 1.5 h in each site at a time. All vehicles circulating in each observation site during the data collection were included in the sample. Characteristics of drivers, vehicles and the environment were also collected and analyzed, using logistic regression analysis and a multiple ordinal regression model to identify factors associated to speeding and more serious violations of speed limits. RESULTS: Average speed of the 3,390 vehicles observed was 50.97 km/h. Prevalence of speeding was 65.66% (95%-CI: 64.04-67.26%); 26.96% (95%-CI: 25.47-28.49) exceeded the speed limit by 50%. Speeding and more serious violations of speed limits were more frequent in light vehicles, residential zones and during weekends. More serious violations of speed limits were also more frequent on smaller roads, where speed limit were lower and during morning hours. CONCLUSIONS: The great majority of vehicles transgress speed limits in Xalapa, Veracruz. Our results support the urgent need to implement speed control measures in the city. Changes in road infrastructure design, as well as promoting a comprehensive speeding legislation (with adequate speed limits and correctly enforced) aimed at reducing exposure to this key risk factor are recommended. As evaluation of road safety interventions is key, our data could be used as a baseline to evaluate the effects and impact of future interventions implemented in this Mexican city.

Impact of Mexican Road Safety Strategies implemented in the context of the UN's Decade of Action.

OBJECTIVE: To evaluate advancements in the prevention of road traffic injuries (RTI) in Mexico in the context of the United Nation's Decade of Action for Road Safety. METHODS: An analysis of the trend and age-period-cohort effects of RTI mortality from 1999 to 2018 was conducted. Mortality figures were age-standardized using the direct method and population estimates of 2018 as the standard. To evaluate whether advancements might be attributed to higher levels of death misclassification, we conducted sensitive analysis using multiple imputation to redistributed deaths allocated to non-specific ICD-10 codes. Non-fatal RTI from four nationally representative health surveys (2000, 2006, 2012 and 2018) were analyzed. FINDINGS: Implementation of Mexico's National Road Safety Strategy 2011-2020 was associated with an average annual percentage change reduction in the age-standardized RTI mortality rate of 1.3% (95%-CI: -1.8,-0.9). Reductions are more evident in pedestrians and four + wheelers (-6.7% and -5.3%, respectively, from 2011 to 2018); mortality trend in motorcyclists increased from 1999 to 2018 an average of 12.8% annually (95%-CI: 9.9, 15.9). Potential underestimation of mortality due to death misclassification decreased from 22.7% in 1999 to 16.4% in 2018; sensitive analysis showed that reductions might not be attributed to death misclassification. Non-fatal injuries decreased in four + wheelers but increased in motorcyclists. The number of individuals suffering permanent consequences from RTI increased. CONCLUSIONS: Results showed some potential gains of Mexico's road safety strategies: RTI in four + wheelers decreased. Efforts should be put in place urgently to prevent the growing number of RTI in motorcyclists.

Prevalence of speeding and associated factors in four Mexican cities.

BACKGROUND: Speeding is responsible for countless traffic collisions and road traffic injuries (RTIs) around the world. It threatens the lives of passengers in motor vehicles as well as the safety of other individuals sharing the public roads. Little evidence has been provided by low- and middle-income countries on speed transgression patterns. OBJECTIVE: To document the prevalence of speeding in motor vehicles with four or more wheels and to analyse the associated factors in four Mexican cities. METHODS: We conducted a cross-sectional study in the cities of Guadalajara-Zapopan, León, Cuernavaca and Villahermosa. Data on speed, drivers, vehicles, road infrastructure and the environment were collected from a randomly selected sample of urban road segments. We identified the factors associated with speeding through a logistic multiple regression model. RESULTS: With an overall prevalence of 47% (95% CI 45.83 to 48.18), speeding occurred most frequently in Villahermosa (61.07%, 95% CI 59.10 to 63.01) as compared to León (51%, 95% CI 48.07 to 53.92), Cuernavaca (47.6%, 95% CI 45.35 to 49.85) and Guadalajara-Zapopan (20.76%, 95% CI 18.75 to 22.88). Speeding increased in the afternoons, on roads with numerous lanes, on Thursdays and Sundays and in foggy weather, but decreased in cities with speed control strategies and on roads with low visibility. No differences were observed between sexes or among age groups. CONCLUSIONS: Evidence from our study highlights the urgent need to implement speed control measures such as changes in road infrastructure and design, and to promote comprehensive speeding legislation aimed at reducing exposure to this important risk factor.

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.

Exposure to unsafe mobility: Traveling in the cargo area of pickup trucks in three Mexican cities.

Objective: To estimate the prevalence of pickup trucks transporting people in the cargo area and to identify factors associated to this behavior in three Mexican cities.Methods: Eight rounds of roadside observations of randomly selected pickup trucks were conducted from August 2012 to November 2014 in three Mexican cities: Guadalajara-Zapopan, León and Cuernavaca.Results: Overall, 4.03% of the 4,611 pickup trucks observed were transporting people in the cargo area (95% CI: 3.48 - 4.64%). This implies that a total of 427 passengers were traveling unsafely in the cargo area of pickup trucks; of all them 22.01% were children and 82.20% were male. Prevalence of exposure to this risky behavior was higher in León (5.77%, 95% CI: 4.73 - 6.97%) than in Cuernavaca (3.73%, 95% CI: 2.49 - 5.35%) and Guadalajara-Zapopan (2.70%, 95% CI: 2.05 - 3.48%). According to this data, exposure to this risk factor has decreased in time. Male drivers, not using seatbelt correctly carried passengers in the cargo area more frequently.Conclusions: Results support the importance of improving and enforcing current legislation and evaluating strategies directed to prevent exposure to this risky behavior with the potential of contributing to lowering the high burden that road traffic injuries imposed in Mexican public health.

[Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19]. / Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19.

OBJECTIVE: To estimate the prevalence of non-fatal uninten-tional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. MATERIALS AND METHODS: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. RESULTS: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depres-sion symptoms. CONCLUSIONS: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

OBJETIVO: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocu-rrencia. MATERIAL Y MÉTODOS: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. RESULTADOS: La pre-valencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. CONCLUSIONES: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

[Unintentional asphyxia in Mexico: a hidden public health problem]. / Las asfixias accidentales en México: un problema de salud pública oculto.

OBJECTIVE: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017. METHOD: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares. RESULTS: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed. CONCLUSIONS: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem.

Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19 / Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19

Resumen Objetivo: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocurrencia. Material y métodos: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. Resultados: La prevalencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. Conclusión: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

Abstract Objective: To estimate the prevalence of non-fatal unintentional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. Materials and methods: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. Results: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depression symptoms. Conclusions: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

[Analysis of unintentional injuries in vulnerable populations, Mexico 2018.] / Análisis de las lesiones accidentales no fatales en población vulnerable, México 2018.

OBJECTIVE: To estimate the prevalence of unintentional injuries (UI) in people residing in localities with <100 000 inhabitants and to analyze its association with different environmental, household and individual characteristics. MATERIALS AND METHODS: Cross-sectional design that analyses the UI component of Ensanut 100k, which is a probabilistic national survey that focused on households beneficiaries of the program Prospera and those with fewer economic capabilities. Prevalence of UI was estimated considering the complex design of the survey. Association with variables of interest was explored using logistic regression analysis. RESULTS: Prevalence of UI was 5.15% (CI95%: 1.43-6.16); probability was higher in male, those living in the region CDMX-EdoMex, and those with hearing and motor disability. CONCLUSIONS: Policies directed to prevent UI need to be strengthened to promote health and quality of life amongst individuals, par- ticularly those with social and economic vulnerability, and to reduce the burden that these conditions impose to public health in Mexico.

OBJETIVO: Estimar la prevalencia de lesiones accidentales en población que reside en localidades con <100 000 habitantes y analizar su asociación con características individuales, ambien­tales y del hoga. MATERIAL Y MÉTODOS: Diseño transversal que analiza el componente de accidentes de la Ensanut 100k, encuesta probabilística, estratificada, por conglomerados que sobrerrepresenta hogares beneficiarios del programa Prospera y aquellos con menos recursos económicos. Su asociación con distintas variables independientes se estableció a partir de un modelo de regresión logística, considerando el muestreo complejo. RESULTADOS: La prevalencia de lesiones acciden­tales fue 5.15% (IC95%: 1.43-6.16) equivalente a cerca de 3.3 millones de personas. La probabilidad fue mayor en hombres, en la región CDMX-EdoMex y en personas con discapacidad auditiva/motora. CONCLUSIONES: Es necesario fortalecer la política de prevención de lesiones accidentales, especialmente la dirigida a grupos con alta vulnerabilidad social y económica, para cuidar su salud y calidad de vida, y reducir la carga que generan para la salud pública.

Análisis de las lesiones accidentales no fatales en población vulnerable, México 2018 / Analysis of unintentional injuries in vulnerable populations, Mexico 2018

Resumen: Objetivo: Estimar la prevalencia de lesiones accidentales en población que reside en localidades con <100 000 habitantes y analizar su asociación con características individuales, ambientales y del hogar. Material y métodos: Diseño transversal que analiza el componente de accidentes de la Ensanut 100k, encuesta probabilística, estratificada, por conglomerados que sobrerrepresenta hogares beneficiarios del programa Prospera y aquellos con menos recursos económicos. Su asociación con distintas variables independientes se estableció a partir de un modelo de regresión logística, considerando el muestreo complejo. Resultados: La prevalencia de lesiones accidentales fue 5.15% (IC95%: 1.43-6.16) equivalente a cerca de 3.3 millones de personas. La probabilidad fue mayor en hombres, en la región CDMX-EdoMex y en personas con discapacidad auditiva/motora. Conclusiones: Es necesario fortalecer la política de prevención de lesiones accidentales, especialmente la dirigida a grupos con alta vulnerabilidad social y económica, para cuidar su salud y calidad de vida, y reducir la carga que generan para la salud pública.

Abstract: Objective: To estimate the prevalence of unintentional injuries (UI) in people residing in localities with <100 000 inhabitants and to analyze its association with different environmental, household and individual characteristics. Materials and methods: Cross-sectional design that analyses the UI component of Ensanut 100k, which is a probabilistic national survey that focused on households beneficiaries of the program Prospera and those with fewer economic capabilities. Prevalence of UI was estimated considering the complex design of the survey. Association with variables of interest was explored using logistic regression analysis. Results: Prevalence of UI was 5.15% (CI95%: 1.43-6.16); probability was higher in male, those living in the region CDMX-EdoMex, and those with hearing and motor disability. Conclusions: Policies directed to prevent UI need to be strengthened to promote health and quality of life amongst individuals, particularly those with social and economic vulnerability, and to reduce the burden that these conditions impose to public health in Mexico.

[The Emergency Medical System's response and its association with different outcomes in traffic accident victims in Mexican cities]. / La respuesta del Sistema Médico de Emergencias y su relación con distintos resultados en salud en personas lesionadas por el tránsito de dos ciudades mexicanas.

The aim of this article was to analyze the timeliness of emergency medical care (time transpired between the injury and the first contact with the Emergency Medical System) and its assocation with different negative health outcome in traffic accident victims treated at two Mexican hospitals, one in Guadalajara, Jalisco, and the other in León, Guanajuato, based on data from the Motor Vehicle Accident Epidemiological Surveillance System of the Bloomberg Philanthropies' Global Road Safety Program. Information was obtained on all patients treated for motor vehicle injuries in referral hospitals from May 2012 to November 2014. Multinomial logistic regression was used to model the health outcomes, categorized as short stay, prolonged hospitalization, disability, and death, compared to timeliness of care, adjusted by different target variables. A total of 2,575 patients were analyzed. Time from injury to care was 103.74 minutes (± 231.36) in León and 75.37 minutes (± 156.87) in Guadalajara; it was 38.02 and 36.23 minutes, respectively, in patients that received prehospital medical care. Timely care was associated with less prolonged hospital stay, but not with lower incidence of disability or death. Receiving prehospital medical care was associated statistically with negative health consequences. Timely care was associated with lower probability of prolonged hospitalization. Strategies are needed to evaluate and in turn improve the technical quality of prehospital medical care, including timeliness of care and adequate regulation.

El objetivo fue analizar la oportunidad de la atención médica de emergencias (tiempo transcurrido desde que ocurrió la lesión hasta el primer contacto con el Sistema Médico de Emergencias -SME) y su relación con distintas consecuencias negativas en salud, en pacientes con lesiones causadas por el tránsito, atendidos en dos hospitales de México, uno en Guadalajara, Jalisco y otro en León, Guanajuato. Se utilizó información del Sistema de Vigilancia Epidemiológica de las Lesiones Causadas por el Tránsito, establecido como parte del Programa Global de Seguridad Vial de la Filantropía de Bloomberg. Se recabó información de todos los pacientes atendidos por lesiones causadas por el tránsito en dos hospitales de referencia, de mayo 2012 a noviembre 2014. Se realizó una regresión logística multinomial para modelar los resultados en salud, categorizados en estancia corta, hospitalización prolongada, discapacidad y defunción, con la oportunidad de la atención, ajustando por distintas variables de interés. 2.575 lesionados fueron analizados. La oportunidad de la atención fue 103,74min (± 231,36) en León y 75,37min (± 156,87) en Guadalajara, siendo 38,02 y 36,23min en quienes recibieron atención médica prehospitalaria, respectivamente. La oportunidad de la atención se asoció con una menor estancia hospitalaria prolongada, pero no con una menor incidencia de discapacidad o muerte. Recibir atención médica prehospitalaria estuvo asociado con consecuencias negativas en salud. Una atención oportuna está asociada a una menor posibilidad de tener hospitalizaciones prolongadas. Es necesario impulsar estrategias para evaluar, y eventualmente mejorar la calidad técnica de la atención médica prehospitalaria, incluyendo la oportunidad de la atención y la adecuada regulación.

O objetivo deste estudo foi analisar a oportunidade da atenção médica de emergências (tempo transcorrido desde que ocorreu a lesão até o primeiro contato com o Sistema Médico de Emergências) e sua relação com distintas consequências negativas para a saúde, em pacientes com lesões causadas pelo trânsito, atendidos em dois hospitais do México, um em Guadalajara, Jalisco e outro em León, Guanajuato. Foi utilizada informação do Sistema de Vigilância Epidemiológica das Lesões Causadas pelo Trânsito, estabelecido como parte do Programa Global de Segurança Rodoviária da Filantropia de Bloomberg. Foram recolhidas informações de todos os pacientes atendidos por lesões causadas pelo trânsito nos hospitais de referência, de maio 2012 a novembro 2014. Foi realizada uma regressão logística multinomial para modelar os resultados na saúde, categorizados como: permanência curta hospitalar, hospitalização prolongada, portadores de deficiência e óbito com oportunidade de atenção, sendo ajustada por diferentes variáveis de interesse. Foram analisados 2.575 lesionados. A chance da atenção foi 103,74min (± 231,36) em León e 75,37min (± 156,87) em Guadalajara, sendo 38.02 e 36.23 min naqueles que receberam atenção médica pré-hospitalar, respectivamente. A chance da atenção foi associada com uma menor permanência hospitalar prolongada, mas não com uma menor incidência de deficiência ou morte. Receber atenção médica pré-hospitalar foi associado com consequências negativas na saúde. Uma atenção oportuna está associada à uma menor possibilidade de sofrer hospitalizações prolongadas. É necessário estimular estratégias para avaliar, e eventualmente melhorar a qualidade técnica da atenção médica pré-hospitalar, incluindo a chance da atenção e uma adequada regulação.

La respuesta del Sistema Médico de Emergencias y su relación con distintos resultados en salud en personas lesionadas por el tránsito de dos ciudades mexicanas / The Emergency Medical System's response and its association with different outcomes in traffic accident victims in Mexican cities / A resposta do Sistema Médico de Emergências e sua relação com distintos resultados na saúde em pessoas lesionadas pelo trânsito de duas cidades mexicanas

Resumen: El objetivo fue analizar la oportunidad de la atención médica de emergencias (tiempo transcurrido desde que ocurrió la lesión hasta el primer contacto con el Sistema Médico de Emergencias -SME) y su relación con distintas consecuencias negativas en salud, en pacientes con lesiones causadas por el tránsito, atendidos en dos hospitales de México, uno en Guadalajara, Jalisco y otro en León, Guanajuato. Se utilizó información del Sistema de Vigilancia Epidemiológica de las Lesiones Causadas por el Tránsito, establecido como parte del Programa Global de Seguridad Vial de la Filantropía de Bloomberg. Se recabó información de todos los pacientes atendidos por lesiones causadas por el tránsito en dos hospitales de referencia, de mayo 2012 a noviembre 2014. Se realizó una regresión logística multinomial para modelar los resultados en salud, categorizados en estancia corta, hospitalización prolongada, discapacidad y defunción, con la oportunidad de la atención, ajustando por distintas variables de interés. 2.575 lesionados fueron analizados. La oportunidad de la atención fue 103,74min (± 231,36) en León y 75,37min (± 156,87) en Guadalajara, siendo 38,02 y 36,23min en quienes recibieron atención médica prehospitalaria, respectivamente. La oportunidad de la atención se asoció con una menor estancia hospitalaria prolongada, pero no con una menor incidencia de discapacidad o muerte. Recibir atención médica prehospitalaria estuvo asociado con consecuencias negativas en salud. Una atención oportuna está asociada a una menor posibilidad de tener hospitalizaciones prolongadas. Es necesario impulsar estrategias para evaluar, y eventualmente mejorar la calidad técnica de la atención médica prehospitalaria, incluyendo la oportunidad de la atención y la adecuada regulación.

Abstract: The aim of this article was to analyze the timeliness of emergency medical care (time transpired between the injury and the first contact with the Emergency Medical System) and its assocation with different negative health outcome in traffic accident victims treated at two Mexican hospitals, one in Guadalajara, Jalisco, and the other in León, Guanajuato, based on data from the Motor Vehicle Accident Epidemiological Surveillance System of the Bloomberg Philanthropies' Global Road Safety Program. Information was obtained on all patients treated for motor vehicle injuries in referral hospitals from May 2012 to November 2014. Multinomial logistic regression was used to model the health outcomes, categorized as short stay, prolonged hospitalization, disability, and death, compared to timeliness of care, adjusted by different target variables. A total of 2,575 patients were analyzed. Time from injury to care was 103.74 minutes (± 231.36) in León and 75.37 minutes (± 156.87) in Guadalajara; it was 38.02 and 36.23 minutes, respectively, in patients that received prehospital medical care. Timely care was associated with less prolonged hospital stay, but not with lower incidence of disability or death. Receiving prehospital medical care was associated statistically with negative health consequences. Timely care was associated with lower probability of prolonged hospitalization. Strategies are needed to evaluate and in turn improve the technical quality of prehospital medical care, including timeliness of care and adequate regulation.

Resumo: O objetivo deste estudo foi analisar a oportunidade da atenção médica de emergências (tempo transcorrido desde que ocorreu a lesão até o primeiro contato com o Sistema Médico de Emergências) e sua relação com distintas consequências negativas para a saúde, em pacientes com lesões causadas pelo trânsito, atendidos em dois hospitais do México, um em Guadalajara, Jalisco e outro em León, Guanajuato. Foi utilizada informação do Sistema de Vigilância Epidemiológica das Lesões Causadas pelo Trânsito, estabelecido como parte do Programa Global de Segurança Rodoviária da Filantropia de Bloomberg. Foram recolhidas informações de todos os pacientes atendidos por lesões causadas pelo trânsito nos hospitais de referência, de maio 2012 a novembro 2014. Foi realizada uma regressão logística multinomial para modelar os resultados na saúde, categorizados como: permanência curta hospitalar, hospitalização prolongada, portadores de deficiência e óbito com oportunidade de atenção, sendo ajustada por diferentes variáveis de interesse. Foram analisados 2.575 lesionados. A chance da atenção foi 103,74min (± 231,36) em León e 75,37min (± 156,87) em Guadalajara, sendo 38.02 e 36.23 min naqueles que receberam atenção médica pré-hospitalar, respectivamente. A chance da atenção foi associada com uma menor permanência hospitalar prolongada, mas não com uma menor incidência de deficiência ou morte. Receber atenção médica pré-hospitalar foi associado com consequências negativas na saúde. Uma atenção oportuna está associada à uma menor possibilidade de sofrer hospitalizações prolongadas. É necessário estimular estratégias para avaliar, e eventualmente melhorar a qualidade técnica da atenção médica pré-hospitalar, incluindo a chance da atenção e uma adequada regulação.

Advances in Mexico in the middle of the Decade of Action for Road Safety 2011-2020.

OBJECTIVE: To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states. METHODS: This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states. RESULTS: Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions. CONCLUSIONS: The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

Estimating the drink driving attributable fraction of road traffic deaths in Mexico.

AIM: To estimate the Drink Driving Attributable Fraction (DDAF) of road traffic injury mortality in car occupants in Mexico during 2010-13. DESIGN: A case-control study was conducted to examine the presence of alcohol in analysed body fluids of car occupants killed in fatal crashes (cases) compared with car drivers tested in alcohol-testing checkpoints who were not involved in a fatal collision (controls). Two data sets were used for the period 2010-13: the forensic module of the Epidemiological Surveillance System on Addictions that included car occupants killed in a collision (cases) and a data set from alcohol-testing at police checkpoints available for matching municipalities (controls). SETTING: Mexico. PARTICIPANTS: The analysed study sample included 1718 car occupants killed in a traffic collision and 80 656 drivers tested at alcohol police checkpoints, all from 10 municipalities. MEASUREMENTS: Unadjusted and adjusted odds ratios (OR) of presence of alcohol in body fluids were obtained stratified by sex and age groups and the interaction with these two variables were assessed. The ORs were used to calculate the DDAF. FINDINGS: It was estimated that 19.5% of car occupants' deaths due to road traffic injuries were attributable to alcohol consumption [95% confidence interval (CI) = 19.1-19.9]. The adjusted OR of presence of alcohol was 6.84 (95% CI = 6.06-7.71) overall. For males it was 7.21 (95% CI = 6.35-8.18) and for females it was 4.45 (95% CI = 3.01-6.60). The ORs were similar across younger age bands (10-19 years: 9.61, 95% CI = 6.72-13.73; 20-29 years: 7.70, 95% CI = 6.28-9.4; and 30-49 years: 7.21, 95% CI = 5.98-8.70); and lower but still elevated among older people (50+ years: 3.19, 95% CI = 2.19-4.65). CONCLUSIONS: An estimated 19.5% of car occupant deaths in Mexico may have been caused by alcohol in 2010-13.

Advances in Mexico in the middle of the decade of action for road safety 2011-2020 / Avances en México a la mitad del decenio de acción para la seguridad vial 2011-2020

ABSTRACT OBJECTIVE To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states. METHODS This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states. RESULTS Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions. CONCLUSIONS The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

RESUMEN OBJETIVO Analizar el avance de la meta esperada a mitad del Decenio de Acción para la Seguridad Vial 2011-2020 en México y sus entidades federativas. MÉTODOS Análisis secundario de las muertes por accidentes de tránsito en México para el 1999-2015. Se proyectó la tendencia para el periodo 2011-2020 utilizando análisis de series de tiempo (modelos autorregresivos integrados de medias móviles). Se utilizó el valor del Criterio de Información de Aikaike para determinar el mejor modelo para el nivel nacional y sus 32 entidades federativas. RESULTADOS México va avanzando cercano a la meta propuesta, lo que se ha traducido en 10,856 defunciones potencialmente prevenidas en el quinquenio 2011 a 2015. Esto ha sido a expensas de una disminución en el número de muertes de ocupantes de vehículos de motor; ya que las muertes en peatones y motociclistas han ido por arriba de lo que se esperaba. Al menos una tercera parte de las entidades federativas tuvo el número de defunciones por debajo de su meta; aunque en cinco de ellas la tasa de mortalidad continúa inaceptablemente alta. Se identificaron cuatro entidades con más muertes que las proyectadas originalmente y otras con tendencia al incremento donde se requiere, para ambos casos, fortalecer las acciones de prevención. CONCLUSIONES El análisis realizado permite observar los avances del país a mitad del Decenio de Acción, así como identificar los retos en materia de prevención de lesiones causadas por el tránsito en usuarios vulnerables. Aporta elementos para soportar la necesidad de replantear tanto la meta nacional como la de las distintas entidades federativas.