[Usefulness of geographic analysis in the study of deaths caused by motor vehicle injuries]

OBJECTIVE

The purpose of this paper is to demonstrate the usefulness of geographic analysis to assess the distribution of fatal pedestrian run-over injuries.

MATERIAL AND METHODS

Cross-sectional study of mortality due to pedestrian run-over injuries was conducted in year 2000. Data were abstracted from death certificates of pedestrians who died due to run-over injuries in Mexico City, during 1994-1997 (International Classification of Diseases code E814.7). Crude mortality rates were obtained by political district and gender. Georeferenced mortality data were mapped by different levels of aggregation, using the software program Map-Info.

RESULTS

A total of 3,687 pedestrian fatalities were reported; 71% of them were Mexico City residents. Only 1,152 deaths (43.5%) were georeferenced, due to availability of the exact place of the event occurrence. Results by level of aggregation were: by political district level; Milpa Alta, Cuajimalpa and Cuauhtemoc had the highest death rates (23 per 100,000). At the next level (neighborhoods or colonias), ten colonias had over nine cases; and at the street level, one point at La Venta in Cuajimalpa presented 25 death cases due to pedestrian run-over injuries.

CONCLUSIONS

This kind of analysis helps us to display the spatial relationship between pedestrian run-over sites and other city landmarks, to advance in the study and prevention of pedestrian run-over deaths.

[Risk factors for injuries caused by traffic accidents and the impact of an intervention on the road]

OBJECTIVE

To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents.

METHOD

It was made a comparative analysis of two cross-sectional studies in 1994 and 1996.

RESULTS

In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66).

CONCLUSION

There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.

[Methodological aspects of measuring injuries from traffic accidents at the site of occurrence]

Traffic accidents are a well-known public health problem worldwide. In Mexico research into risk factors for motor involving vehicles accidents and their consequences has recently been taken into account. The relevant literature does not normally describe the methodological aspects involved in the collection of primary data, since most studies have used secondary data the good quality and validity of which are assumed. The paper presented seeks to discuss and share with researchers in this field, some of the methodological aspects to be considered in the attempt to recreate the scene of the accident and obtain information approximating to reality. The measurements in situ of, such traffic accident variables as injury, use of seat belt, speed and alcohol intake are discussed.

[Safety belt use and severity of injuries in traffic accidents]

OBJECTIVE

To analyze the association between the severity of car accident injuries and the use of safety belts.

MATERIAL AND METHODS

The unit of observation and analysis was car drivers in the Mexico-Cuernavaca toll highway. Variables included were those of car drivers, the vehicles and the physical environment at the accident site. Statistical analysis was carried out by means of chi square, odds ratios, 95% confidence intervals and logistic regression. Data was collected in 422 questionnaires for 324 accident events.

RESULTS

There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10 000 kilometers driven. Variables associated with not using a safety belt (p < 0.05) were: alcohol drinking, vehicle size, night-time and road section. Risk factors for severe injuries were: not using a safety belt (raw OR 4.9, 95% CI 2.2-10.8, adjusted OR 2.94, 95% CI 1.13-7.66); age < 25 years (OR 3.6, 95% CI 1.0-12.7) and > 54 (OR 6.0, 95% CI 1.4-25.0); alcohol drinking (OR 10.8, 95% CI 3.8-30.4); and night time (OR 2.8, 95% CI 1.4-5.8).

CONCLUSIONS

Theses findings suggest the need to formulate interventions aimed at enforcing the use of safety belts and prevention of related factors.

[Mother's work and severity of accidental injuries in children]

A study was conducted in children under five years old, in order to establish the association between the mother's work and the severity of unintentional injuries. The study was carried out at the emergency room of six pediatric hospitals in Mexico City. Cases were children with major injuries that required hospitalization, intensive care, surgery, or who died as a result of the injury. Controls were children of similar age, with minor injuries resolved at the emergency room. Sample size was 350 cases and 350 controls. Variables were grouped according to: mother's occupation; characteristics of the child, socioeconomic status, child care, and those related with home risk factors. Results showed a protective effect on severity of injuries when the mother worked outside home in comparison to mothers who do not work, (or 0.79, 95%CI 0.57-1.07). No differences were found with respect to sex and age of children. Mother age under 24 years old and low schooling (< 3 years of elementary school) were statistically significant with a risk of major injuries (or 2.30, 95%CI 1.5-3.4). Delay of demand of medical care after 60 minutes of injury occurrence is related with a risk of major injury (or 1.68, 95% CI 1.2-2.3). No differences related with household risk factors were found. Results provide valuable information about risk factors related with injury severity and the association with mother's work.

[Mortality due to homicide in children. Mexico, 1979-1990]

A study of homicides in children under five years old was conducted in order to define the mortality panorama by this cause during 1979-1990 in Mexico. Trends of homicide mortality were analyzed, as well as the main causes by age and sex. Rate ratio (RR) by cause and sex were analyzed too. The variables were age, sex, year and external cause of intentional injuries which were analyzed according to the International Classification of Diseases, 9th Revision E960-E969. The total number of deaths due to homicide were 2,939. Each day one children under five years of age died in Mexico due to homicide. The trend of homicide is b = 0.126. Thirty per cent of deaths occurred in children under one year old. Boys were most affected than girls in the causes by age: strangulation < 1 year old RR 21, confidence interval (CI) 15-30; fire arm in two years old children RR 3.1 CI 2.0-5.7; drowning in three years old children RR 2.6 CI 1.7-4.8 and assault by other and unspecified means. Further research in the area and prevention should involve the use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.

[The risk factors for home accidents in children. A case-control study]

INTRODUCTION

The main objective was to determine the risk factors involved in unintentional injuries in children under 10 years old occurring at home.

MATERIAL AND METHODS

A Case Control study was conducted in the emergency room of three pediatrics hospitals in Mexico City. The sample size was 160 cases and 320 controls.

RESULTS

Boys were more affected than girls (OR) 1.7, C.I. (95%) 1.2-2.5. The age group more affected was two-three years old (OR) 1.6, C.I.1.1-2.2. When children play outside home (roof, stairs, patio) the risk was OR 2.48, C.I. 1.63-3.76. If mother is not encharged of children care (OR) 2.9, C.I. 1.8-4.8. The age > 40 years old of the person encharged of children care (OR) 2.2, C.I. 1.4-3.5.

CONCLUSIONS

The results showed us how necessary is to develop injury prevention programs especially to implement passive measures, with target populations people encharged of children care.

[Home accidents in children less than 10 years of age: causes and consequences]

A case-control study was carried out, aimed at identifying and defining the individual, family, household and childcare social support network characteristics, more likely to be associated with the occurrence of accidental home injuries in 0-9 year-old children. This study was carried out in the emergency units of three pediatric hospitals in the Federal District. In this article we report the results of the descriptive analysis only of the cases. The results were as follows: male children (62%) and the one and two year-old children group (37%) were the most affected. Contusions, head injuries and fractures occupied the first three places, the main three causes being falls from one level to another (mainly in stairways and off the bed) falls on the same level (sliding, tripping or stumbling) and burns with boiling liquids (most frequently boiling water for bathing). A history of injuries was documented in only 15% of cases. Thirty nine percent of cases requested medical attention after one hour of the accident; 51% of these were hospitalized. In 25% of cases, the mother worked outside the home, being absent from 6 to 12 hours. Risk factors occurring most frequently were: unprotected electricity inlets (40%); products within reach of children: cleaning products (38%), makeup products (34%), plastic bags (30%) and tools (30%); lack of protection rails for cradles (30%) and for staircases (48%), and free access to roofs (44%). In 62 percent of cases some care was provided in the house of the injured child; twenty six percent counted on a support network, and 3 percent were by themselves. We present some proposals for epidemiologic and health services research, and stress the necessity to implement health education, social security and health services policies to favorably influence the solution of these problems.

[An analysis in traumatic lesions of the demand for emergency services at 12 pediatric hospitals of the city of Mexico]

A study on damages to a child's good health caused by injuries (accidents and violence), has been mainly directed towards the analysis of mortality. In reference to morbidity, very few studies have been carried out in our country. One of the primordial objectives of these studies was to explore morbidity through the demand of hospital emergency services. The study was designed using a questionnaire applied to patients during the months of September-October of 1988 while admitted in 12 pediatric hospital emergency wards. The analysis was done using a representative sample per hospital, applying the finite population formula, with a Zc = 90% and a interval of 0.05. The total number of cases studied was 3,294. The most important variables studied were: type of demand, traumatic lesion, place of occurrence, external cause, age groups, sex, day and shift of the demand, hospitalization and number of days in the ward. The results give an overall view of this health problem concerning morbidity, besides offering a basis for future investigations dealing with the identification of risk factors or the application of concrete interventions for their prevention.

[Mortality as a result of accidental and intentional injuries in the Federal District from 1970 to 1986]

This article presents the results of a retrospective analysis of unintentional and intentional injury mortality in México City for the period 1970-1986. The mortality rates and trends were obtained out of 73,197 registered deaths, (according to the 9th revision of the International Disease Classification). Deaths due to the earthquakes of 1985 were not included. The trend of mortality is undefined (r = -0.430). The most important causes of death were: traffic accidents, homicides, and others accidents. Males accounted 77 per cent of the deaths. The most affected age groups were 15-19 and 20-24 years. The potential years of life lost were analyzed. This study provides information for the prevention and control of injuries and for future research in this field.