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BACKGROUND: Traffic-related crashes are a leading cause of premature death and disability. The safe systems approach is an evidence-informed set of innovations to reduce traffic-related injuries and deaths. First developed in Sweden, global health actors are adapting the model to improve road safety in low- and middle-income countries via technical assistance (TA) programs; however, there is little evidence on road safety TA across contexts. This study investigated how, why, and under what conditions technical assistance influenced evidence-informed road safety in Accra (Ghana), Bogotá (Colombia), and Mumbai (India), using a case study of the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS). METHODS: We conducted a realist evaluation with a multiple case study design to construct a program theory. Key informant interviews were conducted with 68 government officials, program staff, and other stakeholders. Documents were utilized to trace the evolution of the program. We used a retroductive analysis approach, drawing on the diffusion of innovation theory and guided by the context-mechanism-outcome approach to realist evaluation. RESULTS: TA can improve road safety capabilities and increase the uptake of evidence-informed interventions. Hands-on capacity building tailored to specific implementation needs improved implementers' understanding of new approaches. BIGRS generated novel, city-specific analytics that shifted the focus toward vulnerable road users. BIGRS and city officials launched pilots that brought evidence-informed approaches. This built confidence by demonstrating successful implementation and allowing government officials to gauge public perception. But pilots had to scale within existing city and national contexts. City champions, governance structures, existing political prioritization, and socio-cultural norms influenced scale-up. CONCLUSION: The program theory emphasizes the interaction of trust, credibility, champions and their authority, governance structures, political prioritization, and the implement-ability of international evidence in creating the conditions for road safety change. BIGRS continues to be a vehicle for improving road safety at scale and developing coalitions that assist governments in fulfilling their role as stewards of population well-being. Our findings improve understanding of the complex role of TA in translating evidence-informed interventions to country-level implementation and emphasize the importance of context-sensitive TA to increase impact.
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Accidentes de Tránsito , Humanos , Accidentes de Tránsito/prevención & control , Ghana , Salud Global , Colombia , India , Evaluación de Programas y Proyectos de Salud , SeguridadRESUMEN
Public transport priority systems such as Bus Rapid Transit (BRT) and Buses with High Level of Service (BHLS) are top-rated solutions to mobility in low-income and middle-income cities. There is scientific agreement that the safety performance level of these systems depends on their functional, operational, and infrastructure characteristics. However, there needs to be more evidence on how the different characteristics of bus corridors might influence safety. This paper aims to shed some light on this area by structuring a multivariate negative binomial model comparing crash risk on arterial roads, BRT, and BHLS corridors in Bogotá, Colombia. The analyzed infrastructure includes 712.1 km of arterial roads with standard bus service, 194.1 km of BRT network, and 135.6 km of BHLS network. The study considered crashes from 2015 to 2018 -fatalities, injuries, and property damage only- and 30 operational and infrastructure variables grouped into six classes -exposure, road design, infrastructure, public means of transport, and land use. A multicriteria process was applied for model selection, including the structure and predictive power based on [i] Akaike information criteria, [ii] K-fold cross-validation, and [iii] model parsimony. Relevant findings suggest that in terms of observed and expected accident rates and their relationship with the magnitude of exposure -logarithm of average annual traffic volumes at the peak hour (LOG_AAPHT) and the percentage of motorcycles, cars, buses, and trucks- the greatest risk of fatalities, injuries, and property damage occurs in the BHLS network. BRT network provides lower crash rates in less severe collisions while increasing injuries and fatalities. When comparing the BHLS network and the standard design of arterial roads, BHLS infrastructure, despite increasing mobility benefits, provides the lowest safety performance among the three analyzed networks. Individual factors of the study could also contribute to designing safer roads related to signalized intersection density and curvature. These findings support the unique characteristics and traffic dynamics present in the context of Bogotá that could inform and guide decisions of corresponding authorities in other highly dense urban areas from developing countries.
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Accidentes de Tránsito , Planificación Ambiental , Vehículos a Motor , Seguridad , Colombia , Accidentes de Tránsito/estadística & datos numéricos , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/prevención & control , Humanos , Vehículos a Motor/estadística & datos numéricos , Seguridad/estadística & datos numéricos , Modelos Estadísticos , Análisis Multivariante , Ciudades , Transportes/estadística & datos numéricosRESUMEN
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.
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Cannabis , Trastornos Relacionados con Sustancias , Adulto , Humanos , Accidentes de Tránsito/prevención & control , México/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Motocicletas , EtanolRESUMEN
The media plays a key role in shaping the public's perception of road safety. This study analyzes the newspaper coverage and framing of motor vehicle crashes (MVCs) and road safety in Argentina, South America. The content of 304 articles published by 15 newspapers in November 2020 was reviewed. The results show that episodically framed news stories (focused on a single event or incident) prevail over thematically framed articles. MVCs are presented primarily as 'police' events and tend to receive more coverage when fatalities are involved. There is limited information provided on contextual and risk factors, and road safety advice is rarely included. Speeding, infrastructure, alcohol and other human-related variables are the most cited risk factors. Very few articles mention the use of protective devices (seat-belt, helmet and child restraint system). Although motorcyclists represent 40% of RTC deaths in Argentina, only 20% of the news coverage was about them. News coverage was quite similar in national and regional newspapers. There is an opportunity for the media to help build a better road safety culture, but significant changes in news framing are required. Practical recommendations for editors, journalists and road safety practitioners are provided.
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Accidentes de Tránsito , Cinturones de Seguridad , Niño , Humanos , Accidentes de Tránsito/prevención & control , Argentina , Factores de Riesgo , Vehículos a MotorRESUMEN
Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.
Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Política Pública , Motocicletas/estadística & datos numéricos , Accidentes/mortalidad , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/prevención & control , Accidentes de Tránsito/estadística & datos numéricos , Seguridad Vial , Salud Pública , Estudios Retrospectivos , Causas de Muerte , Prevención de AccidentesRESUMEN
Educational traffic campaigns aim to alert the population about adoption of behaviors that bring safety and quality in traffic. Animal-vehicle collisions are one of the most visible impacts on roads, and the planning of measures to reduce these collisions is justified for at least three reasons: animal welfare, financial cost, and drivers and passengers' safety. We evaluated whether the impact of animal-vehicle collisions was present in educational traffic campaigns and if campaigns showed any other environmental issues. We analyzed 205 campaigns from state and national traffic departments in Brazil. Although "collision" was the most frequent subject, animal-vehicle collisions only appeared on two campaigns, both portraying domestic animals. The identified environmental issues were "animal-vehicle collision" and "garbage", and most campaigns did not have an environmental focus. We highlighted some directions to include the subject of wildlife-vehicle collisions in traffic campaigns that could raise public awareness and, ultimately, reduce the impact on humans and animals involved in collisions.
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Accidentes de Tránsito , Animales Salvajes , Animales , Humanos , Accidentes de Tránsito/prevención & control , Brasil , Bienestar del AnimalRESUMEN
INTRODUCTION: Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals. METHODS: An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016. RESULTS: The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application. CONCLUSION: The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.
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Alcoholismo , Conducción de Automóvil , Conducir bajo la Influencia , Adulto , Humanos , Alcoholismo/epidemiología , Conducir bajo la Influencia/prevención & control , Brasil/epidemiología , Análisis de Series de Tiempo Interrumpido , Prevalencia , Nivel de Alcohol en Sangre , Accidentes de Tránsito/prevención & control , Etanol , Consumo de Bebidas Alcohólicas/epidemiologíaRESUMEN
A incidência de trauma durante a gestação é de 6% a 8% (formas graves de trauma: 3%-6%). Das gestantes que necessitam de internação por causa de um trauma, 60% evoluem para o parto. As gestantes têm 1,6 vez mais chances de morrer numa situação de trauma. As alterações anatômicas e fisiológicas da gestação interferem nas repercussões e na abordagem do trauma. A violência doméstica representa o mecanismo mais comum de trauma para a gestante e desencadeia várias complicações obstétricas, devendo ser, idealmente, identificada no pré-natal. No acidente automobilístico, atenção especial deve ser dada ao diagnóstico de descolamento prematuro de placenta (DPP). O ultrassom na sala de trauma possibilita ação na assistência ao trauma e também, como mecanismo rápido, informações necessárias sobre o feto e a gestação (FAST fetal). A maioria dos exames de imagem necessários para a boa assistência ao trauma não representa agravos à gestação. O pré-natal tem papel importante na prevenção dos traumas na gestação. A ação conjunta do cirurgião do trauma e do obstetra é recomendada no atendimento da gestante traumatizada, principalmente nos casos graves e em gestantes acima de 20-24 semanas
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Humanos , Femenino , Embarazo , Embarazo , Obstetricia/estadística & datos numéricos , Atención Prenatal , Ultrasonido/instrumentación , Accidentes de Tránsito/prevención & control , Violencia Doméstica/estadística & datos numéricos , Desarrollo Fetal , Desprendimiento Prematuro de la Placenta/prevención & control , Muerte Materna/prevención & controlRESUMEN
INTRODUCTION: The global motorcycle market has grown significantly, with over 770 million vehicles estimated to be in use worldwide. Motorcycle-related road traffic deaths in low and middle-income countries (LMICs) like Colombia are concerning, comprising 30% of all reported fatalities. Cartagena has an average of 70 motorcycle-related deaths annually between 2019 and 2022, making it a high-risk area for motorcyclists. OBJECTIVE: The study aimed to identify factors associated with motorcyclist safety at unsignalized three-legged and four-legged intersections in Cartagena by observing the behavior of the motorcyclists and the analysis of the potential traffic conflicts. The observational analysis focused on the access of motorcyclists from a secondary road to a main road since it is the behavior offered by the most significant road interaction and the potential risk of traffic conflicts due to crossing. METHODS: The observational process was consolidated at ten three-legged intersections and seven four-legged intersections. Thirty-six hours of videos were collected considering different time slots and weekdays randomly distributed during September 2019 and March 2020. The selection of the intersections included different vehicular flows and road safety conditions. The variables considered in the study were: interaction with other road users, motorcyclist behavior, vehicle handling, potential distractors, and safety elements. The study used the Swedish Traffic Conflict Technique to analyze conflict analysis, incorporating the Post Encroachment Time (PET) measurement. The analysis was developed with descriptive and inferential statistical techniques. The collected variables were analyzed individually (frequency analysis), and contrasts were conducted with the PET values. The study evaluated associations between motorcycles and other motorized road actors at intersections about behaviors and crossroads. RESULTS: In the Records, 10,281 motorcycle accesses at three and four-Legged Intersections were interactions with other road users, where 2417 and 1903 resulted in potential traffic conflicts, respectively. Average potential conflicts per hour were 115 and 127 at three and four-legged intersections. At the two intersections, the average PET values in motorcycles were between 2.09 and 2.10 s, while in the other motorized road users, it averaged around 2.67 to 2.71 s. In the road conditions, it was identified that intersections with a traffic flow of<10,000 vehicles/day and poor visibility to the left of the intersection lead to more unsafe conditions for motorcyclists. Motorcycle taxi drivers were the user group most frequently involved in traffic conflicts. Actions on the part of motorcyclists, such as risky behaviors, not using helmets, not using turn signals, and not waiting patiently for access, showed a relationship with the potential for traffic conflicts. Finally, turns to the left, particularly the indirect turn to the left on the opposite road, showed a greater risk of traffic conflicts. CONCLUSIONS: The study found that motorcycles exhibit more severe traffic conflicts than motorized vehicles at intersections. Infrastructure conditions significantly impact the risk of intersection conflicts. Individual behaviors such as not stopping at intersections and driving recklessly increased the risk of traffic conflicts. The study recommends improving infrastructure such as visibility and signaling and implementing separators to reduce travel speed and traffic conflicts for motorcycles.
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Accidentes de Tránsito , Asunción de Riesgos , Humanos , Accidentes de Tránsito/prevención & control , Colombia , Motocicletas , ViajeRESUMEN
The increasing advances in technologies used in autonomous vehicles have improved the reliability of their controls, making them more likely to be accepted by drivers and thus more common on the streets. When all vehicles become autonomous, traffic lights will need to be more efficient. In this sense, this article presents a computational model to manage the crossing of autonomous vehicles at road intersections, so that they can flow continuously along the roads without needing to stop, except in extreme cases. Based on the developed model, we implemented an algorithm and a simulator to control the behavior of autonomous vehicles with different lengths when crossing an intersection. In order to evaluate the performance of this method, we carried out 10 thousand simulations for each combination of the intersection controller's distances of action and vehicle group size, in a total of 600 thousand simulations. Thus, a relationship was observed between the method's efficiency and the controller's range, where the number of collisions was zero for distances greater than or equal to 2300 m. Method efficiency was also related to the average speeds at which the vehicles crossed the intersection, which was close to their average initial speed.
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Accidentes de Tránsito , Conducción de Automóvil , Accidentes de Tránsito/prevención & control , Vehículos Autónomos , Reproducibilidad de los Resultados , AlgoritmosRESUMEN
BACKGROUND & AIMS: While physical inactivity can contribute to chronic diseases, regular activity like walking can help prevent them. In 2010, one in three adults in the U.S. Virgin Islands (USVI) was physically inactive, higher than most U.S. states and territories. There are few walkable destinations and sidewalks along streets in the USVI. Since community- and street-scale design features can influence walking, we convened a 3-day walkability institute in the USVI to (1) learn about physical activity and best practices for design and (2) develop public health infrastructure that supports implementation. Island teams were formed to develop and implement a territory-wide action plan, focused on passing a Complete Streets policy, and demonstration projects on the islands of St. Croix, St. John, and St. Thomas to advance and pass this policy. An example of the demonstration projects and their significance is the completed one in St. Croix, which is the focus of this article. METHODS: Island teams applied critical components of functioning program infrastructure as described in the Component Model of Infrastructure (CMI) such as engaged data, multilevel leadership, responsive plans and planning, and networked partnerships. We evaluated whether a crosswalk installation in St. Croix could alter driver and pedestrian behavior and create a safer environment for pedestrians. Observers recorded pedestrian crossing time, driver speed, and other behaviors before and after crosswalk installation. RESULTS: Pedestrians took significantly fewer average seconds to cross the street in the postdemonstration period (9.83) compared with predemonstration (13.4) (p = .03). Average car speed declined between the predemonstration (24.3) and long-term demonstration periods (p < .01) and from the postdemonstration (24.7) to the long-term demonstration period (18.2) (p < .01). A greater percentage of pedestrians used the crosswalk to cross the street between the postdemonstration (12.5%) and long-term demonstration periods (53.7%) (p < .01). IMPLICATIONS: The demonstration project in St. Croix shows that improvements to built environment infrastructure can increase safety for pedestrians, thus improving walkability in the USVI. We discuss the importance of CMI elements observed in the success of the St. Croix demonstration and its effectiveness in promoting a Complete Streets policy and the lack of these elements on St. John hindering progress there. Public health practitioners can apply the CMI to future physical activity promotion projects in the USVI and other settings as having functioning program infrastructure helps overcome challenges including natural disasters and a global pandemic and can achieve progress toward sustained policy and systems change.
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Peatones , Adulto , Humanos , Islas Virgenes de los Estados Unidos , Ejercicio Físico , Caminata , Salud Pública , Accidentes de Tránsito/prevención & control , SeguridadRESUMEN
The article aims to investigate the influence of risk exposure factors on the frequency of road crashes from January to August 2020 in Ciudad Juarez, Mexico. It is a longitudinal study with four data sets: road crashes, population and housing census, location of economic activities, and road network information. Specifically, this study investigates the relationship between exposure factors - demographics, main roads and land use - and road crashes. A mixed method analysis was employed, (1) spatial analysis using GIS techniques; and (2) a negative binomial spatial regression model. The results showed a strong spatial dependence (0.274; p-value 0.00) of road crashes in the census tracts, and this effect was statistically significant (0.007) in the spatial regression model. In the model, a high probability (<0.05) of road crashes in the census tracts was found with the population aged 15 to 65 years, the length of main roads and the level of road coverage (Engel index), land uses with economic activities of an industrial and commercial character. The findings of this study successfully capture the social, economic, and urban conditions during the January-August 2020 period in the context of the COVID-19 pandemic. This new knowledge could help create preventive plans and policies to address the frequency of road crashes.
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Accidentes de Tránsito , COVID-19 , Humanos , Accidentes de Tránsito/prevención & control , Regresión Espacial , México/epidemiología , Estudios Longitudinales , Pandemias , COVID-19/epidemiologíaRESUMEN
There have been no studies reporting on the use of biological specimens in Mexico to analyze the prevalence of alcohol and drug use among Emergency Department (ED) patients with a road traffic injury (RTI). We report here on a sample of 304 adult patients, admitted to the ED of a public hospital in Mexico City from January to April 2022, after being involved in an RTI. Patients gave informed consent for a breath test measuring breath alcohol concentration (BAC) and a saliva screening test for six classes of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine). We found that at least one in every four patients (27.6%) had traces of alcohol or drugs in their body upon arrival in the ED. The breath test found a positive BAC in 16.1% of the sample; the most common substances detected in saliva were amphetamines or methamphetamine (8.6%), followed by cocaine (7.0%) and cannabis (6.9%). Only a few variables differentiated those with positive BAC from those with negative BAC (male, arriving on a weekend day or night, and arriving by ambulance), and even fewer variables differentiated those testing positives for drugs than those testing negative (less than 13 years of education and drivers of cars, bicycles, or other vehicles). While alcohol continues to be the single most used substance, our findings indicate that stimulants are of great concern. Since those testing positives for alcohol or drugs are so similar in their demographic pattern to those testing negative, the introduction of biological testing as a routine practice in the ED is highly recommended. Routine testing makes it possible to provide the patient with the best treatment and is also the best way to assess substance use.
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Cocaína , Metanfetamina , Trastornos Relacionados con Sustancias , Adulto , Humanos , Masculino , Accidentes de Tránsito/prevención & control , México/epidemiología , Etanol , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Servicio de Urgencia en Hospital , Anfetaminas , Consumo de Bebidas Alcohólicas/epidemiologíaRESUMEN
BACTERKGROUND: There is debate on whether cannabis affects road traffic injuries (RTIs) separately from the effects of alcohol. Our goals are to report the possible increase in risk of an RTI among alcohol and cannabis users by type of exposure (biological, self-reported and combined) and the possible interaction of alcohol and cannabis in patients with an RTI in an emergency department in Mexico City. METHODS: A case-crossover study with 433 cases of RTI (as a pedestrian, driver or passenger) during the period January-April 2022. A breath sample, an oral sample for cannabis detection and self-reported alcohol and cannabis use 6 hours prior to the RTI and in two control periods were used. We report ORs and 95% CIs from conditional logistic regressions for the case-crossover estimates. RESULTS: Alcohol alone increased the risk of an RTI (OR=6.02, 95% CI 3.29 to 10.99) for most RTIs, regardless of whether we used information from self-reports or a breath sample in the hazard period. Conversely, cannabis only increased the RTI when we added information in the hazard period from self-reports or oral samples. Nevertheless, this increase in risk disappeared (OR=2.06, 95% CI 0.90 to 4.70) among those who only used cannabis. We also found no evidence of interaction between alcohol and cannabis in the risk of an RTI. CONCLUSIONS: Alcohol is the most commonly used substance in Mexico and a high-risk factor for RTI in Mexico City. Although cannabis alone was not associated with an RTI, continuous monitoring of its effects is required.
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Cannabis , Heridas y Lesiones , Humanos , Accidentes de Tránsito/prevención & control , Cannabis/efectos adversos , México/epidemiología , Estudios Cruzados , Factores de Riesgo , Heridas y Lesiones/epidemiologíaRESUMEN
BACKGROUND: Mexico City implemented the Pasos Seguros programme to prevent pedestrian injuries and deaths at dangerous road intersections, which included street-level design changes, such as visible pedestrian crossings, sidewalk widening, refuge islands, lane reductions, pedestrian signals and adjustment of traffic light timing at these intersections. Few studies in low and middle-income countries (LMICs) have evaluated the effect of such interventions on pedestrian safety. AIM: Assess the effectiveness of the Pasos Seguros programme at reducing total, injury and fatal pedestrian-motor vehicle crashes. METHODS: Two-group quasi-experimental design. Monthly pedestrian crashes were obtained from the road incident database from Mexico City's Citizen Contact Center. The programme's effectiveness was evaluated by comparing 12 months preintervention to 12 months postintervention implementation using a negative binomial regression with random intercept with a difference-in-difference estimation. A qualitative comparative analysis was used to find the configuration of intersection characteristics and programme components associated with a decrease in pedestrian crashes. RESULTS: Total pedestrian crashes were reduced by 21% (RR 0.79; 95% CI 0.62 to 0.99) after implementation of Pasos Seguros programme. This reduction was observed for pedestrian injury crashes (RR 0.79; 95% CI 0.62 to 1.00) and for fatal crashes (RR 0.61; 95% CI 0.13 to 2.92) although not statistically significant for the latter. A decrease in pedestrian crashes was found at the most complex intersections where more of the programme components was implemented. CONCLUSION: The Pasos Seguros programme successfully decreased total and injury pedestrian crashes. Similar interventions may improve walking safety in other LMIC cities.
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Peatones , Heridas y Lesiones , Humanos , Accidentes de Tránsito/prevención & control , Ciudades , México/epidemiología , Caminata , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
BACKGROUND: Mexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths. METHODS: Collisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis. RESULTS: The 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI -0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different. CONCLUSION: Policies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.
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Accidentes de Tránsito , Heridas y Lesiones , Humanos , Ciudades/epidemiología , Análisis de Series de Tiempo Interrumpido , México/epidemiología , Accidentes de Tránsito/prevención & control , Políticas , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlAsunto(s)
Humanos , Automóviles/legislación & jurisprudencia , Automóviles/normas , Accidentes de Tránsito/legislación & jurisprudencia , Accidentes de Tránsito/prevención & control , Prevención de Accidentes/legislación & jurisprudencia , Conducción de Automóvil , Percepción Visual , Seguridad Vial , Tráfico Vial , VidrioRESUMEN
Abstract Cannabis sativa L. is one of the most consumed drugs in the world and recent studies have associated its use with an increase in the number of traffic accidents in different countries. In many countries, like Brazil, simple and reliable methodologies are still needed for the detection of drugs on site, mainly cannabinoids, considering its prevalence of use and oral fluid (OF) has been proved as an appropriate biological matrix for this purpose. Considering that, this work aims to review previous studies on immunochromatographic devices for on-site detection of cannabinoids in OF, discussing their sensitivity, specificity, cut-offs values and confirmatory methods. This data shows the importance of choosing a screening device and it reinforces the need for its implementation in Brazil. The research was conducted on 5 databases and all original articles, published in the last 10 years, were selected. A total of 32 articles were found, providing data for 17 screening devices of distinct brands. Only 2 screening devices showed satisfactory sensitivity and specificity in the evaluated studies (≥80% and ≥90% respectively). However, it should be considered that the screening devices still have some limitations, such as a higher cut-off than those recommended by international guidelines (cut-off > 2 ng/mL), therefore demonstrating the need for more studies in the area and the importance of confirmatory analysis usually fulfilled by LC-MS/MS, GC-MS/MS or GC-MS. Thus, the screening analyzes should not be evaluated by itself, but in association with confirmatory results and observational traits (behavioral changes), for a better understanding of the traffic scenario
Asunto(s)
Cannabinoides/análisis , Triaje/clasificación , Cromatografía de Afinidad/instrumentación , Dronabinol/agonistas , Cannabis/efectos adversos , Accidentes de Tránsito/prevención & control , Detección de Abuso de Sustancias/instrumentaciónRESUMEN
BACKGROUND: Brazil occupies the fifth position in the ranking of the highest mortality rates due to RTI in the world. With the objective of promoting traffic safety and consequently reducing deaths, Brazil created the Life in Traffic Project (LTP). The main goal of LTP is reducing 50% of RTI deaths, by promoting interventions to tackle risk factors, such as driving under the influence of alcohol and excessive and/or inappropriate speed. Thus, the aim of this study was to estimate the magnitude of risky and protective factors for RTI in capitals participating in the LTP in Brazil. We estimated these factors according to sociodemographic (age group, sex, education, race and, type of road user). METHODS: A total of 5,922 car drivers and motorcyclists from 14 Brazilian capitals participating in the LTP were interviewed. Data collection was carried out in sobriety checkpoints at night and consisted of the administration of an interview and a breathalyzer test. Risky and protective behaviors associated with RTI were investigated. Covariates of the study were: age, sex, education, race and, type of road user. Poisson multiple regression analysis was used to assess the relationship between variables of interest. RESULTS: The prevalence of individuals with positive blood alcohol concentration (BAC) was 6.3% and who reported driving after drinking alcohol in the last 30 days was 9.1%. The others risky behaviors reported were: driving at excessive speed on roads of 50 km/h, using a cell phone for calls while driving, using a cell phone to send or read calls while driving, running a red light. Use of seatbelts and helmets showed prevalence above 96,0% Use of seatbelts showed prevalence of 98.6% among car drivers, and helmet use was described by 96.6% of motorcycle drivers. Most risky behaviors were more prevalent in younger age groups (except BAC measurement higher in older participants), in males (except for cell phone use), in participants with higher education level and without a driver's license. CONCLUSION: Excessive speed and driving under the influence of alcohol, defined as priorities within the LTP, need more consistent interventions, as they still have considerable prevalence in the cities investigated. The factors described such as cell phone usage and passing red traffic lights should also need to be prioritized as a focus on promoting traffic safety.