At least 30 % of traffic-related injuries involve pedestrians. These events typically result in incapacitating physical injury and may even cause death. Productive-agedmen, aged 20 to 45, represent the people generally affected in Latin-America. They tend to be heads of household supporting their families and whose absence greatly affects the home's financial situation. A systematic review was conducted of the burden represented by traffic-related injuries, especially those involving pedestrians, and of the primary preventative measures designed and implemented for controlling fatal and non-fatal injuries to pedestrians by improving road safety. There have been few studies in Latin-America regarding these types of accidents and most interventions aimed at reducing traffic-related injuries have been directed towards vehicle drivers and passengers, little attention being focused on other traffic-related actors. This increases pedestrian inequality and vulnerability. There is a consensus among experts worldwide that rigorous investigation is needed (especially in low- and middle-income countries) to evaluate the effectiveness of interventions focused on other traffic-related actors. This review presents a variety of primary prevention strategies, other than pedestrian bridges, which (according to the available evidence) should start to be implemented. These would include modifying the physical environment, education, speed controls, enforcing legislation and imposing respect for pedestrians, valuing their limitations and vulnerability.

Dentro de las lesiones causadas por el tránsito (LCT) los atropellamientos representan a nivel mundial al menos la tercera parte de éstas; son eventos que habitualmente generan lesiones corporales incapacitantes e incluso pueden provocar la muerte. En Latino-América las personas afectadas, en general, son hombres entre 20 y 45 años, en edad productiva, jefes de hogar, personas que sostienen sus familias, su ausencia genera gran impacto en la economía de sus hogares. Se realizó una revisión sistemática sobre la carga que representan las LCT, en especial los atropellamientos y sobre las medidas de prevención primaria diseñadas e implementadas para el control de lesiones fatales y no fatales en peatones a través del mejoramiento de procesos de seguridad vial. En Latino- América los atropellamientos han sido poco estudiados; el grueso de intervenciones para reducir las LCT se han orientado hacia el conductor y ocupantes de vehículos y poco hacia los demás actores del tránsito, incrementando la desigualdad y vulnerabilidad de peatones; existe consenso mundial entre expertos, que es necesario investigaciones rigurosas, en especial en países de bajos y medianos ingresos orientados a evaluar la efectividad de intervenciones focalizadas hacia otros actores del tránsito; en la presente revisión se expone una variedad de estrategias de prevención primaria diferentes a puentes peatonales que según la evidencia disponible debe empezar a implementarse. Varias de éstas incluyen modificaciones al medio ambiente físico, educación, control de la velocidad, cumplimiento de la legislación y respeto por el peatón, valorando sus limitantes y vulnerabilidad.

Dentro de las lesiones causadas por el tránsito (LCT) los atropellamientos representan a nivel mundial al menos la tercera parte de éstas; son eventos que habitualmente generan lesiones corporales incapacitantes e incluso pueden provocar la muerte. En Latino-América las personas afectadas, en general, son hombres entre 20 y 45 años, en edad productiva, jefes de hogar, personas que sostienen sus familias, su ausencia genera gran impacto en la economía de sus hogares. Se realizó una revisión sistemática sobre la carga que representan las LCT, en especial los atropellamientos y sobre las medidas de prevención primaria diseñadas e implementadas para el control de lesiones fatales y no fatales en peatones a través del mejoramiento de procesos de seguridad vial. En Latino- América los atropellamientos han sido poco estudiados; el grueso de intervenciones para reducir las LCT se han orientado hacia el conductor y ocupantes de vehículos y poco hacia los demás actores del tránsito, incrementando la desigualdad y vulnerabilidad de peatones; existe consenso mundial entre expertos, que es necesario investigaciones rigurosas, en especial en países de bajos y medianos ingresos orientados a evaluar la efectividad de intervenciones focalizadas hacia otros actores del tránsito; en la presente revisión se expone una variedad de estrategias de prevención primaria diferentes a puentes peatonales que según la evidencia disponible debe empezar a implementarse. Varias de éstas incluyen modificaciones al medio ambiente físico, educación, control de la velocidad, cumplimiento de la legislación y respeto por el peatón, valorando sus limitantes y vulnerabilidad.

At least 30 % of traffic-related injuries involve pedestrians. These events typically result in incapacitating physical injury and may even cause death. Productive-agedmen, aged 20 to 45, represent the people generally affected in Latin-America. They tend to be heads of household supporting their families and whose absence greatly affects the home's financial situation. A systematic review was conducted of the burden represented by traffic-related injuries, especially those involving pedestrians, and of the primary preventative measures designed and implemented for controlling fatal and non-fatal injuries to pedestrians by improving road safety. There have been few studies in Latin-America regarding these types of accidents and most interventions aimed at reducing traffic-related injuries have been directed towards vehicle drivers and passengers, little attention being focused on other traffic-related actors. This increases pedestrian inequality and vulnerability. There is a consensus among experts worldwide that rigorous investigation is needed (especially in low- and middle-income countries) to evaluate the effectiveness of interventions focused on other traffic-related actors. This review presents a variety of primary prevention strategies, other than pedestrian bridges, which (according to the available evidence) should start to be implemented. These would include modifying the physical environment, education, speed controls, enforcing legislation and imposing respect for pedestrians, valuing their limitations and vulnerability.

OBJETIVO: Analisar o efeito das características do indivíduo carente, da família e do próprio sistema de atendimento com a utilização da vacinação infantil, após a reforma do sistema de saúde, na Colômbia. MÉTODOS: Os dados foram colhidos numa amostra aleatória de assegurados em agregados familiares de baixo rendimento, em Bogotá, em 1999. O padrão analítico e conceitual utilizado baseou-se no Modelo Comportamental de Utilização de Serviços de Saúde de Andersen. Este considera duas unidades de análise para avaliar a vacinação e seus determinantes: 1) a população carente assegurada, inclusive características das crianças e suas famílias; e 2) o sistema de saúde. As análises estatísticas incluíram o teste do qui-quadrado com intervalo de confiança de 95%, modelos de regressão multivariada e coeficiente alfa de Cronbach. RESULTADOS: A análise de regressão mostra que a vacinação esteve relacionada com o tamanho da família (OR=4,3), a área da residência (OR=1,7), a idade da criança (OR=0,7) e os anos de escolaridade do chefe de família (OR=0,5). Também esteve relacionada com as características do sistema de saúde, tais como a disponibilidade de posto de atendimento (OR=6,0), e a informação sobre os programas e horários dos serviços de saúde (OR=2,1). CONCLUSÕES: Os baixos níveis de vacinação e a importante relação que existe com o sistema de atendimento mostram barreiras que devem ser avaliadas e resolvidas. A inexistência de postos com atendimento regular e a deficiente informação à população são fatores que podem limitar a utilização dos serviços.

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

OBJETIVO: Analisar o efeito das características do indivíduo carente, da família e do próprio sistema de atendimento com a utilização da vacinação infantil, após a reforma do sistema de saúde, na Colômbia. MÉTODOS: Os dados foram colhidos numa amostra aleatória de assegurados em agregados familiares de baixo rendimento, em Bogotá, em 1999. O padrão analítico e conceitual utilizado baseou-se no Modelo Comportamental de Utilização de Serviços de Saúde de Andersen. Este considera duas unidades de análise para avaliar a vacinação e seus determinantes: 1) a população carente assegurada, inclusive características das crianças e suas famílias; e 2) o sistema de saúde. As análises estatísticas incluíram o teste do qui-quadrado com intervalo de confiança de 95%, modelos de regressão multivariada e coeficiente alfa de Cronbach. RESULTADOS: A análise de regressão mostra que a vacinação esteve relacionada com o tamanho da família (OR=4,3), a área da residência (OR=1,7), a idade da criança (OR=0,7) e os anos de escolaridade do chefe de família (OR=0,5). Também esteve relacionada com as características do sistema de saúde, tais como a disponibilidade de posto de atendimento (OR=6,0), e a informação sobre os programas e horários dos serviços de saúde (OR=2,1). CONCLUSÕES: Os baixos níveis de vacinação e a importante relação que existe com o sistema de atendimento mostram barreiras que devem ser avaliadas e resolvidas. A inexistência de postos com atendimento regular e a deficiente informação à população são fatores que podem limitar a utilização dos serviços.

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Objective. To assess the prevalence of tobacco smoking by work type among healthcare workers of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Morelos State, Mexico. Material and Methods. A cross-sectional was conducted in 3 133 healthcare workers in the 23 medical units of IMSS Morelos District, from October 1998 to March 2000. Data were collected using a self-applied questionnaire on tobacco smoking for different life-stages, some demographic characteristics, and work type. The prevalence rates of smoking and 95% confidence intervals (95% CI) were estimated by age groups, gender, and work type. Results. A total of 3 133 employees participated; 53.4% (95% CI 50.8-56.8) of men and 27.4% (95% CI 25.4-29.3) of women reported having smoked tobacco some time in their lives. The prevalence of current smoking was 28.3% (95% CI 25.6-31.0) and 14.4% (95% CI 12.8-15.9) in men and women, respectively. Among men, physicians have a lower prevalence (20.9%) of current smoking than that of other workers; for example, the prevalence was 26,6% among technicians and 33% among administrative personnel. Women in general had a lower prevalence than men in all categories, and in nurses it was still lower t(12,5%) than that of female physicians (16%). Conclusions. The prevalence of tobacco smoking in healthcare workers of IMSS Morelos was lower than that of the general population. Nevertheless, it is necessary to keep working on tobacco control programs to encourage smoking cessation among healthcare workers and make them aware of the positive role they may play in promoting programs to stop tobacco smoking and nicotine addiction.

Objetivo. Determinar la prevalencia de hábito tabáquico por categoría laboral en trabajadores de la salud del Instituto Mexicano del Seguro Social (IMSS), en el estado de Morelos, México. Material y métodos. Se realizó un estudio transversal en 3 133 empleados de los servicios médicos de las 23 unidades médicas con que cuenta la delegación Morelos del IMSS, durante el periodo de octubre de 1998 a marzo de 2000. Mediante un cuestionario autoaplicable se recolectó información sobre patrones de consumo de tabaco en distintas etapas de la vida, así como algunas características demográficas y categoría laboral. Se estimaron prevalencias e intervalos de confianza al 95% por grupos de edad y sexo para distintas categorías laborales. Resultados. De los 3 133 empleados participantes, 53.4% (IC 95% 50.8-56.8) de los hombres y 27.4% (IC 95% 25.4-29.3) de las mujeres contaban con historia de tabaquismo en algún momento de la vida. La prevalencia de tabaquismo activo fue de 28.3 % (IC 95% 25.6-31.0) y 14.4% (IC 95% 12.8-15.9) en hombres y mujeres, respectivamente. Entre los hombres, los médicos presentan una prevalencia de tabaquismo activo menor (20.9%) que la observada entre trabajadores de otras áreas: personal administrativo (33.0%) y personal técnico de distintas categorías (26.6%). Las mujeres muestran en general una prevalencia menor que los hombres en todas las categorías, y las enfermeras presentan una prevalencia discretamente menor (12.5%) que las médicas (16.0%). Conclusiones. El patrón del consumo de tabaco observado en profesionales de la salud del IMSS Morelos muestra una prevalencia menor a la observada en población general. Sin embargo, es necesario continuar con programas para desalentar el consumo del tabaco entre profesionales de la salud, y tratar de hacerlos concientes acerca de la influencia positiva que pueden y deben ejercer en la sociedad para impulsar programas integrados contra el consumo del tabaco y la adicción a la nicotina.

Objective. To assess the prevalence of tobacco smoking by work type among healthcare workers of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Morelos State, Mexico. Material and Methods. A cross-sectional was conducted in 3 133 healthcare workers in the 23 medical units of IMSS Morelos District, from October 1998 to March 2000. Data were collected using a self-applied questionnaire on tobacco smoking for different life-stages, some demographic characteristics, and work type. The prevalence rates of smoking and 95% confidence intervals (95% CI) were estimated by age groups, gender, and work type. Results. A total of 3 133 employees participated; 53.4% (95% CI 50.8-56.8) of men and 27.4% (95% CI 25.4-29.3) of women reported having smoked tobacco some time in their lives. The prevalence of current smoking was 28.3% (95% CI 25.6-31.0) and 14.4% (95% CI 12.8-15.9) in men and women, respectively. Among men, physicians have a lower prevalence (20.9%) of current smoking than that of other workers; for example, the prevalence was 26,6% among technicians and 33% among administrative personnel. Women in general had a lower prevalence than men in all categories, and in nurses it was still lower t(12,5%) than that of female physicians (16%). Conclusions. The prevalence of tobacco smoking in healthcare workers of IMSS Morelos was lower than that of the general population. Nevertheless, it is necessary to keep working on tobacco control programs to encourage smoking cessation among healthcare workers and make them aware of the positive role they may play in promoting programs to stop tobacco smoking and nicotine addiction.

Objetivo. Determinar la prevalencia de hábito tabáquico por categoría laboral en trabajadores de la salud del Instituto Mexicano del Seguro Social (IMSS), en el estado de Morelos, México. Material y métodos. Se realizó un estudio transversal en 3 133 empleados de los servicios médicos de las 23 unidades médicas con que cuenta la delegación Morelos del IMSS, durante el periodo de octubre de 1998 a marzo de 2000. Mediante un cuestionario autoaplicable se recolectó información sobre patrones de consumo de tabaco en distintas etapas de la vida, así como algunas características demográficas y categoría laboral. Se estimaron prevalencias e intervalos de confianza al 95% por grupos de edad y sexo para distintas categorías laborales. Resultados. De los 3 133 empleados participantes, 53.4% (IC 95% 50.8-56.8) de los hombres y 27.4% (IC 95% 25.4-29.3) de las mujeres contaban con historia de tabaquismo en algún momento de la vida. La prevalencia de tabaquismo activo fue de 28.3 % (IC 95% 25.6-31.0) y 14.4% (IC 95% 12.8-15.9) en hombres y mujeres, respectivamente. Entre los hombres, los médicos presentan una prevalencia de tabaquismo activo menor (20.9%) que la observada entre trabajadores de otras áreas: personal administrativo (33.0%) y personal técnico de distintas categorías (26.6%). Las mujeres muestran en general una prevalencia menor que los hombres en todas las categorías, y las enfermeras presentan una prevalencia discretamente menor (12.5%) que las médicas (16.0%). Conclusiones. El patrón del consumo de tabaco observado en profesionales de la salud del IMSS Morelos muestra una prevalencia menor a la observada en población general. Sin embargo, es necesario continuar con programas para desalentar el consumo del tabaco entre profesionales de la salud, y tratar de hacerlos concientes acerca de la influencia positiva que pueden y deben ejercer en la sociedad para impulsar programas integrados contra el consumo del tabaco y la adicción a la nicotina.