SummaryMotor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. This review summarizes studies on the epidemiology of motor vehicle accidents in developing countries and examines the evidence for association with alcohol.

La violencia es una constante en la vida de gran número de personas en todo el mundo, y nos afecta a todos de un modo u otro. Para muchos, permanecer a salvo consiste en cerrar puertas y ventanas, y evitar los lugares peligrosos. Para otros, en cambio, no hay escapatoria, porque la amenaza de la violencia está detrás de esas puertas, oculta a los ojos de los demás. Y para quienes viven en medio de guerras y conflictos, la violencia impregna todos los aspectos de la vida.Este informe, que constituye la primera recapitulación general del problema a escala mundial, no solo presenta el tributo humano que la violencia se cobra, materializado en más de 1,6 millones de vidas perdidas cada año e innumerables más dañadas de maneras no siempre evidentes, sino que expone también los muchos rostros de la violencia interpersonal, colectiva y dirigida contra uno mismo, así como los ámbitos en los que se desarrolla. Demuestra que allí donde la violencia persiste, la salud corre grave peligro.El informe nos lanza también un reto en muchos terrenos. Nos obliga a ir más allá de nuestro concepto de lo aceptable y cómodo para cuestionar la idea de que los actos violentos son meras cuestiones de intimidad familiar o de elección individual, o bien aspectos inevitables de la vida. La violencia es un problema complejo, relacionado con esquemas de pensamiento y comportamiento conformados por multitud de fuerzas en el seno de nuestras familias y comunidades, fuerzas que pueden también traspasar las fronteras nacionales. El informe nos insta a trabajar con colaboradores diversos y a adoptar una estrategia preventiva, científica e integral.Como queda de manifiesto a lo largo de todo el informe, disponemos de algunos de los instrumentos y de los conocimientos necesarios para cambiar la situación, los mismos instrumentos que se han utilizado con éxito para abordar otros problemas de salud, y sabemos dónde aplicar nuestros conocimientos. A menudo, la violencia puede preverse y prevenirse. Al igual que otros problemas de salud, no se distribuye de manera uniforme entre los diversos grupos de población o ámbitos. Muchos de los factores que elevan el riesgo de violencia son comunes a los distintos tipos de esta, y es posible modificarlos.Una cuestión que se repite en todo el informe es la importancia de la prevención primaria. En este aspecto, incluso las inversiones pequeñas pueden reportar beneficios importantes y duraderos, pero es indispensable contar con líderes resueltos y con el respaldo a las iniciativas de prevención por parte de un variado conjunto de colaboradores de los sectores público y privado, y de los países tanto industrializados como en desarrollo.La salud pública ha logrado algunos éxitos notables en las últimas décadas, sobre todo en lo tocante a reducir la frecuencia de muchas enfermedades de la infancia. Sin embargo, sería un fracaso de la salud pública salvar a nuestros niños de estas enfermedades solo para verlos caer víctimas de la violencia o, ya mayores, de su pareja, o de la ferocidad de las guerras y los conflictos,...

IntroductionThe infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries.MethodsWe systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analysed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible.ResultsIn most locations in developing countries, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups.Age-specific IFRs were roughly 2 times higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure.ConclusionThe burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to ensure medical equity to populations in developing countries through provision of vaccine doses and effective medications.

Worldwide, millions of people are annually affected by conflict and over $2bn was spent on non-food emergency aid each year between 1991 and 1997. 1 Recently, 30 million people were estimated to be internally displaced and 23 million to be refugees (seeking refuge across international borders), the vast majority of whom were fleeing conflict zones. 2 More agencies than ever are working in relief activities; over 200 humanitarian agencies responded to the Rwandan genocide and population displacement. 3 Populations affected by armed conflict experience severe public health consequences as a result of food insecurity, population displacement, the effects of weapons, and the collapse of basic health services. 4 5 Though most conflicts after the second world war took place in Africa, the Middle East, Asia, and Latin America, since the end of the Cold War and break up of the Soviet Union we have also witnessed conflicts in Europe and the former Soviet Union, notably in Tajikistan, Chechnya, former Yugoslavia, and NagornoKarabakh. 6 Increasingly, with relatively few exceptions, conflicts are internal rather than waged between states.This article argues that the evidence base for humanitarian health interventions should be actively developed and explores mechanisms for its promotion.

Background: Post-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically. Methods: To gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox's Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12. Results: We identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same-sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal helpseeking behaviors.