Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados

Lost years, mortality burden: the impact of COVID-19 pandemic on premature death due to road traffic accidents in a northern state in Malaysia

BACKGROUND

This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths.

METHODOLOGY

The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia.

RESULTS

This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic.

CONCLUSION

The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

COST ANALYSIS OF MOTORCYCLE ACCIDENT VICTIMS AT A UNIVERSITY HOSPITAL: PERSPECTIVES FROM 2017 AND 2020

Introduction

Motorcycle accidents constitute a public health problem that affects public and private health services due to the expenses of the victim's treatment and rehabilitation.

Objective

Evaluate the impact of motorcycle accident costs in a university hospital in 2020.

Method

Comparative analysis of the costs of motorcycle accident patients in 2020 and 2017.

Results

Among 151 patients included in the study, the average cost was U$3,083.54, and the average days of hospitalization were 5.3 days. The patient with the highest cost to the hospital spent U$22,504.05, and the patient with the lowest cost spent U$356.72. The longest stay among these patients was 41 days, and the shortest was one day. The average cost per patient per day for the entire sample was U$581.80.

Conclusion

The formulation and application of strategies that promote the reduction of motorcycle accidents in the city of Campinas are necessary. Level of evidence II, Retrospective study.

[Time trend in hospitalizations from motor vehicle accidents in the city of São Paulo, Brazil, 2000-2019]

This study assessed the hospitalization rates from motor vehicle accidents in the Brazilian Unified National Health System (SUS) in residents of the city of São Paulo, Brazil, from 2000 to 2019, according to sex, age bracket, and means of transportation (pedestrians, cyclists, motorcyclists, and motor vehicle occupants). A segmented regression model with negative binomial response was adjusted with inflection points to accommodate possible changes in trends. 189,765 hospitalizations were recorded during the study period, mostly males (80.5%) and from 20 to 49 years of age (71.2%). The most frequent type of accident involved motorcyclists (42.8%), followed by run-over pedestrians (33.7%). In general, the period from 2000 to 2007 was marked by increasing hospitalization rates from motor vehicle accidents involving all means of transportation, in both sexes, and in most age brackets. The year when the rates stopped increasing (or in some cases began to drop) differed according to the means of transportation. For vehicle occupants and cyclists, the trend in most age brackets turned downward in 2008, but the same did not happen with pedestrians and motorcyclists until 2012. Starting in 2015, the decline stopped in pedestrians, and the rates in cyclists turned upward again in most age brackets. For motorcyclists, the rates turned upward again in men 20 to 59 years of age (7.2% per year, exceeding 140 per 100,000 inhabitants in 2019) and in women 15 to 39 years of age (4.9% per year). The benefits of traffic safety measures implemented thus far in Brazil may have reached their limit, so that the current control and prevention measures need to be revised.

[The relationship between Brazilian legislation on the mandatory use of restraint devices for zero- to four-year-old children in vehicles and the numbers of injured and dead in traffic accidents]

The scope of this article is to address the relationship between mandatory restraint devices and hospitalizations and deaths of zero- to four-year-old age children in traffic accidents in Brazil. Based on the mandatory use of child restraint devices for children up to 4 years of age under Brazilian traffic legislation in 2010, the authors apply data from the DataSUS and Denatran databases to analyze the time series of hospitalizations and deaths of zero- to four-year-old age children in traffic accidents between September 2005 and August 2015. Two cut-off sample periods were examined, the first consisting of an analysis from 2005 to 2015, which was subsequently subdivided into two samples, namely before and after the requirement. The results of both cut-off sample periods suggest that demands concerning the use of restraint devices led to decreased hospitalizations and deaths of children due to traffic accidents in the zero- to four-year-old age group, with a prevalence of decreased rates of hospitalization over deaths.

MORTALITY DUE TO TRANSPORT ACCIDENTS IN THE CITY OF SÃO PAULO: 2005-2015

OBJECTIVE

To characterize cases of land transport accidents in the macro-regions of city of São Paulo in 2005, 2010, and 2015.

METHODS

This is a population-based, longitudinal and retrospective study of time series, based on a quantitative survey of land transport accidents that occurred in the city of São Paulo in 2005, 2010 and 2015 using data from the Mortality Information System of the City of São Paulo.

RESULTS

A total of 1,343, 1,567 and 1,088 deaths by accident recorded in the city' population in the years 2005, 2010 and 2015 respectively. The highest occurrences were in the age groups 15 to 24 years and 24 to 34 years. The highest number of deaths due to accidents was among males. The mortality rates observed in the macro-regions were South (23.8%), East (22%), North (21.6%), West (7.1%), and Center (3%). In comparing the years examined, there was a decline in the mortality rate per 100,000 inhabitants in most macro-regions.

CONCLUSION

Despite the decrease in overall accident mortality in most macro-regions, it still deserves attention on preventive traffic actions focused on young males living in peripheral neighborhoods, since they represent the most susceptible group. Level of evidence II; Retrospective Study.

Relationship between GDP per capita and traffic accidents in Brazilian municipalities in 2005, 2010 and 2015

OBJECTIVE

The main objective of this paper was to analyze the relation between GDP and three variables linked to traffic accidents in Brazilian municipalities: traffic accident mortality, deaths per vehicle; and vehicles per inhabitant.

METHODS

2005, 2010 and 2015 traffic accident (TA) mortality rates were estimated using a three-year moving average and were standardized; then, we applied the empirical Bayes estimator (EBE). Fatality rates (deaths per vehicle) were also based on EBE. The variable vehicles per inhabitant considered the ratio between the fleet and the population at municipal level. For every studied year, we estimated linear regression models between GDP and the interest variables.

RESULTS

The variables distribution indicates that, between 2005 and 2015, GDP and vehicles per inhabitant kept the same rising relationship. Fatality rates show a decreasing association with GDP. The distribution of mortality by TA had an inverted U-shaped pattern. The model coefficients practically did not change for the vehicle per inhabitant. Estimated association between deaths per vehicle and GDP kept the same sign, but diminished between 2005 and 2015. Model coefficient sign changed in 2015 for TA mortality.

CONCLUSION

Similar to what was observed in developed countries, the relation between mortality by traffic accidents and GDP changed in the analyzed period.

Mortality of motorcyclists due to traffic injuries in Brasil: a population-based study in Brazilian capitals

OBJECTIVE

To analyze the mortality trend of young men who were victims of traffic injuries involving motorcycles in all Brazilian capitals from 2001 to 2015.

METHODS

A time-series study on all deaths of men aged 20-39 years old due to traffic injuries involving motorcycles in all 27 Brazilian capitals. We used the joinpoint regression model for temporal analysis and calculated the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) to verify the mortality trends.

RESULTS

A total of 12,058 deaths of young men were recorded in the Brazilian capitals during the period studied. The highest mortality rates were observed in Boa Vista/Roraima (34.0/100,000 population) and Palmas/Tocantins (29.80/100,000). Twelve of the 27 capitals showed an increasing trend in mortality, with the highest percentage increase being observed in Salvador (APC: 29.0%) and São Paulo (APC: 13.1%). None of the capitals showed a decline in the trend of mortality.

CONCLUSIONS

Overall, the mortality of young men from traffic injuries involving motorcycles shows an increasing trend in 12 of the 27 capitals, which represents a public health problem that requires the implementation of more effective public policies.

Analysis of the Influence of Training and Feedback Based on Event Data Recorder Information to Improve Safety, Operational and Economic Performance of Road Freight Transport in Brazil

Road transport is the principal means of transporting freight and passengers in most developing countries, but several factors, both alone and in conjunction, contribute to increased inefficiency, risk and instability in the sector. The main factors are related to the high number of accidents, structural precariousness, fleet obsolescence, low-skilled drivers and high rates of greenhouse gas emissions. This paper evaluates the influence of implementing a training and feedback procedure associated with event data recorder (EDR) systems for the promotion of better behavior among professional drivers based on safety, operation and economy criteria. The analyses are based on interventions that were carried out during four monitoring phases using data generated by vehicles collected over 13 months of research. The data were converted into indicators and evaluated individually against the criteria and through data envelopment analysis (DEA). The analyses led to the conclusions that the use of EDR systems had positive impacts on all three of the criteria under analysis, and that safety levels can be increased without having to reduce productivity or increase fuel consumption. However, the safety criterion was more sensitive to the association between the technology and training process applied, leading to significant reductions in the indicators analyzed. The study contributes to the association between the methods of analysis and the adoption of specific indicators derived from time variables, leading to the conclusion that the use of EDR systems associated with management training and monitoring procedures can improve economic and operational results in road freight transport (RFT). Furthermore, using the trip data as a structural basis for the training and feedback proved to be very promising for the reduction of unsafe behavior to avoid road accidents.

Occupational hazards and risks among commercial motorcyclists in the peri-urban city of Lagos, Nigeria

Although a significant proportion of road hazards and their associated health risks in Nigeria involve motorcycles, relatively little research explores whether commercial motorcyclists have unique seasonal accident experiences. This article analyses survey data from 241 commercial motorcyclists in selected terminals in Ifo, Nigeria, to explore how road hazards and health risks experienced differ from one season to another. The study established that seasonality of motorcycle hazards and health risks cannot be assumed across the terminals and routes as some were dominant in either rainy or dry seasons or both. In particular, most motorcycle hazards and health risks were less likely caused by seasonal variation but by human errors and road conditions. The results underscore the importance of collecting commercial motorcyclists' perceptual data because many experience hazards and health risks that are burdensome to them.

Female motorcycle mortality in Brazilian municipalities, 2005, 2010 and 2015

OBJECTIVE

To analyze the spatial distribution of female mortality due to motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period.

METHODS

Female mortality rates for the years 2005, 2010 and 2015 were estimated considering a three-year moving average around the base year, standardized by the direct method. Rates were standardized using the same pattern (Brazilian females in 2010) for each year. Then, the empirical Bayes estimator was used to reduce the effect of the random fluctuation. The percentage variation of the standardized rates was also analyzed for different population sizes (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants).

RESULTS

Bayesian rates showed a clear increase in female mortality due to motorcycle accidents, especially in the North, Northeast and Midwest regions. In the municipalities of the South and Southeast regions, mainly in the period between 2010 and 2015, there was an apparent decrease in mortality. The percentage variation showed a reduction in the indicator analyzed in the period between 2010 and 2015 for the largest municipalities in the South and Southeast regions. For almost all regions and population sizes, the period between 2010 and 2015 showed a deceleration in the growth of rates.

CONCLUSION

The analysis clearly shows concentrations of municipalities with higher mortality, while also showing that the phenomenon has spread to a greater number of municipalities. The studied period allows the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents.

Victims of road accidents with serious injuries and dependence on some individual, climatic and infrastructure factors on federal highways in Brazil

Road or urban traffic accidents in Brazil have a large presence in external causes of mortality. The main goal of this study is to discover significant factors in the incidence of accidents on Brazilian highways based on a database with information on each person injured on federal highways in Brazil reported by the Federal Highway Police. Some factors are considered in the study as cause of the accident, type of accident, stage of the day, weather condition, highway type, highway facility, age of the victim, gender of the victim and type of vehicle. From the obtained results of chi-square tests and logistic regression models, it was observed statistical dependence (p < 0.05) of the occurrence of injured people with serious injuries and the factors cause of the accident, type of accident, day, highway type and vehicle type. Considering the dead victims, the covariates age, time of day, highway type, highway facility, gender and type of vehicle showed significance (p < 0.05). These results are of great interest for authorities to increase road enforcement, improve highway facilities and target the production of vehicles with better safety standards.

Prevalence and Factors Associated with Driving Under the Influence of Alcohol in Brazil: An Analysis by Macroregion

Objective: To analyze the prevalence and factors associated with driving under the influence of alcohol (DUIA) in Brazil, according to macroregion. Methods: A cross-sectional study was conducted using data from individuals aged 18 years or older who participated in the 2013 National Health Survey in Brazil. Subjects were selected by probabilistic sampling and interviewed through home visits. Prevalence of DUIA was estimated according to the number of drivers and/or motorcyclists who reported consuming alcohol in the previous 30 days (n = 9537). Poisson regression was used to analyze the factors associated with DUIA to Brazil and in each macroregion of the country. Results: The prevalence of DUIA was 27.5%, 29.4%, 29.6%, 22.9%, and 20.8% in the North, Northeast, Central-West, South, and Southeast macroregions, respectively. The overall prevalence of Brazil was 24.3%. In most macroregions, the main predictors of DUIA were male sex, high educational level, living in outside the capital or metropolitan regions (other regions), and binge drinking in the previous 30 days. Depression was a predictor in Brazil and two macroregions. Conclusion: A high prevalence of DUIA was observed in Brazil, especially in the Central-West, Northeast and, North macro-regions. Factors associated with DUIA can be incorporated to develop effective interventions to reduce this behavior in Brazil.

Uso de capacete e gravidade de lesões em motociclistas vítimas de acidentes de trânsito nas capitais brasileiras: uma análise do Viva Inquérito 2017

RESUMO: Objetivo: Analisar o efeito do uso de capacete na gravidade de lesões em condutores e passageiros de motocicletas envolvidos em acidentes de trânsito. Métodos: Estudo de corte seccional sobre vítimas de acidentes de transporte terrestre envolvendo motociclistas, atendidos nos serviços de urgência e emergência e participantes do Inquérito de Vigilância de Violências e Acidentes (Viva Inquérito) 2017. Resultados: Verificou-se predomínio de indivíduos na faixa de 18 a 29 anos (46,6%), negros (75,2%) e com ensino médio (50,6%). Em 14,1% dos acidentes houve relato de uso de álcool. O uso do capacete reduziu em 76% a ocorrência de trauma cranioencefálico e em 28% a ocorrência de encaminhamento para outro hospital, internação ou óbito. Conclusão: Motociclistas jovens, negros, de baixa escolaridade e do sexo masculino apresentaram-se mais vulneráveis aos acidentes. O uso do capacete mostrou-se protetor para lesões graves.

Sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico: una revisión sistemática

Objetivo Elaborar un sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico, con el fin de mejorar los procesos de recopilación y registro de la información de seguridad vial en el país.Materiales y Métodos Revisión sistemática cualitativa de artículos científicos publicados en revistas indexadas en las principales bases de datos (Scopus, PubMed, Lilacs, SciELO, Google Scholar), sobre accidentes de tráfico desde el año 1995 hasta el año 2015. La información recolectada pasó por 4 fases de revisión.Resultados Se seleccionaron 84 indicadores, agrupados en nueve dimensiones: accidentalidad, morbilidad, mortalidad, temporalidad, geoespacial, sociodemográfica, parque vehicular, impacto en salud pública, tipos y causas.Conclusiones Una gestión eficaz sobre seguridad vial exige que cada país cuente con un sistema de indicadores efectivo e institucionalizado que permita recolectar, analizar y gestionar la información de forma rápida y oportuna, enmarcada en el campo de la investigación científica, para difundir a la comunidad y organismos responsables de la seguridad vial, con miras a la adopción de medidas preventivas y correctivas. Por lo que, se recomienda a los organismos competentes de seguridad vial del país incorporar el sistema de indicadores elaborado en la presente investigación, lo cual permitirá contar con un sistema de registro da datos confiables.

Sialochemical analysis in polytraumatized patients in intensive care units

The profiles of polytraumatized patients in intensive care units were characterized. Serum and salivary markers were compared with normality between Classes I and II of APACHE II and between periods of hospitalization; these results were correlated. This was a prospective study on saliva charts and collection (n = 70). Profile: male, 27 years old, blunt traumas and collisions. Serum parameters with normality: decrease in pH, creatinine at admission to Class I, and at 48 and 72 hours in both classes; K+ at 48 h in Class II; Ca+ on admission in both classes and at 72 h in Class I. Increase in urea at 72 h in Class II, glucose at all times and in all classes, and Ca+ at 48 h in both classes. Class II had high Na+ at 48 and 72 h compared to Class I. In Class I, creatinine reduction occurred in 48 h and 72 h compared to admission and an increase of Ca+ at 48 h with admission. In Class II, pH and Na+ increased at 48 h and 72 h compared to admission. K+ decreased from admission to 48 h and increased from 48 h to 72 h. Urea increased from 48 to 72 hours. Creatinine decreased from admission to 48 and 72 hours. Ca+ increased from admission to 48 hours and decreased from 48 to 72 hours. There was an increase in the saliva levels in both classes and times in relation to normality. There was an increase in urea at admission, glucose at 72 h, and Ca+ at 48 h in Class II compared with Class I. Class I urea increased from admission to 48 h and Ca+ decreased from admission to 48 h. Class II urea decreased from 48 h to 72 h. Strong or very strong positive correlation was identified between blood and creatinine saliva at all times and regular and negative Ca+ at 72 h. This study provides evidence that salivary and serum biomarkers can be used together to monitor the evolution of the clinical symptoms of ICU patients.

Acidentes Automobilísticos no Brasil em 2017: estudo ecológico dos anos de vida perdidos por incapacidade

RESUMO Este estudo se propõe a descrever o impacto dos Acidentes Automobilísticos no Brasil, no ano de 2017, sobre os anos de vida perdidos ajustados por incapacidade. Estudo ecológico, com dados secundários da Global Health Data Exchange (Global Burden of Disease 2017) disponibilizados pelo Institute for Health Metricsand Evaluation. Os dados foram obtidos utilizando filtros de causa (ferimentos na estrada por veículo automotor), localização (global, Brasil e sul da América Latina) e indivíduos de ambos os sexos, com idades entre 15 e 49 anos. Foram considerados os anos de vida perdidos por incapacidade e a taxa de mortes por 100 mil habitantes. Os dados foram exportados para o Excel® for Windows 2010 e analisados conforme a literatura. Observa-se, no Brasil, um decréscimo nas taxas de óbitos (19,68%) e de anos de vida perdidos por incapacidade (22,10%) por acidente automobilístico entre indivíduos de ambos os sexos, com idades entre 15 e 49 anos, porém mostram-se superiores as taxas globais e do sul da América Latina. Estudos como este são importantes para o aperfeiçoamento e o direcionamento de politicas públicas específicas, para formular e implementar estratégias de promoção e prevenção da saúde de segurança no trânsito.

Brazilian adaptation of the driving anger expression inventory: testing its psychometrics properties and links between anger behavior, risky behavior, sensation seeking, and hostility in a sample of Brazilian undergraduate students

INTRODUCTION

In Brazil, driver aggressiveness in road traffic is a critical issue and could be an important contributing factor to the high number of traffic accidents. Because no instruments are available in Portuguese to register driving aggressiveness or driving anger in Brazil, we adapted English instruments into the Brazilian context. The aims of this study were to provide a Brazilian adaptation of the Driving Anger Expression Inventory (DAX) and to try to validate it by testing its psychometric properties and investigating its relationships with risky driving behaviors (DBQ), road accidents, driving sensation seeking, and hostility.

METHOD

The Brazilian adaptations of the DAX, DBQ, the Driving Sensation Seeking Scale (DSSS) and the hostility Scale were administered to a sample of 512 undergraduate students (with a mean age of 23.7 years, 52.1% men).

RESULTS

Confirmatory factor analysis of the Brazilian DAX (DAX-BR) items yielded a four-factor solution with 43 items, which obtained the best goodness-of-fit to the data. Cronbach's alpha for the DAX-BR factors ranged from 0.69 to 0.88. Other results on validity were a positive correlation (range 0.39-0.59) between the factors of the DAX-BR, DSSS, and DBQ.

CONCLUSION

DAX-BR as the same structure as the original and is a reliable instrument for use with young drivers. Other studies should be conducted to further validate the DAX-BR in different types of populations such as older and more experienced drivers, professional drivers, and traffic regulation offenders whose driver's license has been taken away. Practical applications: This Brazilian version can be recommended for the assessment of driving anger expression in Brazil among young drivers in view of helping them driver more safely, and in particular to reduce traffic violations.

Drink driving and speeding in Sao Paulo, Brazil: empirical cross-sectional study (2015-2018)

OBJECTIVES

To evaluate the prevalence of drink driving and speeding during 2015-2018 in Sao Paulo, Brazil.

DESIGN

Cross-sectional observational study.

SETTING

Roads representing the five main regions of the city of Sao Paulo in Brazil, one of the world's largest urban areas.

PARTICIPANTS

Drivers (N=10 294) stopped at routine roadside breath testing checkpoints and those driving in selected roads for speeding measurement (N=414 664).

PRIMARY AND SECONDARY OUTCOME MEASURES

Microwave radar guns were used to measure the speed of vehicles, while the prevalence of drivers under the influence of alcohol was observed in police checkpoints. Data were collected during three consecutive years (2016-2018) following a baseline study established in 2015 using a city-level representative sample of observational data representing all days of the week.

RESULTS

Alcohol-related fatalities kept at a constantly high percentage, with 39% of road traffic deaths involving alcohol in 2016. Drivers testing above the legal breath alcohol concentration limit showed a decreasing trend, from 4.1% (95% CI 2.9% to 5.5%) at baseline to 0.6% (95% CI 0.2% to 1.2%) in the end of 2018 (p<0.001); however, more than half of drivers refused breath tests at checkpoints despite steep legal penalties. The prevalence of speeding among all vehicles decreased from 8.1% (95% CI 7.9% to 8.2%) to 4.9% (95% CI 4.7% to 5.1%) by the end of 2016 (p<0.001), but then increased again to 13.5% (95% CI 13.2% to 13.9%) at the end of the study period (p<0.001).

CONCLUSIONS

Drink driving rates have reduced, likely due to an increase in drivers refusing breath alcohol tests, while speeding rates have increased significantly by the end of the study period, particularly among motorcycles. Future strategies aiming at reducing road traffic injuries in the major Brazilian city should tailor drink driving and speeding enforcement based on the new evidence provided here.

Alcohol use and associated factors among physicians and nurses in northeast Brazil

The consequences of alcohol use are closely related to its pattern of intake. The aim of this study is to analyze the pattern of alcohol use by doctors and nurses. Associated co-factors have also been considered. We calculated a representative sample of doctors and nurses from two hospitals in Maranhão, Northeastern Brazil. The Alcohol Use Disorders Identification Test (AUDIT) was employed to assess patterns of alcohol consumption. A score ≥8 was defined as alcohol misuse, and an answer to question number 3 > 1 was indicative of heavy episodic drinking (HED). In order to identify factors associated with HED and alcohol misuse, bivariate and multiple logistic regression analyses were performed with SPSS v20.0. A sample of 510 professionals was examined and 25% of those were abstainers; among those who had drinks containing alcohol, 86% were classified as low-risk alcohol use, scoring lower than 8, while 10.6% of the whole sample was categorized as alcohol misusers, scoring more than 8. The habit of smoking (OR = 6.02; CI: 1.71-21.16), following the Catholic religion (OR = 3.55; CI: 2.47-8.58), and also gender (OR = 3.09; CI: 1.68-5.71) were independently associated with alcohol misuse. HED was found in 14.3%. Younger age (OR = 0.96; CI: 0.92-0.98), male gender (OR = 5.13; CI: 2.55-10.30), the Catholic religion (OR = 3.22; CI: 1.44-7.21), and smoking habits (OR = 5.25; CI: 1.26-21.75) were associated with HED. Therefore, physicians and nurses have a lesser prevalence of abstainers, similar rates of alcohol misuse, and greater prevalence of HED when compared to the general Brazilian adult population. More studies involving these professionals need to be carried out in other Brazilian states in order to determine whether the results can be understood as widespread throughout the country.

Mortality by road traffic accidents in adolescents and young people, Brazil, 1996-2015: will we achieve SDG 3.6?

This paper aims to analyze the main characteristics of Road Traffic Accidents (RTA) mortality in Brazil for the period 1996-2015, focusing on the 10-29 years' age group. This is a two-step study consisting of (i) a bibliographic review on the topic of traffic violence in Brazil, and (ii) a study on RTA mortality in the Mortality Information System (SIM). The former situates the state of the art of scientific production on the theme and produces the theoretical reference for the analysis of the latter. During the period, about 39,000 people died by RTA, of which about 13,200 adolescents and young people died. The country should curb mortality to somewhere around 19,500/year and, among adolescents and young people, to 6,500/year to achieve SDG 3.6. With the establishment of the Brazilian Traffic Code (CTB), RTA mortality rate fell between 1997 and 2000. The rate increased in the subsequent decade. The focus on adolescents and young people help us understand that, in the post-CTB and Prohibition, male black and brown motorcyclists became the main victims. The literature provides data analysis and shows that reduction is currently submitted to an articulated discussion that involves worker's health, gender, employment, urban mobility and advertising policies. Concerning SDG, this means that achieving SDG 3.6 is a process that involves interacting with policies targeting other SDGs.

Burden of disease in Brazil, 1990-2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

BACKGROUND

Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.

METHODS

We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.

FINDINGS

Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0-68·9) in 1990 to 75·2 years (74·7-75·7) in 2016, and HALE increased from 59·8 years (57·1-62·1) to 65·5 years (62·5-68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4-34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7-32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.

INTERPRETATION

Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.

FUNDING

Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.

[Spatial analysis of motorcycle-related mortalities in Brazilian municipalities]

Analysis of the distribution of motorcycle-related mortality rates in Brazilian municipalities is fundamental to understand and seek to minimize the occurrence of this growing phenomenon. The main objective of this work is to analyze the spatial distribution of motorcycle rider mortality rates in Brazil, based on more robust and reliable estimates. An attempt was also made to identify the presence of spatial clusters in the distribution of such mortality rates in given municipalities. The rates were estimated based on the average number of motorcyclist deaths recorded in the years 2014, 2015 and 2016. These rates were then directly standardized and graduated based on the local empirical Bayesian estimator. A Local Indicator of Spatial Autocorrelation (LISA) indicated the presence of spatial patterns. The Northeast and Mid-West regions concentrated most of the municipalities with high mortality rates as well and most of the clusters of municipalities with a high-high distribution pattern. Graduated Bayesian estimation was effective to deal with the occurrence of extreme values, thereby improving the reliability of the estimates and enhancing the visualization of the rates on the map.

Road traffic accidents: Global Burden of Disease study, Brazil and federated units, 1990 and 2015

Objective:

To describe the global burden of disease due to road traffic accidents in Brazil and federated units in 1990 and 2015.

Methods:

This is an analysis of secondary data from the 2015 Global Burden of Disease study estimates. The following estimates were used: standardized mortality rates and years of life lost by death or disability, potential years of life lost due to premature death, and years of unhealthy living conditions. The Mortality Information System was the main source of death data. Underreporting and redistribution of ill-defined causes and nonspecific codes were corrected.

Results:

Around 52,326 deaths due to road traffic accidents were estimated in Brazil in 2015. From 1990 to 2015, mortality rates decreased from 36.9 to 24.8/100 thousand people, a reduction of 32.8%. Tocantins and Piauí have the highest mortality risks among the federated units (FU), with 41.7/100 and 33.1/100 thousand people, respectively. They both present the highest rates of potential years of life lost due to premature deaths.

Conclusion:

Road traffic accidents are a public health problem. Using death- or disability-adjusted life years in studies of these causes is important because there are still no sources to know the magnitude of sequelae, as well as the weight of early deaths. Since its data are updated every year, the Global Burden of Disease study may provide evidence to formulate traffic security and health attention policies, which are guided to the needs of the federated units and of different groups of traffic users.

Truck drivers' traffic accidents in the State of São Paulo: prevalence and predictors

Abstract The mortality rate of traffic accidents (TA) is high in Brazil. Trucks are the second category of motor vehicles most often involved in TA. However, few studies have addressed the issue of TA among these professionals. The study aimed to estimate the prevalence of TA and their predictors in a sample of 684 truck drivers recruited in the state of São Paulo during 2012 and 2013. We requested participants to answer a research instrument on their personal and occupational data and their involvement in TA and traffic violations. A logistic regression model was developed to identify TA predictors. Almost 11% of the respondents suffered at least one TA in that timeframe. We identified the following TA predictors: having few years of experience as professional drivers (OR = 1.86; CI 95% = 1.05-3.38; p = 0.036); receiving some traffic tickets (OR = 1.91; CI 95% = 1.04-3.66; p = 0.043) and working more than 12 hours daily (OR = 1.84; CI 95% = 1.04-3.24; p = 0.034). Given those results, we suggest the development of a joint action among all the involved social stakeholders in order to negotiate truck drivers' work organization aiming at reducing behaviors that may lead to traffic accidents.

Analysis of factors associated with traffic accidents of cyclists attended in Brazilian state capitals

Introduction:

Brazil has the sixth largest bicycles fleet in the world and bicycle is the most used individual transport vehicle in the country. Few studies address the issue of cyclists' accidents and factors that contribute to or prevent this event.

Methodology:

VIVA is a cross-sectional survey and is part of the Violence and Accidents Surveillance System, Brazilian Ministry of Health. We used complex sampling and subsequent data review through multivariate logistic regression and calculation of the respective odds ratios.

Results:

Odds ratios showed greater likelihood of cyclists' accidents in males, people with less schooling and living in urban and periurban areas. People who were not using the bike to go to work were more likely to suffer an accident.

Discussion:

The profile found in this study corroborates findings of other studies. They claim that the coexistence of cyclists and other means of transportation in the same urban space increases the likelihood of accidents.

Conclusion:

The construction of bicycle-exclusive spaces and educational campaigns are required.

Health impact modelling of different travel patterns on physical activity, air pollution and road injuries for São Paulo, Brazil

BACKGROUND

São Paulo city, Brazil, faces challenges caused by rapid urbanization. We illustrate how future travel patterns could lead to different health consequences in the city.

METHODS

We evaluated the health impacts of different travel pattern scenarios for the São Paulo adult population by comparing the travel patterns of São Paulo in 2012 with counterfactual scenarios in which the city adopted travel patterns of i) those living in the city's expanded centre; ii) London (2012); iii) a highly motorized São Paulo (SP California); and iv) a visionary São Paulo (SP 2040), with high levels of walking and cycling and low levels of car and motorcycle use. For each scenario we estimated changes in exposure to air pollution, road injury risk, and physical activity. Health outcomes were estimated using disability adjusted life years (DALYs) and premature deaths averted. Sensitivity analyses were performed to identify the main sources of uncertainty.

RESULTS

We found considerable health gains in the SP 2040 scenario (total 63.6k DALYs avoided), with 4.7% of premature deaths from ischemic heart disease avoided from increases in physical activity alone. Conversely, we found substantial health losses in the scenario favouring private transport (SP California, total increase of 54.9k DALYs), with an increase in road traffic deaths and injuries among pedestrians and motorized vehicles. Parameters related to air pollution had the largest impact on uncertainty.

CONCLUSIONS

Shifting travel patterns towards more sustainable transport can provide major health benefits in São Paulo. Reducing the uncertainties in the findings should be a priority for empirical and modelling research on the health impacts of such shifts.

Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

OBJECTIVE

to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.

METHODS

retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.

RESULTS

a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.

CONCLUSION

pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

Readmissions due to traffic accidents at a general hospital

Objective:

to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents.

Methods:

victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories.

Results:

among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year.

Conclusion:

the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

Factors associated with access to physical rehabilitation for victims of traffic accidents

OBJECTIVE

Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors.

METHODS

A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables.

RESULTS

Among the 155 respondents, the majority were adolescents and adults between 15–29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7–59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term – family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management – written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10).

CONCLUSIONS

This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan).

Pattern of Injuries from Road Traffic Accidents Presented at a Rural Teaching Institution of Karachi

The aim of the study is to study the pattern of injuries from road traffic accidents presented at the emergency department of a rural teaching institution in Karachi. This descriptive case series was conducted prospectively in the Emergency Department of Fatima Hospital and Baqai Medical University from 1 January 2012 to 21 March 2013. There were 385 patients in the series. All of the patients with recent injuries from road traffic accidents were included. Cases with injuries more than 72 h old were excluded. The majority of patients had lower limb injuries 172 (44.7%), followed by head and neck injuries 107 (27.8%), multiple injuries 62 (16.1%), upper limb injuries 22 (5.7%), abdominoperineal injuries 19 (5%), and chest injuries 3 (0.8%). Majority (229, 59.5%) of patients were given first aid treatment and discharged, while 151 (39.3%) patients were either admitted or referred to better equipped hospitals. Three patients were brought dead, and two patients left against medical advice. The lower limb injuries were the commonest road traffic accidental injuries, followed by head and neck injuries, multiple injuries, upper limb injuries, abdominoperineal injuries, and chest injuries.

Transition of the morbidity and mortality profile in a municipality in the interior of the Brazilian Amazon

INTRODUCTION

The morbidity and mortality profile in a given region reflects its quality of life and provides tools for improving public health policies in that region.

METHODS

A cross-sectional epidemiological study was performed using secondary mortality data collected from the Monte Negro municipality of the Brazilian Western Amazon from 2000 to 2011. These data were compared with data from similar municipalities in other Brazilian macro-regions. Data were obtained through the Departamento de Informática do Sistema Único de Saúde (DATASUS) information system.

RESULTS

The number of deaths reported over the study period was 606. The most common cause of death was external causes of morbidity and mortality [International Classification of Diseases (ICD)-10 chapter 20], followed by diseases of the circulatory system (ICD-10 chapter 9). Among the causes of death according to age group, infectious and parasitic diseases were the most common for 2- to 9-year-old children; external causes of disease were the most prevalent for 10- to 59-year-old people; and circulatory diseases prevailed in individuals over 60 years of age. Eleven percent of deaths were due to unknown causes.

CONCLUSIONS

These results point to a fragility in the public policies for prevention and awareness of this problem. Infectious and parasitic diseases contribute only 4.5% of deaths, but had the third highest Disability-Adjusted Life Year score (1,190 days). Improving support to the Estratégia Saúde da Família (Family Health Strategy) program and implementing a death verification service would significantly aid in reducing the occurrence of non-transmissible chronic diseases and clarifying unknown causes of death.

Os Usos de Simuladores Durante a Formação Profissional para a Condução de Transportes Rodoviários

Resumo Este estudo teórico pretende contribuir com o debate sobre o uso de simuladores nos processos de formação para os profissionais de transporte terrestre rodoviário. Nesse tipo de transporte no Brasil ocorrem muitos acidentes, configurando-se em um problema de saúde pública. Procurou-se analisar criticamente, a partir da produção acadêmica sobre uso de simuladores, suas potencialidades em situações de formação para condutores profissionais. A partir de uma perspectiva ergológica, que permite a articulação com outras clínicas do trabalho, também utilizadas, o artigo tem como objetivos: discutir as características que conformam a atividade de condução, fazer uma análise dos pressupostos epistemológicos subjacentes às pesquisas e treinamentos que usam simuladores e articular criticamente tais pontos para avaliar a pertinência do uso de simuladores em processos de formação profissional. Evidenciou-se que os processos de formação profissional mediado pelo uso de simuladores podem ser pertinentes para a grave situação do trânsito brasileiro, embora se reconheça ausência de pesquisas nacionais sobre a temática, bem como alguns possíveis limites da perspectiva epistemológica utilizadas nas pesquisas internacionais, afetando a eficácia deste uso.

Urgent and emergency care for pedestrians injured in Brazilian traffic

This paper aimed to describe the epidemiological profile of pedestrians injured in traffic accidents treated at urgent and emergency facilities participating in the 2014VIVA Survey and the characterization of these events and consequences for these victims. This is a cross-sectional study conducted in the period from September to November 2014 in 24 Brazilian state capitals and the Federal District. We analyzed variables that characterize the victim, the accident and its severity and case outcome. We calculated simple and relative frequencies and performed a bivariate analysis by gender and age group. We used the Rao-Scott test with a 5% significance level in order to verify the independence of variables. Results show that 34.3% of attendances were for individuals aged 20-39 years, 54.2% had brown skin and 35.9% of individuals had up to 4 years of schooling. Run-overs occurred mainly at night (33.6%) and in the afternoon (31.3%). Most cases resulted in discharge in all age groups, but 41.6% of the elderly (60 years and over) required hospitalization. We stress the need for public investment, prioritizing pedestrian circulation in traffic and road infrastructure planning.

Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence — a population-based study

Abstract This study aimed to describe the profile of motorcycle users and determine the prevalence of use. Also, to evaluate the reason for using a motorcycle, users' perceived risk of traffic accident, pattern of helmet wearing and number of accidents related to motorcycle use in the last 12 months. This cross-sectional study was conducted in the city of Pelotas, Southern Brazil. Sampling process was carried out in two stages, with the primary unit being the census track and the secondary the house. The study included 3,004 individuals aged 10 to 59 years, which answered a structured questionnaire. The outcome of the study was the use of motorcycle. The prevalence of motorcycle use was 25%. The majority of the riders were composed by males (79%). Individuals aged from 18 to 35-years-old comprised 42% of the total number of users, mainly as riders (24%). Forty percent of the users were not using properly the helmet strap. The major part of the users (76%) had a perception of high risk for accidents. The prevalence of accidents was 8%; it was higher among males and among those individuals aged from 18 to 35 years. The use of motorcycle was widespread in the population. Users were aware of the risk of accident, even though they reported to not wear correctly the helmet.

Regional disparities in road traffic injuries and their determinants in Brazil, 2013

BACKGROUND

In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions.

METHODS

We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants.

RESULTS

The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1).

CONCLUSIONS

There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

Mortality and potential years of life lost by road traffic injuries in Brazil, 2013

OBJECTIVE

To estimate the potential years of life lost by road traffic injuries three years after the beginning of the Decade of Action for Traffic Safety.

METHODS

We analyzed the data of the Sistema de Informações sobre Mortalidade (SIM - Mortality Information System) related to road traffic injuries, in 2013. We estimated the crude and standardized mortality rates for Brazil and geographic regions. We calculated, for the Country, the proportional mortality according to age groups, education level, race/skin color, and type or quality of the victim while user of the public highway. We estimated the potential years of life lost according to sex.

RESULTS

The mortality rate in 2013 was of 21.0 deaths per 100,000 inhabitants for the Country. The Midwest region presented the highest rate (29.9 deaths per 100,000 inhabitants). Most of the deaths by road traffic injuries took place with males (34.9 deaths per 100,000 males). More than half of the people who have died because of road traffic injuries were of black race/skin color, young adults (24.2%), individuals with low schooling (24.0%), and motorcyclists (28.5%). The mortality rate in the triennium 2011-2013 decreased 4.1%, but increased among motorcyclists. Across the Country, more than a million of potential years of life were lost, in 2013, because of road traffic injuries, especially in the age group of 20 to 29 years.

CONCLUSIONS

The impact of the high mortality rate is of over a million of potential years of life lost by road traffic injuries, especially among adults in productive age (early mortality), in only one year, representing extreme social cost arising from a cause of death that could be prevented. Despite the reduction of mortality by road traffic injuries from 2011 to 2013, the mortality rates increased among motorcyclists.

OBJETIVO

Estimar os anos potenciais de vida perdidos por acidente de transporte terrestre após três anos do início da Década de Ação pela Segurança no Trânsito.

MÉTODOS

Foram analisados os dados do Sistema de Informações sobre Mortalidade correspondentes aos acidentes de transporte terrestre, em 2013. Foram calculadas as taxas de mortalidade bruta e padronizada para o Brasil e regiões geográficas. Foi calculada, para o País, a mortalidade proporcional segundo faixas etárias, escolaridade, raça/cor da pele e tipo ou qualidade da vítima enquanto usuária da via pública. Foram estimados os anos potenciais de vida perdidos segundo sexo.

RESULTADOS

A taxa de mortalidade, em 2013, foi de 21,0 óbitos por 100 mil habitantes para o País. A região Centro-Oeste apresentou a taxa mais elevada (29,9 óbitos por 100 mil habitantes). A maioria dos óbitos por acidentes de transporte terrestre foi observada no sexo masculino (34,9 óbitos por 100 mil homens). Mais da metade das pessoas que faleceram em decorrência de acidentes de transporte terrestre eram da raça/cor da pele negra, adultos jovens (24,2%), indivíduos com baixa escolaridade (24,0%) e motociclistas (28,5%). A taxa de mortalidade, no triênio 2011 a 2013, apresentou redução de 4,1%, mas aumentou entre os motociclistas. Em todo o País, mais de um milhão de anos potenciais de vida foram perdidos, em 2013, devido aos acidentes de transporte terrestre, especialmente na faixa etária de 20 a 29 anos.

CONCLUSÕES

O impacto da alta taxa de mortalidade é de mais de um milhão de anos potenciais de vida perdidos por acidentes de transporte terrestre, principalmente entre adultos em idade produtiva (mortalidade precoce), em apenas um ano, representando extremo custo social decorrente de uma causa de óbito que poderia ser prevenida. Apesar da redução da mortalidade por acidentes de transporte terrestre de 2011 a 2013, as taxas de mortalidade aumentaram entre os motociclistas.

Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil

OBJECTIVE

The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011-2012.

METHODS

Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography-flame ionization method for alcohol and by a gas chromatography-mass spectrometry for amphetamines, cocaine, and cannabis.

RESULTS

The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine.

CONCLUSIONS

For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.

Bebida Alcoólica e Direção Automotiva: Relatos de Policiais Militares Sobre a “Lei Seca”

Resumo Dirigir sob efeito de bebida alcoólica é comportamento de risco associado a expressivo volume de acidentes de trânsito. Em vários estados brasileiros foram adotadas ações de fiscalização e punição de motoristas flagrados em tal comportamento de risco. O objetivo do presente estudo foi conhecer o contexto atual de realizações e dificuldades um programa de fiscalização implantado em 2003, no estado do Espírito Santo, por meio de entrevistas com 25 policiais militares que atuam em tal programa. O material textual composto pela transcrição das entrevistas foi processado por meio do software Alceste, que organizou as respostas dos policiais em 6 classes de conteúdos: Naturalização e valorização do beber excessivo; Menosprezo do risco da associação entre bebida e direção; Realizações e dificuldades no contexto das ações de fiscalização; Realizações e dificuldades no contexto das ações educativas; Aspectos Legais e operacionais em torno da verificação da embriaguez; Aspectos legais e operacionais relativos à punição do condutor. Considera-se que as concepções de profissionais que participam de forma direta da intervenção relativa ao problema podem contribuir para a discussão e aprimoramento das modalidades de intervenção a serem continuadas.

Lesões no trânsito e uso de equipamento de proteção na população brasileira, segundo estudo de base populacional

Resumo O artigo tem por objetivo descrever as lesões no trânsito segundo características demográficas, utilização de equipamentos de proteção, uso de serviços de saúde, limitação de atividades e incapacidades. Estimou-se o percentual de envolvimento em acidentes de trânsito com lesões, o de uso de equipamentos de proteção, o uso de serviços saúde, limitação de atividades habituais, incapacidades e sequelas, segundo escolaridade, raça-cor, sexo, idade e região de residência. O uso de cinto de segurança na população adulta foi de 79,4% e 50,2%, nos bancos da frente e de trás, respectivamente; o de uso do capacete entre os condutores e passageiros de motocicleta foi respectivamente de 83,4 e 80,1. Equipamentos de segurança são menos usados nas regiões Norte e Nordeste e na zona rural. Relataram acidente de trânsito no último mês 3,1%, sendo maior no sexo masculino 4,5%, nas pessoas de escolaridade de nível fundamental completo e médio completo, adulto jovem e de raça-cor parda. Entre os acidentados receberam algum tipo de assistência de saúde devido a este acidente 52,4% foram internados, 7,7% relataram ter tido limitação de atividades habituais, incapacidades e sequelas decorrente de acidente de trânsito 14,1%. Os acidentes de trânsito são elevados no país.

Urban road traffic deaths: data linkage and identification of high-risk population sub-groups

This study analyzes the profile of deaths from road traffic accidents in Belo Horizonte, Minas Gerais State, Brazil, by linking two public databases, the Information System of the Urban Transportation and Transit Company (BH10) and the Mortality Information System (SIM). The linked database (n = 306) identified a 24% under-recording rate for deaths and differed in the age distribution from the BH10 database and in roadway user category when compared to the mortality database. The mortality rate for road traffic accidents within the city limits was 10.2 per 100,000 thousand, and was higher among men, young adults, and the elderly. Poisson multivariate regression showed a higher mean death rate for motorcycle occupants (rate ratio - RR: 1.81); pedestrians (RR: 1.32); males (RR: 1.24); single/divorced (RR: 1.27); young adults 18-29 years of age (RR: 1.75); elderly (RR: 1.59); and deaths at the crash site (RR: 1.39) when compared to the reference categories. The study unveils the city's traffic violence, expressed by the large proportion of deaths at the crash site and within the first 24 hours, and confirms the relevance of database linkage for characterizing vulnerable groups and traffic accident mortality in the urban setting.

Do speed cameras reduce speeding in urban areas?

This observational study aimed to estimate the prevalence of speeding on urban roadways and to analyze associated factors. The sample consisted of 8,565 vehicles circulating in areas with and without fixed speed cameras in operation. We found that 40% of vehicles 200 meters after the fixed cameras and 33.6% of vehicles observed on roadways without speed cameras were moving over the speed limit (p < 0.001). Motorcycles showed the highest recorded speed (126km/h). Most drivers were men (87.6%), 3.3% of all drivers were using their cell phones, and 74.6% of drivers (not counting motorcyclists) were wearing their seatbelts. On roadway stretches without fixed speed cameras, more women drivers were talking on their cell phones and wearing seatbelts when compared to men (p < 0.05 for both comparisons), independently of speed limits. The results suggest that compliance with speed limits requires more than structural interventions.

Quando e onde se acidentam e morrem os motociclistas em Belo Horizonte, Minas Gerais, Brasil

Resumo O objetivo foi analisar a tendência dos acidentes de transporte terrestre com motociclistas em Belo Horizonte, Minas Gerais, Brasil, de 2007 a 2011, e identificar aglomerados e interseções das vias públicas de maior risco. Foram utilizadas as bases de dados da Polícia Militar e do Serviço de Atendimento Móvel de Urgência (SAMU). Para identificar as interseções críticas foram calculadas as taxas de severidade dos acidentes. Utilizou-se duas técnicas de estatística espacial para analisar os aglomerados de acidentes: análise de kernel e estatística Scan (modelo de Poisson contínuo). Os aglomerados de risco de acidentes foram detectados na Região Central e nos corredores de tráfego. O risco de acidentes, inclusive fatais, foi maior em segmentos que nas interseções. As interseções críticas são rotas de acesso para as regiões da Grande Belo Horizonte. As taxas de mortalidade e de acidentes apresentaram duas tendências distintas. Além disso, a maioria dos óbitos ocorreu à noite. Justifica-se a importância da melhoria das rotas para os motociclistas e do transporte público.

O Serviço Integrado de Atendimento ao Trauma em Emergência (SIATE) como fonte de informações de acidentes de trabalho em Londrina, PR

Resumo Objetivo: descrever as características dos acidentes de trabalho e o perfil das vítimas atendidas pelo Serviço Integrado de Atendimento ao Trauma em Emergência, de Londrina (SIATE), PR. Métodos: trata-se de estudo descritivo transversal. Os dados foram coletados no período de 1º julho a 31 de dezembro de 2008, por meio de entrevistas telefônicas às vítimas ou familiares e busca de informações complementares em relatórios de atendimento dos socorristas. Resultados: foram realizadas 1.312 entrevistas, sendo 465 (35,4%) casos considerados acidentes de trabalho. O perfil predominante dos acidentados é jovem, do sexo masculino, inserido no mercado formal de trabalho como empregado. A maioria dos acidentes de trabalho ocorreu na rua, sendo 376 (80,9%) relacionados ao trânsito; desses, cerca de 65,0% foram identificados como acidentes de trajeto. Nenhum dos casos foi notificado em sistema de informação do Ministério da Saúde. Junto à Previdência Social houve subnotificação de cerca de 40% dos casos de acidentes ocorridos com trabalhadores formais. Conclusão: os serviços de Saúde do Trabalhador devem priorizar ações de prevenção de acidentes ocorridos no espaço da rua, assim como implantar rotinas sistematizadas a fim de intensificar a notificação dos casos em bancos de dados de interesse nacional, conforme preconiza o Ministério da Saúde.

A evolução da carga de causas externas no Brasil: uma comparação entre os anos de 1998 e 2008

Resumo O objetivo foi comparar as estimativas das causas externas provenientes do estudo Carga Global de Doenças, entre os anos 1998 e 2008. A estimação do DALY (disability-adjusted life year) e do YLL (years of life lost) foi baseada em metodologia do estudo Carga Global de Doenças. Para o cálculo do YLD (years lived with disability), foram incluídas informações sobre atendimentos em emergências. Para comparabilidade, fez-se necessária a aplicação da mesma metodologia nos dois momentos analisados, tendo sido a mais recente eleita como padrão de referência. Em ambos os anos as causas externas foram responsáveis por cerca de 10% do total do DALY. Entretanto, sua distribuição interna apresentou marcada diferença entre as regiões do Brasil, com queda no Sudeste e aumento no Norte e Nordeste. Houve aumento das causas intencionais e o DALY se tornou mais letal (maior parcela de YLL). Espera-se que tais resultados balizem a formulação de políticas e/ou o aprimoramento das já existentes com vistas ao efetivo enfrentamento das causas externas.

Patterns of Alcohol Consumption and Related Behaviors in Brazil: Evidence from the 2013 National Health Survey (PNS 2013)

This study uses data from a nationally representative household survey (the 2013 National Health Survey, n = 62,986) to describe patterns of alcohol consumption and related behaviors among Brazilian adults. Analyses include descriptive and multivariable Poisson regression for self-reports in the past 30 days of: drinking any alcohol, binge drinking, binge drinking 4 or more times, and driving after drinking (DD); as well as age of alcohol consumption initiation. Results show that current drinking prevalence was 26%, with an average age of initiation of 18.7 years. Binge drinking was reported by 51% of drinkers, 43% of whom reported binge drinking 4 or more times. Drinking and driving was reported by nearly one quarter of those who drive a car/motorcycle. Current drinking was more likely among males, ages 25-34, single, urban, and those with more education. Binge drinking was more likely among males, older age groups, and people who started drinking before 18. Drinking and driving was higher among males, those with more education, and rural residents. Those who binge-drink were nearly 70% more likely to report DD. All behaviors varied significantly among Brazilian states. Given their potential health consequences, the levels of injurious alcohol behaviors observed here warrant increased attention from Brazilian policymakers and civil society.

Acidentes de trânsito em Belo Horizonte: o que revelam três diferentes fontes de informações, 2008 a 2010

OBJETIVO: Analisar a contribuição de três diferentes fontes de informações na descrição de acidentes de trânsito em Belo Horizonte. MÉTODOS: Estudo exploratório dos Sistemas de Informação da Empresa de Transportes e Trânsito, de Internações Hospitalares e Mortalidade, com análise de proporções, coeficientes e medidas de associação. RESULTADOS: Preenchimento inadequado nas três fontes, destacando o uso de equipamentos de segurança e de álcool pelo condutor. Perfil de homens, jovens, ocupantes de motocicleta ou pedestres semelhante nos três sistemas. Além do alto coeficiente de mortalidade dos residentes em Belo Horizonte (19,4 por cem mil habitantes) no período, observou-se aumento dos acidentes e de vítimas não fatais com concomitante elevação na taxa de internação (34%) e custos hospitalares (53%) e maior envolvimento de motocicletas, proporcionalmente à frota. Os homens condutores apresentaram mais chance de serem feridos ou mortos. Passageiros ou pedestres apresentaram 1,8 vezes a chance de morrer, comparados aos condutores. Verificou-se aumento (12%) das mortes em via pública com 55% de positividade nos exames toxicológicos e 50% mais chance de acidentes fatais nos finais de semana. CONCLUSÃO: Apesar da incompletude dos registros, foi possível caracterizar como principais fatores associados aos acidentes os pedestres idosos, motociclistas, o uso de álcool e excesso de velocidade. O estudo demonstrou a complementaridade das três fontes de dados, com seus diferentes objetivos e permitiu revelar importantes aspectos da cadeia de eventos relacionados aos acidentes e vítimas de trânsito, desde sua ocorrência até a eventual evolução fatal, fornecendo informações relevantes da magnitude do problema para guiar estratégias de controle.

Óbitos por acidentes de transporte terrestre em município do noroeste do Paraná - Brasil

Introdução: os problemas relacionados aos acidentes de trânsito não são atributos exclusivos das grandes cidades; o crescimento do número de veículos circulantes, acrescido ao fato de os veículos serem incorporados no cotidiano das comunidades, faz com que até mesmo os municípios de pequeno e médio porte evidenciem nesses eventos um complexo e importante problema social. Objetivo: o objetivo do estudo foi o de descrever as características dos óbitos por acidente de transporte terrestre (ATT) no município de Cianorte-PR, no período de 2000 a 2010. Métodos: trata-se de um estudo descritivo. O instrumento utilizado para coleta de dados foram as declarações de óbito obtidas do Sistema de Informação de Mortalidade (SIM), incluídos nas categorias V01 a V89 do CID-10-capítulo XX. Resultados: foram estudados 224 óbitos. No ano de 2010, foi registrada a maior taxa de mortalidade (45,7/100.000 hab), e em 2008 a menor (16,7/100.000 hab). Os homens foram 79% (n=177) das vítimas, e a razão de sexo foi 3,7:1. A maior proporção das mortes foi no grupo de 20 a 39 anos (n=95;42%). Motociclistas, ciclistas e pedestres foram os mais vulneráveis (n=127; 57%); no local do acidente, ocorreram 59% dos óbitos (n=132). Os óbitos predominaram nas rodovias (n=139; 62%), no horário das 18 às 24h (n=45; 34,1%) e nos finais de semana (n=70;54%). Conclusão: os ATT configuram-se em uma questão atual de saúde dessa população. Homens adultos jovens são os mais atingidos. Idosos também são vulneráveis. Estratégias de intervenção são intensamente apresentadas na literatura, mas, no cotidiano dos serviços, isso continua um desafio a ser enfrentado.

Man, road and vehicle: risk factors associated with the severity of traffic accidents

OBJECTIVE

To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds.

Built environment and physical activity for transportation in adults from Curitiba, Brazil

The goal of this study was to assess the association between features of the built environment and levels of walking and cycling as forms of transportation in the city of Curitiba, Brazil. Data collection was conducted through a telephone survey in 2008. The International Physical Activity Questionnaire was used to identify walking or cycling as forms of transportation. The built environment characteristics were obtained through the Geographic Information System for 1,206 adults. Density indicators were computed, considering a radius of 500 m around each individual's household. For the accessibility measures, the shortest distance to selected built environment features (e.g., bus stop, bike path) was used. The association between characteristics of the environment and the practice of walking or cycling was assessed through logistic regressions. After considering individual characteristics, higher-income areas (OR = 0.56, 95 % CI = 0.41-0.76), higher density of Bus Rapid Transit stations (OR = 1.50, 95 % CI = 1.22-1.84), and the proportion of residential (OR = 1.25, 95 % CI = 1.02-1.53) and commercial (OR = 1.47, 95 % CI = 1.13-1.91) areas were associated with any walking prevalence (≥ 10 min/week). Higher access to bike paths (OR = 0.80, 95 % CI = 0.64-1.00) was inversely associated with walking at recommended levels (≥ 150 min/week). Higher-income areas (OR = 0.26, 95 % CI = 0.08-0.81), greater number of traffic lights (OR = 0.27, 95 % CI = 0.09-0.88), and higher land use mix (OR = 0.52, 95 % CI = 0.31-0.88) were inversely associated with cycling. The neighborhood built environment may affect active commuting among adults living in urban centers in middle-income countries.