RISK FOR INJURIES AMONG MOTORCYCLISTS INVOLVED IN TRAFFIC INCIDENTS

The objective of this study was to identify, among motorcyclists involved in traffic incidents, the factors associated with risk of injuries. In 2004, in the city of Maringa-PR, it was determined that there were a total of 2,362 motorcyclists involved in traffic incidents, according to records from the local Military Police. Multivariate analysis was applied to identify the factors associated with the presence of injury. A significantly higher probability of injury was observed among motorcyclists involved in collisions (odds Ratio = 11.19) and falls (odds Ratio = 3.81); the estimated odds ratio for females was close to four, and those involved in incidents including up to two vehicles were 2.63 times more likely to have injuries. Women involved in motorcycle falls and collisions with up to two vehicles stood out as a high-risk group for injuries.

Gram-negative osteomyelitis: clinical and microbiological profile

Introduction: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. Objectives and methods: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of Sao Paulo. Results: Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. Conclusion: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy. (C) 2012 Elsevier Editora Ltda. All rights reserved.

Risco de lesões em motociclistas nas ocorrências de trânsito

Este estudo teve como objetivo identificar entre os motociclistas envolvidos em ocorrências de trânsito fatores associados ao risco de lesões. No ano de 2004, foram identificados, em Maringá-PR, um total de 2.362 motociclistas envolvidos em ocorrências de trânsito com registro nos boletins da Polícia Militar. Para identificar os fatores associados à presença de lesão, foi utilizada a análise multivariada. Uma probabilidade, significantemente mais elevada de motociclistas se ferirem, foi observada entre aqueles envolvidos em colisão (Odds Ratio = 11,19) e quedas (Odds Ratio = 3,81); para o sexo feminino, a razão de chance estimada foi em torno de 4, e aqueles que estiveram envolvidos em ocorrências com até dois veículos, mostraram 2,63 vezes mais chances de apresentar lesões que os demais. Mulheres, envolvidas em ocorrências com motocicleta do tipo quedas e colisões com até dois veículos destacaram-se como grupo de risco para apresentar lesões.

Fatores associados ao óbito de motociclistas nas ocorrências de trânsito

Para identificar fatores associados ao óbito em motociclistas envolvidos em ocorrências de trânsito, em Maringá-PR, foi realizado estudo retrospectivo incluindo os motociclistas envolvidos em acidentes no ano de 2004. As fontes de dados foram os registros da Polícia Militar, do SIATE e do Instituto Médico Legal. Foram realizadas análises bivariadas e regressão logística binária. Identificaram-se 2.362 motociclistas nos Boletins de Ocorrência e, destes, 1.743 tinham registros nos Relatórios de Atendimento do Socorrista. As vítimas fatais diferiram das demais quanto à faixa etária, ao local de residência, ao tempo de habilitação e as suas condições fisiológicas na cena da ocorrência. No modelo final permaneceram as seguintes variáveis: Escala de Coma de Glasgow (ECGl), Revised Trauma Score (RTS), pulso e saturação de O2 no sangue. As condições fisiológicas das vítimas na cena do acidente se destacaram no modelo final e a ECGl superou o RTS na associação com óbito.

Vítimas de ocorrência de trânsito submetidas a procedimentos cirúrgicos: características e intercorrências transoperatórias

Esta pesquisa objetivou caracterizar as vítimas de ocorrência de trânsito submetidas a procedimentos anestésico-cirúrgicos, segundo dados demográficos e clínicos, e identificar os preditores de intercorrências no período transoperatório (choque hemorrágico ou óbito). Estudo de corte transversal desenvolvido a partir de consulta aos prontuários dos pacientes submetidos à cirurgia, no Instituto Central do Hospital das Clínicas da FMUSP. Nos 69 pacientes, predominaram os jovens, do sexo masculino, vítimas de acidentes motociclísticos/ciclísticos e que receberam atendimento pré-hospitalar. As variáveis: abdome como região mais gravemente lesada pelo Injury Severity Score e as cirurgias geral e ortopédica, apresentaram associação estatística significativa com choque e óbito. A idade associou-se apenas com choque. No modelo final, o Injury Severity Score foi preditor para choque e óbito e a cirurgia geral, apenas para choque. A cirurgia ortopédica foi fator de proteção para óbito. Esses achados subsidiam a equipe cirúrgica no planejamento de estratégicas que visem à redução de desfechos indesejados.

Accidents by external causes in adolescents: care in sentinel urgency and emergency services in the Brazilian State Capitals-2009

Adolescents are seeking new references and experiences, which may involve attitudes of risk and exposure to accidents and violence from external causes. These events constitute a serious Public Health problem. The scope of this study was to analyze the occurrence of accidents by external causes in adolescents from 10 to 19 years of age attended at sentinel urgency and emergency services in Brazil. Data from the 2009 Surveillance System for Violence and Accidents (VIVA 2009) was analyzed in 74 emergency units in 23 state capitals and the Federal District. The findings revealed that 6,434 adolescents (89.8%) were victims of accidents and 730 (10.2 %) were victims of violence. The main causes of the accidents were falls and traffic accidents, and assaults were predominant in violence. For both accidents and violence, non-white male adolescents were predominant and the events occurred most frequently on the public highways. A marked increase was detected, with hospitalization of victims of violence between 15 and 19 years of age. Understanding the epidemiological reality of external causes among adolescents represents an important tool for health prevention and promotion policies and the culture of peace seeking to reduce morbidity and mortality.

The association between low alcohol use and traffic risk behaviors among Brazilian college students

Although there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population. (C) 2012 Elsevier Inc. All rights reserved,

Influence of Helmet Use in Facial Trauma and Moderate Traumatic Brain Injury Victims of Motorcycle Accidents

Objective: The objective of this research was to study the influence of the use of helmet in facial trauma victims of motorcycle accidents with moderate traumatic brain injury. Methods: We retrospectively reviewed the incidence of facial injuries in helmeted and nonhelmeted victims with moderate traumatic brain injury at a referral trauma hospital. Results: The sample consisted of 272 patients predominantly men (94.5%) and between 21 and 40 years old (62.9%). The majority of patients were using helmet (80.1%). The occurrence of facial fractures was most frequent for zygomatic bone (51.8%), followed by mandible (18.8%) and nasal bones (9.2%). Conclusions: Individuals in the most productive age group are most affected, which causes a great loss to financial and labor systems. It is important to take measures to alert the public regarding the severity of injuries likely to occur in motorcycle-related accidents and ways to prevent them.

Work Precariousness and Risk of Accidents in Civil Construction: A study based on the Collective Work Analysis

This paper aims to describe the construction workers' activities, as well as their perceptions about risks and workload. The study, based on the Collective Work Analysis, is part of a broader public policies project for the improvement of SIVAT (Surveillance System of Work Accidents) - in the city of Piracicaba (Southeastern Brazil). Civil construction was prioritized given the epidemiological magnitude of the occurrence of work accidents and the limited efficacy of traditional surveillance initiatives in this sector due to informal employment practices, outsourcing, high staff turnover, etc. The workers have a high level of awareness concerning the risk of accidents, but they believe that the main preventive measures hinder or even make it impossible for them to carry out the tasks. Our findings question the efficacy of traditional training for adherence to safety practices, thus highlighting the need for a transformative pedagogy for preventive practices and the health promotion of workers.

Whole-body computerized tomography and concomitant spine and head injuries A study of 355 cases

The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.

Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil

Drugs are important risk factors for traffic accidents. In Brazil, truck drivers report using amphetamines to maintain their extensive work schedule and stay awake. These drugs can be obtained without prescription easily on Brazilian roads. The use of these stimulants can result in health problems and can be associated with traffic accidents. There are Brazilian studies that show that drivers use drugs. However, these studies are questionnaire-based and do not always reflect real-life situations. The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State, Brazil, during 2009. Drivers of large trucks were randomly stopped by police officers on the interstate roads during morning hours. After being informed of the goals of the study, the drivers gave written informed consent before providing a urine sample. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Urine samples were screened for amphetamines, cocaine, and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry (GC-MS). Of the 488 drivers stopped, 456 (93.4%) provided urine samples, and 9.3% of them (n = 42) tested positive for drugs. Amphetamines were the most commonly found (n = 26) drug, representing 61.9% of the positive samples. Ten cases tested positive for cocaine (23.8%), and five for cannabinoids (11.9%). All drivers were male with a mean age of 40 +/- 10.8 years, and 29.3% of them reported some health problem (diabetes, high blood pressure and/or stress). A high incidence of truck drivers who tested positive for drug use was found, among other reported health problems. Thus, there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aimed at controlling the use of drugs by truck drivers in Brazil. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Acidentes e violência na infância: evidências do inquérito sobre atendimentos de emergência por causas externas - Brasil, 2009

Compreender as características e a magnitude das causas externas (acidentes e violência) em crianças de 0 a 9 anos de idade torna-se cada vez mais importante em Saúde Pública. O objetivo do presente artigo foi analisar os atendimentos de emergência por causas externas em crianças. Utilizaram-se dados do Sistema de Vigilância de Violências e Acidentes em Serviços Sentinelas de Urgência e Emergência (Inquérito VIVA), realizado em 74 serviços de urgência do Distrito Federal e 23 capitais no ano 2009. Analisaram-se dados de 7.123 crianças: 6.897 (96,7%) vítimas de acidentes e 226 (3,3%) de violência. Em comparação às vítimas de violência, os atendimentos por acidentes foram mais frequentes entre crianças de 2 a 5 anos, de pele branca e ocorridos no domicílio (p < 0,05). Dentre os acidentes, as quedas e queimaduras predominaram no grupo de 0 a 1 ano, enquanto os acidentes de transporte foram mais frequentes no grupo de 6 a 9 anos (p < 0,001). Quanto às violências, atendimentos por negligência e agressão física predominaram, respectivamente, nos grupos extremos de faixa etária, sendo um familiar identificado como agressor (p < 0,001). Informações sobre ocorrência de causas externas em crianças podem apoiar políticas de promoção da saúde, além de orientar profissionais de saúde, educadores e famílias na prevenção destas causas.

Forum: social network for the surveillance and prevention of workplace accidents

In 2008, academic researchers and public service officials created a university extension studies platform based on online and on-site meetings denominated "Work-Related Accidents Forum: Analysis, Prevention, and Other Relevant Aspects. Its aim was to help public agents and social partners to propagate a systemic approach that would be helpful in the surveillance and prevention of work-related accidents. This article describes and analyses such a platform. Online access is free and structured to: support dissemination of updated concepts; support on-site meetings and capacity to build educational activities; and keep a permanent space for debate among the registered participants. The desired result is the propagation of a social-technical-systemic view of work-related accidents that replaces the current traditional view that emphasizes human error and results in blaming the victims. The Forum uses an educational approach known as permanent health education, which is based on the experience and needs of workers and encourages debate among participants. The forum adopts a problematizing pedagogy that starts from the requirements and experiences of the social actors and stimulates support and discussions among them in line with an ongoing health educational approach. The current challenge is to turn the platform into a social networking website in order to broaden its links with society.

Erros de utilização de assentos de segurança infantil por menores de 4 anos

OBJETIVO: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. MÉTODOS: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. RESULTADOS: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). CONCLUSÃO: Os dados são coerentes com publicações internacionais.

Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do estado de São Paulo

OBJETIVO: Identificar aglomerados espaciais de microrregiões segundo taxas de óbito por acidentes de trânsito, no Estado de São Paulo, 1 ano antes e 1 ano após a Lei Seca. MÉTODOS: Estudo ecológico e exploratório, no período de 2007 e 2009, em 63 microrregiões do Estado de SP, Brasil. Utilizaram-se ferramentas de geoprocessamento com dados do DATASUS; analisando óbitos decorrentes de acidentes de trânsito em taxas por 100 mil habitantes, construindo coropletes. Nova estatística foi obtida subtraindo-se a taxa de 2009 de 2007, observando regiões de melhora ou piora. RESULTADOS: Em 2007, ocorreram 5.204 óbitos, com média de 83 óbitos/microrregião, variando entre 1 e 1.440. Já 2009 obteve 5.065 óbitos com a média de 80 óbitos/microrregião, variando entre 1 e 1.453. O coeficiente de Moran em 2007 foi I = 0,09 (p = 0,04) com correlação espacial positiva e 2009 obteve I = 0,04 (p = 0,16), sem correlação. A diferença entre as taxas obteve I = 0,23 (p = 0, 007), indicando associação espacial. Em 2007, Presidente Prudente, Rio Claro, Campinas, Bragança Paulista, Osasco e São Paulo tiveram altas taxas de óbito. Dessas regiões citadas, somente Osasco não se destacou em 2009. Ribeirão Preto, Ourinhos e Avaré obtiveram piora em 2009. A diferença entre as taxas de 2009 e 2007 mostrou que Amparo, Bragança Paulista e Campinas tiveram melhora, e Presidente Prudente e Ourinhos apresentaram piora. CONCLUSÃO: Foi possível identificar os locais com as maiores taxas de mortalidade, apontando locais onde as ações de fiscalização devem ser revisadas.