Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace

Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. Methods: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. Results: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/ dependence than among those presenting such abuse (OR for CAGE = 13, p < 0.05; OR for CAGE-GGT = 11, p < 0.05) or dependence (OR for CAGE = 76, p < 0.0 1; OR for GGT = 5, p < 0.0 1). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. Conclusions: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings. (C) 2008 Elsevier Ltd. All rights reserved.

Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo

Aims: The aims of the present study were to characterize fatal traffic accident victims in a major urban center in Brazil and their association with alcohol consumption. Methods: Cross-sectional study of 907 fatal traffic accident victims in Sao Paulo, in 2005. Results: Adult males between the ages of 25 and 54 represented the majority of cases with positive blood alcohol concentrations (BAC). Overall, males had a higher proportional BAC and mean BAC than females. Pedestrians, particularly those with no detectable BAC, were typically older than other victims. Most accidents (total and BAC-positive) happened on weekends between midnight and 6 a.m. Considering all victims, 39.4% were positive (BAC over 0.1 g/l). When only drivers (automobile, motorcycle and bicycle) were evaluated. 42.3% had BAC over the legal limit (0.6 g/l). Conclusions: Alcohol is associated with nearly half of all traffic accident deaths in the city of Sao Paulo. especially for days and times associated with parties and bars (weekends between 12 a.m. and 6 a.m.). (C) 2010 Elsevier Ltd. All rights reserved.

Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country

Background: Traffic accidents constitute the main cause of death in the first decades of life. Traumatic brain injury is the event most responsible for the severity of these accidents. The SBN started an educational program for the prevention of traffic accidents, adapted from the American model ""Think First"" to the Brazilian environment, since 1995, with special effort devoted to the prevention of TBI by using seat belts and motorcycle helmets. The objective of the present study was to set up a traffic accident prevention program based on the adapted Think First and to evaluate its impact by comparing epidemiological variables before and after the beginning of the program. Methods: The program was executed in Maringa city, from September 2004 to August 2005, with educational actions targeting the entire population, especially teenagers and young adults. The program was implemented by building a network of information facilitators and multipliers inside the organized civil society, with widespread population dissemination. To measure the impact of the program, a specific software was developed for the storage and processing of the epidemiological variables. Results: The results showed a reduction of trauma severity due to traffic accidents after the execution of the program, mainly TBI. Conclusions: The adapted Think First was systematically implemented and its impact measured for the first time in Brazil, revealing the usefulness of the program for reducing trauma and TBI severity in traffic accidents through public education and representing a standardized model of implementation in a developing country. (C) 2009 Elsevier Inc. All rights reserved.

Relation between alcohol consumption and traffic violations and accidents in the region of Ribeirao Preto, Sao Paulo State

In recent years, alcohol consumption has been considered an important public health problem. Ethanol, the alcohol used in beverages, is a drug that affects the central nervous system (CNS) and impairs driving skills and co-ordination, increasing risk of deaths and injuries derived from crashes and road accidents. Consumption of alcoholic beverages is implicated with premature deaths, injuries and damages caused by motor vehicle crashes, which result in high costs to government and society. Considering that alcohol consumption is the main responsible factor for deaths and disabilities in young people, the aim of this work was to evaluate the prevalence of blood alcohol in offenders and/or fatal and non-fatal victims of traffic occurrences in the region of Ribeirao Preto, Sao Paulo State, from 2005 to 2007. The results revealed that in 2134 cases investigated, blood alcohol positivity was generally found in young adults, 25-45 years old and male. The study showed the high risk of drinking and driving and the importance in establishing actions of prevention and intervention to promote the reduction in the number of traffic occurrences related to consumption of alcoholic beverages. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Impact of an intervention on the availability and consumption of fruits and vegetables in the workplace

Objective: To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias. Design: This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre. Settings: Companies of Sao Paulo, Brazil. Subjects: Twenty-nine companies and 2510 workers. Results: After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers` consumption of fruits and vegetables (about 11 g) in the meals offered by the companies. Conclusions: Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

Improving the Fluorescence Detectability of Polycyclic Aromatic Hydrocarbons for Evaluation of Workplace Environments of Cement Industries Processing Organic Residues

The burning of organic residues and wastes in furnaces of cement industries has been an attractive and lucrative approach to eliminate stocks of these pollutants. There is a potential risk for producing PAH in the workplace of industries burning organic wastes, so that highly sensitive analytical methods are needed for monitoring the air quality of these environments. An official method for determination of PAH is based on liquid chromatography with fluorescence detection at fixed excitation and emission wavelengths. We demonstrate that a suitable choice of these wavelengths, which are changed during the chromatographic run, significantly improves the detectability of PAH in atmosphere and particulate matter collected in cement industries.

A retrospective study of Traumatic Dental Injuries in a Brazilian dental urgency service

Epidemiologic aspects of traumatic dental injuries (TDI) were evaluated in the permanent dentition in a sample of 847 patients treated at the Dental Urgency Service of the Dental School of the Federal University of Goiás, Brazil, between May 2000 and May 2008. The statistical treatment analyzed data from frequency distribution and chi-square test. The level of significance was set at 5% for all analyses. The results showed a higher incident among males (610; 72.01%) with mean age of 6-10 year-old. Uncomplicated crown fracture (without pulp exposure) (502; 26.95%), avulsion (341; 18.30%) and complicated crown fracture (with pulp exposure) (330; 17.71%) were the most prevalent TDI. The prevalence of trauma throughout the years showed proportionality, being observed a larger number of cases between July and September (249; 29.39%). The most affected teeth were the maxillary central incisors (65.65%), followed by the maxillary left lateral incisors (19.67%). In 311 participants (18.25%), only one tooth was involved, while in most patients (536; 81.75%), TDI occurred in more than one tooth. Significant proportion (82.27%) of traumatized teeth presented completely formed root apex. The main etiologic factors involved in TDI were falls (51.71%), traffic accidents (22.90%) and violence (5.67%). Based on the obtained data, it may be concluded that accurate policies of TDI prevention must be established, capable of stimulating the exposure of appropriate protocols for management of these lesions. The prevalence of TDI in Goiânia subpopulation is compared to the prevalence reported in epidemiological studies in others populations.

Diagnostic agreement between panoramic radiographs and color doppler images of carotid atheroma

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Uso da Classificação Internacional de Doenças na análise do absenteísmo odontológico

OBJETIVO: Comparar o uso das codificações da classificação de doenças e agravos em solicitações de afastamento do trabalho por motivo odontológico. MÉTODOS: Foram analisadas 240 solicitações emitidas em um serviço público federal entre janeiro de 2008 e dezembro de 2009. O uso da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde - Décima Revisão (CID-10) foi comparado ao sistema de Classificação Internacional de Doenças em Odontologia e Estomatologia (CID-OE). Foi determinada a especificidade da codificação nas solicitações de afastamento, bem como da codificação atribuída por peritos oficiais em inspeções indiretas, perícias e juntas odontológicas. RESULTADOS: Do total de atestados, 22,9% não apresentaram a CID, 7,1% apresentaram a CID-9, 3,3% a CID-OE e 66,7% a CID-10. A maioria das codificações foi concordante (55,1%), com maior especificidade nas codificações atribuídas após avaliação dos cirurgiões-dentistas peritos oficiais. CONCLUSÕES: É necessário aperfeiçoar a utilização da CID-10 entre os profissionais de Odontologia e perícia odontológica no trabalho. Sugere-se a incorporação do uso da CID-OE e da Classificação Internacional de Funcionamento, Incapacidade e Saúde para a análise dos afastamentos do trabalho, fornecendo dados relevantes para o monitoramento do absenteísmo por motivo odontológico.

Spatial analysis of urban violence based on emergency room data

OBJECTIVE: To estimate the spatial intensity of urban violence events using wavelet-based methods and emergency room data. METHODS: Information on victims attended at the emergency room of a public hospital in the city of São Paulo, Southeastern Brazil, from January 1, 2002 to January 11, 2003 were obtained from hospital records. The spatial distribution of 3,540 events was recorded and a uniform random procedure was used to allocate records with incomplete addresses. Point processes and wavelet analysis technique were used to estimate the spatial intensity, defined as the expected number of events by unit area. RESULTS: Of all georeferenced points, 59% were accidents and 40% were assaults. There is a non-homogeneous spatial distribution of the events with high concentration in two districts and three large avenues in the southern area of the city of São Paulo. CONCLUSIONS: Hospital records combined with methodological tools to estimate intensity of events are useful to study urban violence. The wavelet analysis is useful in the computation of the expected number of events and their respective confidence bands for any sub-region and, consequently, in the specification of risk estimates that could be used in decision-making processes for public policies.

Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003- 2008

O objetivo foi analisar a evolução do perfil de utilização de serviços de saúde, entre 2003 e 2008, no Brasil e nas suas macrorregiões. Foram utilizados dados da PNAD. A utilização de serviços de saúde foi medida pela proporção de pessoas que procuraram e foram atendidas nas 2 semanas anteriores e pelos que relataram internação nos últimos 12 meses, segundo SUS e não SUS. Foram analisadas as características socioeconômicas dos usuários, o tipo de atendimento e de serviço e os motivos da procura. A proporção de indivíduos que procuraram serviços de saúde não se alterou, assim como a parcela dos que conseguiram atendimento (96%), entre 2003 e 2008. O SUS respondeu por 56,7% dos atendimentos, realizando a maior parte das internações, vacinação e consultas e somente 1/3 das consultas odontológicas. Em 2008, manteve-se o gradiente de redução de utilização de serviços de saúde SUS conforme o aumento de renda e escolaridade. Houve decréscimo da proporção dos que procuraram serviços de saúde para ações de prevenção e aumento de procura para problemas odontológicos, acidentes e lesões e reabilitação. O padrão de utilização do SUS por região esteve inversamente relacionado à proporção de indivíduos com posse de planos privados de saúde.

Fatores associados à capacidade para o trabalho de trabalhadores do Setor Elétrico

O Setor Elétrico passou por recente processo de reestruturação produtiva com reflexos nas condições e organização do trabalho, podendo comprometer a capacidade para o trabalho. Este estudo objetivou avaliar fatores associados à capacidade para o trabalho junto a 475 trabalhadores de uma empresa do Setor Elétrico no Estado de São Paulo, Brasil. Neste estudo transversal foi realizada análise descritiva e análise de regressão linear múltipla. A média do Índice de Capacidade para o Trabalho (ICT) foi de 41,8 pontos (escala de 7,0 a 49,0 pontos). A análise múltipla mostrou que os fatores que melhor explicaram a variabilidade do ICT foram estresse no trabalho (p < 0,001) e saúde física (p < 0,001 em todas as dimensões). Em outra análise, excluídas as dimensões da saúde, as variáveis associadas ao ICT foram estresse no trabalho (p < 0,001), local de trabalho (p = 0,022), prática de atividade física (p = 0,001), consumo de álcool (p = 0,012) e índice de massa corporal (p < 0,001). Os resultados identificaram aspectos a serem considerados no desenvolvimento de medidas visando a preservação da capacidade para o trabalho, com ênfase no controle do estresse no trabalho e na promoção da saúde.

Gastos do Sistema Único de Saúde com internações por causas externas em São José dos Campos, São Paulo, Brasil

O objetivo do estudo foi mensurar os gastos diretos do Sistema Único de Saúde (SUS) com internações por causas externas em São José dos Campos, São Paulo, Brasil. Foram estudadas as internações por lesões decorrentes de causas externas, respectivamente capítulos XIX e XX da CID-10, no primeiro semestre de 2003, no Hospital Municipal Dr. José de Carvalho Florence. Foram analisados os valores pagos através do SUS, após a verificação da qualidade dos dados nos prontuários de 976 internações. Os maiores gastos totais foram por internações decorrentes de acidentes de transporte e quedas. O maior gasto médio de internação foi por acidentes de transporte (R$ 614,63), seguido das agressões (R$ 594,90). As lesões que representaram maior gasto médio foram as fraturas de pescoço (R$ 1.191,42) e traumatismo intracraniano (R$ 1.000,44). As internações com maior custo-dia foram fraturas do crânio e dos ossos da face (R$ 166,72) e traumatismo intra-abdominal (R$ 148,26). Os resultados encontrados demonstraram que os acidentes de transporte, as quedas e as agressões são importantes fontes de gastos com internações por causas externas no município.

Análise epidemiológica das causas externas em unidades de urgência e emergência em Cuiabá/Mato Grosso

OBJETIVO: Apesar da importância das causas externas como problema de saúde pública, pouco se conhece sobre a demanda de serviços de urgência e emergência. Este estudo tem como objetivo caracterizar a morbidade por causas externas em unidades de urgência e emergência do município de Cuiabá/MT. MÉTODO: Trata-se de um estudo transversal e descritivo. Foram analisadas 3.786 vítimas de causas externas atendidas pelas cinco unidades de urgência e emergência da Secretaria Municipal de Saúde de Cuiabá/MT, no período de 1 de maio a 30 de junho de 2005. RESULTADOS: Aproximadamente 88% dos atendimentos se referiam a vítimas de acidentes, 9% corresponderam a agressões e 2% a lesões autoprovocadas. Os acidentes de transportes representaram 22% dos atendimentos, sendo os motociclistas as principais vítimas (49%); as quedas foram as causas mais freqüentes no grupo de outras causas externas de traumatismos acidentais. A prevalência em homens superou a de mulheres. A maior parte das vítimas era menor de 40 anos (79%). No entanto, a análise por tipo de causa externa apresenta resultados diferentes segundo sexo e faixa etária. Cerca da metade dos eventos ocorreu em casa e, em sua maioria, as vítimas receberam alta após o atendimento, sendo que a taxa de mortalidade foi baixa (0,4%). CONCLUSÃO: Os resultados revelam a importância da análise sistemática dos dados referentes às vítimas de acidentes e violência atendidas em unidades de urgência e emergência, como complemento às informações sobre mortalidade e morbidade hospitalar visando o monitoramento dessas causas.

Confiabilidade da informação sobre hospitalizações por causas externas de um hospital público em São José dos Campos, São Paulo, Brasil

OBJETIVO: Conhecer a qualidade dos dados de internação por causas externas em São José dos Campos, São Paulo. MÉTODO: Foram estudadas as internações pelo Sistema Único de Saúde por lesões decorrentes de causas externas no primeiro semestre de 2003, no Hospital Municipal, referência para o atendimento ao trauma no Município, por meio da comparação dos dados registrados no Sistema de Informações Hospitalares com os prontuários de 990 internações. A concordância das variáveis relativas à vítima, à internação e ao agravo foi avaliada pela taxa bruta de concordância e pelo coeficiente Kappa. As lesões e as causas externas foram codificadas segundo a 10ª revisão da Classificação Internacional de Doenças, respectivamente, capítulos XIX e XX. RESULTADOS: A taxa de concordância bruta foi de boa qualidade para as variáveis relativas à vítima e à internação, variando de 89,0% a 99,2%. As lesões tiveram concordância ótima, exceto os traumatismos do pescoço (k=0,73), traumatismos múltiplos (k=0,67) e fraturas do tórax (k=0,49). As causas externas tiveram concordância ótima para acidentes de transporte (k=0,90) e quedas (k=0,83). A confiabilidade foi menor para agressões (k=0,50), causas indeterminadas (k=0,37), e complicações da assistência médica (k=0,03). Houve concordância ótima nos acidentes de transporte em pedestres, ciclistas e motociclistas. CONCLUSÃO: A maioria das variáveis de estudo teve boa qualidade no nível de agregação analisado. Algumas variáveis relativas à vítima e alguns tipos de causas externas necessitam de aperfeiçoamento da qualidade dos dados. O perfil da morbidade hospitalar encontrado confirmou os acidentes de transporte como importante causa externa de internação hospitalar no Município.