Caracterização do acidente de trânsito e gravidade do trauma: um estudo em vítimas de um hospital de emergência de Natal

Descriptive exploratory study, with quantitative approach and prospective data performed on the Monsenhor Walfredo Gurgel Hospital Complex (MWGH), in Natal/RN, aiming to classify the type of motor vehicle involved in the accident, the public roadway s user quality and the more frequent injuries; to evaluate the severity of trauma in traffic accident victims; characterized the severity of the injuries and the trauma, and the type of motor vehicle involved. The population comprises 605 traffic accident victims, with data collected between October and December 2007. We used as a support for the evaluation of severity of injuries and trauma the Glasgow Coma Scale (GCSl), the Condensed Abbreviated Injury Scale (CAIS) and the Injury Severity Score (ISS). The results show that 82.8% of the victims were male; 78.4% were aged 18 to 38; the victims originating from the State s Countryside prevailed (43.1%); 24.3% of the population had completed middle-level instruction; 23.1% worked on commerce and auxiliary activities; most (79.4%) was catholic; 48.8% were married/consensual union; 76.2% earned up to two monthly minimum wages; Sunday was the day with the most accidents (25.1%); 47.4% were attended to in under an hour after the event; the motorcycle on its own was responsible for 53.2% of the accidents; 42.3% were attended to by the SAMU; 61.8% were victims of crashes; over half (53.4%) used individual protection equipment (IPE); 49.4% were helmets and 4.0% the seatbelt; 61.3% were motorcycle drivers; 43.3% of the accidents took place in the afternoon shift; from 395 drivers, 55.2% were licensed, and 50.7% among those had been licensed for 1 to 5 years; 90.7% of the victims had GCS1 between 13 and 15 points at the time of evaluation; the body area most affected was the external surface (35.9%); 38.8% of the injuries were light or moderate (AIS=1 and AIS=2); 83.2% had light trauma (ISS between 1 and 15 points). In face of the results, we can conclude that there is a risk for the elevation of injury severity and trauma resulting from traffic accidents, when these events are related to certain variables such as gender, age, weekday, the interval between the accident and the first care, ingestion of drugs, type of accident, the public roadway s user quality, the use of IPE, day shift, body regions and the type of motor vehicle involved in the accident

Trânsito de saberes e campo representacional na visão dos profissionais da saúde da família e do programa de educação pelo trabalho e para a saúde

The Family Health Strategy (ESF) is emerging as a possible restructuring of services and new practices of intervention in health care; it requires skilled professionals to work with that framework. Within this purpose, we established the Education Programme for Work and Health (PET-Saúde), in order to integrate teaching and service activities, focusing on primary care. On this basis, the aim of this work is to apprehend the social representation of nurse, doctor and dentist (Project PET-Natal Health RN preceptors) on the ESF, while practice field of them. It is a descriptive and exploratory study, with a qualitative approach, carried out in 07 Family Health Units (USF) included in the PET-Saúde Natal (RN). The population was composed of 35 professional components of the primary care team with bachelor's degree of the USF linked to this project. The sample was composed of 05 nurses, 05 physicians and 05 dentists, for a total of 15 subjects. Data were collected through three instruments: the drawing-themed story, a semi-structured individual interviews and field diary. The data relating to the identification of the subjects were entered and tabulated by the Microsoft Excel software 2007 version. The drawing analysis and interpretation is given by the significance attributed to the resource chart from title and keywords assigned by the subjects, considering the ESF as an inductive term. The stories and interviews were transcribed and typed and then subjected to read/listen the material and a lexical analysis through Alceste. After this process, the discursive material was analyzed and discussed by theoretical and methodological feature of the Social Representations theory. The majority of health professionals were female, aged between 46 and 52 years old, married, income less than six minimum wage, time since graduation ranged from 22 to 29 years and working time in the ESF range from 02 to 11 years. From the classification system ALCESTE were selected categories identified by: Category 1 - ESF: relations and territory; Category 2 - Training and bond profile; Category 3 - Working process in the ESF; Category 4 - Articulation between teaching and service; Category 5 - Health care and disease prevention. The representational field construction, while a process, followed the logic of structural cores in existing categories. In this sense, it is clear that the ESF is an environment rich in diversity, experience and relationships with potential such as the relationship "very subject-subject" and the link established between professional-community, but also has some weaknesses such as poor working conditions, lack of popular participation and management support, thus difficulties in the achievement of teamwork. Being essential to that end, the teaching-service aimed at the formation of a new health professional able to work in the ESF. In this research, the training of the representational field encountered a diversity of structural cores, or thoughts on training, about the ESF because of the greater emphasis on the here and now of the interaction between health professionals, the ESF, the community, PET Health-UFRN and students, emphasizing that such proposals are still considered as concepts in the context of recent health and that, therefore, are not fully realized in the social imaginary

Da negatividade a positividade: possível trânsito de saberes, práticas e representações sociais sobre o estigma da hanseníase

Leprosy is a chronic infectious-contagious disease, caused by Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms and has great disabling power. It was marked by a strong stigma throughout its history, since its bearers represented a threat, target of fear and social contempt. Currently, leprosy has treatment and cure, and the need to separate the diseased from family and social environment is no more necessary. However, patients still suffer prejudice and discrimination. This study aimed to understand the social representations of leprosy that interfere modifying mental health of the patient with leprosy in relation to stigma and prejudice. This is a descriptive and exploratory study, with qualitative approach, which involved 22 users of the Special Care Clinic in Infectious Diseases at the Hospital Giselda Trigueiro, located in Natal / RN. They were in use of multidrug therapy in the period of data collection, were of both sexes, aged between 16 and 80 years of age and classified as paucibacillary or multibacillary. The study was approved by the UFRN Ethics in Research Committee. Data collection was performed by filling the questionnaire identification and then for conducting the semi-structured interview, which was recorded. After the end of data collection, there was the construction of tables and graphs, using the Microsoft Excel Start 2010 for proper characterization of the research subjects; and for the treatment of the data obtained from the interviews, was used the Content Analysis and based on the Theory of Social Representations. The subjects studied were mostly male (64%), married or in a stable relationship (68%), concentrated in the age group 50-60 years (36%) and 28-38 years (23%), had at most elementary education (65%) and were low-income (59%). Of the total respondents, 64% were classified as multibacillary, with predominantly dimorfous form, and 50% had disability grade I or II, with different periods of diagnosis. The reports originate two categories: 1. The negative meanings of illness and leprosy; and 2. The positive meanings of illness in leprosy, which were subsequently subdivided into subcategories. Thus, it was found that in the group studied, the social representation of leprosy experiences a moment of transition, as regards the understanding of the disease and its way of experiencing the disease process. Such representation is anchored in the quality of information on the disease of its bearers and aimed at an attempt to face the illness of leprosy as a "normal process". It was found in this study that the transition is due to the work of combating stigma and consequences of leprosy, which is able to gradually transform reality, both regarding the team work of reference, and in relation to a broader character, of actions of health education, which favors overcoming of psychosocial disabilities

Conversão do metano via oxicloração em reator de leito fixo utilizando catalisador do tipo CuCl2/SiO2

Supported catalysts of CuCl2 on sílica were used in the methane oxychlorination reaction. The materials were synthesized by the ion exchange technique in a basic solution, using a copper-ammonia complex with 3 and 6 % of nominal copper loading. The materials where characterized by thermogravimetry (TG), X-ray Fluorescence Spectroscopy (XRF), Temperature Programmed Reduction (TPR), Scanning Electron Microscopy with X-ray microanalysis (SEM/EDS), BET specific area and pore distribution. The characterization confirms the presence of copper on the support surface, concluding that the ion exchange technique was adequate in the catalyst synthesis. For the reaction test, an oxychlorination bench scale unit was employed. The tests were carried at 673 and 773 K. The results showed the influence of temperature and catalyst copper content on the oxychlorination of methane reaction

Conversão catalítica de clorometano em hidrocarbonetos

Amorphous silica-alumina and modified by incipient impregnation of iron, nickel, zinc and chromium were synthetized in oxide and metal state and evaluated as catalysts for the chloromethane conversion reaction. With known techniques their textural properties were determined and dynamics techniques in programmed temperature were used to find the acid properties of the materials. A thermodynamic model was used to determine the adsorption and desorption capacity of chloromethane. Two types of reactions were studied. Firstly the chloromethane was catalytically converted to hydrocarbons (T = 300 450 oC e m = 300 mg) in a fixed bed reactor with controlled pressure and flow. Secondly the deactivation of the unmodified support was studied (at 300 °C and m=250 g) in a micro-adsorver provided of gravimetric monitoring. The metal content (2,5%) and the chloromethane percent of the reagent mixture (10% chloromethane in nitrogen) were fixed for all the tests. From the results the chloromethane conversion and selectivity of the gaseous products (H2, CH4, C3 and C4) were determined as well as the energy of desorption (75,2 KJ/mol for Ni/Al2O3-SiO2 to 684 KJ/mol for the Zn/Al2O3-SiO2 catalyst) considering the desorption rate as a temperature function. The presence of a metal on the support showed to have an important significance in the chloromethane condensation. The oxide class catalyst presented a better performance toward the production of hydrocarbons. Especial mention to the ZnO/Al2O3-SiO2 that, in a gas phase basis, produced C3 83 % max. and C4 63% max., respectively, in the temperature of 450 oC and 20 hours on stream. Hydrogen was produced exclusively in the FeO/Al2O3-SiO2 catalysts (15 % max., T = 550 oC and 5,6 h on stream) and Ni/SiO2-Al2O3 (75 % max., T = 400 oC and 21,6 h on stream). All the catalysts produced methane (10 à 92 %), except for Ni/Al2O3-SiO2 and CrO/Al2O3-SiO2. In the deactivation study two models were proposed: The parallel model, where the product production competes with coke formation; and the sequential model, where the coke formation competes with the product desorption dessorption step. With the mass balance equations and the mechanism proposed six parameters were determined. Two kinetic parameters: the hydrocarbon formation constant, 8,46 10-4 min-1, the coke formation, 1,46 10-1 min-1; three thermodynamic constants (the global, 0,003, the chloromethane adsorption 0,417 bar-1, the hydrocarbon adsorption 2,266 bar-1), and the activity exponent of the coke formation (1,516). The model was reasonable well fitted and presented a satisfactory behavior in relation with the proposed mechanism

Grande Sertão: Veredas e Don Quijote de la Mancha: melancolia em trânsito

Esta disertación aborda la lectura e interpretación de las obras Grande Sertão: Veredas, de João Guimarães Rosa y Del Ingenioso Hidalgo Don Quijote de la Mancha, de Miguel de Cervantes Y Saavedra, enfocando aspectos relacionados a las acciones de los caballeros andantes Riobaldo, el jagunço de Rosa y don Quijote, el Caballero de Cervantes, las cuales tuvieron decisiva influencia en su estado de espíritu melancólico. En la base teórica de este trabajo, investigamos la noción de melancolía, sistematizada por Kristeva y Freud, así como los estudios de la melancolía y de la alegoría a la luz del pensamiento de Walter Benjamin. Este estudio se concentra, sobre todo, en el aspecto que denominamos de alegoría de la circularidad, que permea las dos novelas, mientras expresión de cosas inacabadas que sugiere la idea de movimientos de espiralamento. Se percibió que lo retorno es consagrado en ambas las obras, es decir diferente el igual, dicho que consagra la diferencia y cierra las puertas para la repetición literal de sentido. En tal comprensión, ese movimiento no puede ser concebido como metáfora del mismo, pues sugiere la travesía que permanece inacabada y tortuosa, su estatuto de repetición no se honda en el encuentro de las dos puntas del ovillo, porque gira en el interior de aquello que repite como diferencia y liberación

Letramento no trânsito: eventos e práticas na formação de condutores de veículos

In the contemporary society, the language is presented in all social spaces and assumes many different purposes in order to meet the needs that emerge from each of these sphere. In traffic, this reality is not different. To guide vehicles, it is necessary to know, by means of reading artifacts, what the legislation establishes in what concerns the way to act in this domain. Thus, this works aims at describing the practices of literacy held in events of driver trainings and know the expectations generated by drivers/learners from this training. In theoretical terms, it anchors in Literacy Studies, comprehended here as social practices (BARTON; HAMILTON, 1998; KLEIMAN, 1995, 2008; MORTATTI, 2004; STREET, 1984; OLIVEIRA, 2008, 2010; ROJO, 2009; PAZ, 2008). Genre Theory (BRONCKART, 2004, 1999; OLIVEIRA, 2010) and in your multimodal instance (KRESS; VAN LEEUWEN, 1996; DIONÍSIO, 2006). In terms of methodology, it follows the bias of qualitative research, because of its ethnographic nature (BOGDAN; BIKLEN, 1994; MINAYO, 2010; CANÇADO, 1994; CHIZZOTTI, 2005). The research corpus was generated by reading the Brazilian Traffic Code, by observing the literacy events held in Drivers Training Centers of Natal, analysis of course books used in these events, plus questionnaires with open and closed questions and semistructured interviews. The collaborators are constituted of drivers in training, and instructors who work in this field. The analyses show significant contributions regarding the placement more committed of future drivers with the welfare and safety of those who use the public roads, from the practice or reading done during the traffic training. The contribution of this work lies in the possibility to expand the discussion about the language practice uses regarding the training for the traffic, more specifically, the training of drivers of vehicles

Reflexões filosóficas em torno da constituição do sujeito religioso-moral no pensamento de Freud

The present research deals with a philosophical reflection about the constitution of the subject religious and moral in the thought of Freud, starting from of question of religion while one of the various spaces concretion of the individual morality. Our hypothesis is that religion presents itself as a space of revival of the primary relationship with the mother of the subject and as a moral agency. That primary relationship corresponds to the period before the Oedipus complex. The cut caused in the Oedipus complex sake in the an emptiness the subject, leading him to a situation of helplessness. In trying to fill the emptiness and consequently out of the situation of displeasure occasioned by the helplessness, the individual seeks diverses means, between which, the religion. The religion, that sense, quest for one part, that support be filling of the existential emptiness, triggered in the Oedipus complex, and on the other, works as a staunch ally of the Superego, which for turn is direct heir of the Oedipus complex and whose function is to require of the subject to moral living, as is established by the social body, where the individual is inserted. Therefore, we seek to draw this subject starting from general ideas of the philosophy, about the moral, as well as some theoretical elements of freudian thought, since his idea of the origin of the culture, morality and religion the more specific elements that pertain to the individual subject, ie, the psychism

A incorporação da saúde bucal no programa saúde da família do Rio Grande do Norte: investigando a possibilidade de conversão do modelo assistencial

The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models

Indicadores associados a acidentes de trânsito envolvendo motoristas de ônibus da cidade de Natal

The purpose of this study was to investigate indicators of urban bus drivers involvement in transit accidents. We analyzed their involvement in accidents in relation to several indicators suggested by the literature, including the temporal dimension of those bus drivers, as expressed in Zimbardo's Time Perspective Inventory (ZTPI), for previous studies have shown that people more present time oriented revealed greater tendency to engage in risk driving. A questionnaire was applied to 457 bus drivers of the city of Natal, RN, Brazil, with questions about participants socio-demographic information, their professional performance and items on time perspective, presented in a five points Likert type scale. Among the indicators analyzed, the best predictors of traffic accidents were: worried about not being on schedule, family problems, and falling asleep; to work overtime, passengers complaints, work while on vacations and medical leaves. In regard to drivers' time perspective, the sub-scale of "combined present" showed a positive relationship with involvement in transit accidents, while the future scale a negative one, in both cases in accordance with the expect direction, even though the effects have not been statistically significant. The selected predictive variable indicate that traffic accidents are mainly associated to situational factors, that could be prevented through the betterment of work conditions of the bus drivers and other organizational and public policies, since transit accidents should be part of initiatives in the areas of health and safety

Turismo religioso na cidade da santa: a percepção da comunidade sobre a construção do Complexo Turístico e Religioso Alto de Santa Rita, Santa Cruz/RN

The general objective of this study was to analyze the city of Santa Cruz cope with the impacts of the changes caused by the insertion of religious tourism with the construction of the Tourist Complex Religious Alto de Santa Rita, and specific objectives: to identify the economic activities from building the Tourist Complex Religious Alto de Santa Rita with the monument of Santa Rita; describe the research scenario to respect the traditions, rituals and spatial organization of the city and to evaluate the impacts through construction of movement by Religious Tourism Complex human capital and economic development fostered by Religious Tourism. To this end, we used the methods of application of Questionnaires and interviews, as well as the method was conducted participant observation, individual and systematic, having exploratory held through a correlational analysis regarding the impacts by inserting Tourism religious elsewhere. Was performed also discourse analysis of speeches Stakeholder city of Santa Cruz / RN for understanding the local reality. Literature search was performed readings of books, articles, theses and dissertations dealing with the issue, it was necessary to use data from websites. As for the media research field was qualitative. At the end of the study, it was concluded that the city of Santa Cruz suffered socio-economic and cultural, as a result, especially the lack of a previously developed tourism planning

Fatores capazes de influenciar o apoio dos residentes ao desenvolvimento do turismo religioso em Santa Cruz - RN

This study is about the primary stakeholder management - the resident community, given its participation and support for the development of tourism in touristic destinations. It has as a general aim to analyze the factors that are capable to influence the residents‟ support to the development of religious tourism in Santa Cruz, RN, and the existing interrelationships between factors. In order to achieve this objective, it was necessary to use exploratory and descriptive research, followed by a quantitative approach through questionnaires with 422 residents of Santa Cruz -RN. The study was based on the variables relationship model proposed by Nunkoo and Ramkissoon (2012), it was also used the technique of Structural Equation Modeling - SEM, aiming to explain the relationships between the constructs studied. The results found on the survey suggest that the more residents realize the benefits generated by tourism, as well as trust in government actors in charge of tourism development, the more there will be a propensity to support the development of religious tourism. This result is similar to the one found in the study of Nunkoo and Ramkissoon (2012). We conclude that the structural model that best represents the reality of Santa Cruz -RN is composed of the factors: benefits, costs, and confidence in governmental actors, which are able to influence the support of Santa Cruz‟s residents for the development of religious tourism. It is also noteworthy that it was found a highly significant connection between the factors benefits perceived from tourism and confidence in governmental actors and between both of them, the political support for tourism

Sistema de conversão de energia eólica baseado no gerador de indução duplamente alimentado: análise e contribuição ao controle da máquina

The humanity reached a time of unprecedented technological development. Science has achieved and continues to achieve technologies that allowed increasingly to understand the universe and the laws which govern it, and also try to coexist without destroying the planet we live on. One of the main challenges of the XXI century is to seek and increase new sources of clean energy, renewable and able to sustain our growth and lifestyle. It is the duty of every researcher engage and contribute in this race of energy. In this context, wind power presents itself as one of the great promises for the future of electricity generation . Despite being a bit older than other sources of renewable energy, wind power still presents a wide field for improvement. The development of new techniques for control of the generator along with the development of research laboratories specializing in wind generation are one of the key points to improve the performance, efficiency and reliability of the system. Appropriate control of back-to-back converter scheme allows wind turbines based on the doubly-fed induction generator to operate in the variable-speed mode, whose benefits include maximum power extraction, reactive power injection and mechanical stress reduction. The generator-side converter provides control of active and reactive power injected into the grid, whereas the grid-side converter provides control of the DC link voltage and bi-directional power flow. The conventional control structure uses PI controllers with feed-forward compensation of cross-coupling dq terms. This control technique is sensitive to model uncertainties and the compensation of dynamic dq terms results on a competing control strategy. Therefore, to overcome these problems, it is proposed in this thesis a robust internal model based state-feedback control structure in order to eliminate the cross-coupling terms and thereby improve the generator drive as well as its dynamic behavior during sudden changes in wind speed. It is compared the conventional control approach with the proposed control technique for DFIG wind turbine control under both steady and gust wind conditions. Moreover, it is also proposed in this thesis an wind turbine emulator, which was developed to recreate in laboratory a realistic condition and to submit the generator to several wind speed conditions.

O atendimento do enfermeiro aos acidentados de trânsito terrestre

Considered the disease of the 20th century, the trauma is still the main cause of mortality in the age group of one to forty-four years old in World, and among several possible etiologies, the terrestrial transit accident has a strong impact on these statistics. The operational essentiality of nurses in the organization and integration of this scenario of care to the terrestrial transit casualties and the recognition that the moments after the trauma are decisive in the victim's prognosis, justify this study. Thus, it was sought to evaluate the nurses´care to casualties of land transit in this crucial process in a public hospital in urgent and emergency reference. This is an normative evaluative study with qualitative approach, carried out at the Hospital Monsenhor Walfredo Gurgel, located in the municipality of Natal/RN. Data collection occurred in May 2014, with approval of the Ethics Committee in Research (CAAE 27971114.9.0000.5537). The target population of the study were the nurses who work in Politrauma area of the hospital, following the inclusion criteria: agree to be part of the study voluntarily and act in the mentioned area and, as exclusion: allocated professionals in other areas (eventually acting in the area) and professionals on vacation and/or medical license. A semi-structured interview and non-participant observation was held to obtain data submitted subsequently to the technique of Content Analysis based on Bardin. The lack of specific training for trauma care was identified, whose severity can be mitigated with proper and skilled care. Therefore, the urgent need of the nurses' training for qualification of care to the victims of traffic accidents on land was evidenced

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.