El pediatra y los padres en la toma de decisiones de tratamiento en plagiocefalia posicional: una revisión narrativa / The pediatrician and parents in treatment decision-making in positional plagiocephaly: A narrative review

La plagiocefalia posicional (PP) es una de las causas más frecuentes de consulta en neurocirugía pediátrica. La incidencia de PP aumentó en los '90, a partir de la campaña Dormir de espaldas. Junto con el aumento de la demanda de atención, se verifica un debate acerca de la eficacia de los distintos tratamientos. La interacción padres ­ pediatra orientada a elegir la mejor terapéutica adquiere importancia, particularmente cuando se trata de decisiones sensibles a la preferencia. Es necesario saber más acerca de la naturaleza de la toma de decisiones de tratamiento de PP, para contribuir al desarrollo de procesos decisorios eficaces. Se realizó una revisión narrativa sobre investigaciones en toma de decisiones de tratamiento en PP. Se identificaron artículos en PubMed y Google Scholar (1990 ­ 2022) en una búsqueda con los descriptores "plagiocephaly", "decision making" y "parents". Se incluyeron artículos cuyo tema central fuera la toma de decisiones en PP, o que la desarrollaran como parte de otro tema. Se excluyeron trabajos en los que la toma de decisiones aparece de modo secundario o tangencial. Se encontraron 3 artículos con distintos diseños metodológicos, en los que la severidad de la presentación, los elementos socioculturales y emocionales, y los aspectos relacionados con el tratamiento son los factores más implicados en la toma de decisiones. Las relaciones entre la ansiedad parental, las expectativas de tratamiento y la percepción subjetiva de la PP, y el rol del pediatra como proveedor de información válida y confiable son temas que necesitan de ulterior investigación (AU)

Positional plagiocephaly (PP) is one of the main reasons for consultation in pediatric neurosurgery. The incidence of PP increased in the 1990s, after the "Back to Sleep" campaign. Concurrently, the growing demand for care has led to a debate regarding the effectiveness of the different treatments. The parent-pediatrician interaction is aimed at choosing the best therapeutic approach becomes important, particularly when it comes to preference-sensitive decisions. There is a need to better understand the nature of PP treatment decision-making in order to contribute to the development of effective decisionmaking processes. In this narrative review, we evaluated the research on treatment decision-making in PP. Articles were identified in PubMed and Google Scholar (1990 - 2022) using the search terms "plagiocephaly", "decision-making" and "parents". Articles were included if their central theme was decision-making in PP, or if they developed it as part of another subject. We excluded articles in which decision-making appeared in a secondary or tangential way. Three articles were identified with different methodological designs, in which the severity of the presentation, sociocultural and emotional aspects, and aspects related to treatment were the factors most implicated in decision making. The relationships between parental anxiety, treatment expectations, subjective perception of PP, and the role of the pediatrician as a provider of valuable and reliable information are topics that require further investigation (AU)

Equipamentos de proteção individual para atendimento de casos suspeitos ou confirmados do novo Coronavírus / Equipo de protección personal para el manejo de casos sospechosos o confirmados del nuevo Coronavirus / Personal protective equipment for handling suspected or confirmed cases of the new Coronavirus

Objetivo: refletir sobre especificações técnicas e indicação de uso de equipamentos de proteção para profissionais da saúde no atendimento de casos suspeitos ou confirmados do novo Coronavírus na perspectiva das recomendações internacionais e nacionais. Método: ensaio teórico reflexivo, oriundo de estudos de professores de uma universidade pública brasileira, fundamentado na literatura internacional e nacional sobre o tema. Resultados: o uso de aventais impermeáveis foi unânime em relação às recomendações de proteção dos profissionais. Entretanto, apesar da eficácia dos equipamentos gorros, toucas e macacões, esses não pertenciam às diretrizes da maioria dos países, inclusive do Brasil. Alguns estabelecimentos de saúde, para garantir maior segurança dos trabalhadores, disponibilizaram esses equipamentos de modo autônomo. Conclusões: o estudo refletiu acerca das indicações do uso de equipamentos de proteção individual pela literatura científica e por órgãos governamentais no mundo, considerando a pandemia do novo Coronavírus.(AU)

Objective:to reflect on the technical specifications and indication of using protective equipment to health workers when caring suspicious or confirmed cases of the novel coronavirus from the perspective of the international and national recommendations. Method:theoretical and reflective essay derived from studies carried out by professorsfrom a Brazilian public university based on the international and national literature about the theme. Results:the use of impermeable aprons is unanimous regarding the recommendations for the workers` protection. However, although the efficacy of equipment like caps, medical scrub caps and overalls, these items are not included in the guidelines of most countries including Brazil. A few health institutions have provided this equipment in an autonomous way to guarantee more safety to their workers. Conclusions:the study reflected on the recommendations to use personal protective equipment by the scientific literature and government agencies in the world in view of coronavirus pandemic. (AU)

Objetivo:reflexionar sobre las especificaciones técnicas e indicación del uso de equipos de protección para profesionales de la salud durante laatención de los casos sospechosos o confirmados del nuevo coronavirus en la perspectiva de las recomendaciones internacionales y nacionales. Método:ensayo teórico reflexivo, proveniente de estudios de profesores de una universidad pública brasileña. Resultados:el uso de delantales impermeables fue unánime con relación a las recomendaciones de protección de los profesionales. Sin embargo, pese a la eficacia de los equipos como gorras, sombrerosy overoles, estos no hacen parte de las directrices de la mayoría de los países, incluso de Brasil. Algunos estabelecimientos de salud ponen esos equipos a disposición de modo autónomo a los trabajadores para garantizarles mayor seguridad. Conclusiones:el estudio reflexiona acerca del uso de equipos de protección personal según proveídas por la literatura científica y las entidades gubernamentales en el mundo debido a la pandemia.(AU)

Cascos fríos para la prevención de alopecia inducida por quimioterápicos / Cold caps for the prevention of chemotherapy-induced alopecia

Uno de los efectos adversos que generan mayor impacto psicosocial en los pacientes que se someten a quimioterapia es la pérdida de cabello. El uso de los cascos fríos podría representar una alternativa para prevenir la alopecia. Estos dispositivos producen vasoconstricción en los vasos sanguíneos del cuero cabelludo provocando que los quimioterápicos lleguen en menores concentraciones a los folículos pilosos, y por consiguiente, evitando que los citotóxicos alcancen el metabolismo de las células foliculares. Se propone que este proceso permita prevenir la alopecia, aunque existe una preocupación que es la posibilidad de metástasis en cuero cabelludo si la quimioterapia no llega a este tejido. Partiendo de la consulta de una paciente con diagnóstico reciente de cáncer de mama, surge el interrogante si en pacientes en tratamiento con quimioterapia el uso de cascos fríos en comparación con su no utilización, disminuye la caída del cabello y si aumenta el riesgo de metástasis en cuero cabelludo. Luego de realizar una búsqueda, se analizaron los resultados de tres artículos pertinentes. Se concluye que el uso de cascos fríos en pacientes que reciben quimioterapia representaría una opción válida para prevenir la alopecia sin indicios de problemas de seguridad y se realiza una reseña acerca de la disponibilidad de los cascos fríos en Argentina. (AU)

One of the adverse effects that generate greater psychosocial impact in patients undergoing chemotherapy is hair loss. The use of cold caps could represent an alternative to prevent alopecia. These devices produce vasoconstriction in the blood vessels of the scalp, causing chemotherapeutic agents to reach the hair follicles in lower concentrations, and there forepreventing toxins from being metabolized by the follicular cells. Thus, alopecia could be prevented but, there is a concern that is the possibility of metastasis to the scalp if the therapy does not reach this tissue. Based on a consultation of a patient recently diagnosed with breast cancer, the question arises whether in patients undergoing chemotherapy the useof cold caps compared to their non-use reduces hair loss and whether it in creases the risk of metastasis to the scalp. After performing a search, the results of three relevant articles were analyzed. It is concluded that the use of cold helmets in patients receiving chemotherapy would represent a valid option to prevent alopecia without indications of safety problems. Finally, a review is made about the availability of scalp-cooling devices in Argentina.

Uso de capacete e gravidade de lesões em motociclistas vítimas de acidentes de trânsito nas capitais brasileiras: uma análise do Viva Inquérito 2017 / Helmet use and injury severity among crashed motorcyclists in Brazilian state capitals: an analysis of the violence an accidents survey 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.

ABSTRACT: Objective: To analyze the effect of helmet use on injury severity among motorcyclists and passengers involved in traffic accidents. Methods: Cross-sectional study of traffic accidents involving motorcyclists attended at the emergency healthcare units participating in the Violence and Accidents Survey Conducted in Sentinel Emergency Departments (Viva Survey) 2017. Results: There was a predominance of individuals aged 18 to 29 years old (46.6%), black (75.2%), with high school education (50.6%). Alcohol use was observed in 14.1% of cases. Helmet use was associated with a 76% reduction in the occurrence of head trauma and a 28% reduction in the referral, hospitalization or death. Conclusion: Young, male, black individuals and those with low education were the most frequent victims of accidents. Helmet use was protective for severe injuries.

Análisis de la frecuencia de pacientes politraumatizados en accidentes en motocicleta en la población pediátrica atendida en el Hospital Pediátrico de Sinaloa entre los años 2015 y 2017 / Analysis of the frequency of polytraumatized patients in motorcycle accidents in the pediatric publication attended in the Pediatric Hospital of Sinaloa between the years 2015 and 2017

Resumen: Objetivos: Determinar la frecuencia de los pacientes pediátricos politraumatizados involucrados en accidentes por motocicleta atendidos en el Hospital Pediátrico de Sinaloa entre los años 2015 y 2017, así como determinar la frecuencia de traumatismos craneoencefálicos, lesiones torácicas, abdominales, en extremidades, días de estancia hospitalaria y mortalidad. Material y métodos: La población seleccionada fueron pacientes menores de 18 años de edad que se encontraron involucrados en accidentes de motocicleta atendidos en el Hospital Pediátrico de Sinaloa en un período comprendido entre el 1o de Enero de 2015 al 31 de Diciembre de 2017. Resultados: El género más afectado fue el masculino, con edad más frecuente de 14 años, los accidentes ocurrieron con mayor frecuencia los Viernes y Sábados en horario nocturno. Julio fue el mes con mayor índice de accidentes. La cantidad de accidentes se incrementó cada año. La mayoría de los lesionados fueron pasajeros, 98.4% no utilizó equipo de seguridad, la lesión más común fue el traumatismo craneoencefálico, seguido de lesiones en extremidades inferiores, superiores, traumatismo torácico y la menos común, el traumatismo abdominal. Discusión: Hay un incremento progresivo en los accidentes en motocicleta donde se involucra la población pediátrica, el uso de casco es casi nulo, la mayoría de los pacientes presentó traumatismo craneoencefálico, este estudio sirve para analizar el panorama actual, así como ser la base de estudios posteriores y realizar más campañas para la prevención de accidentes en motocicleta y fomentar el uso de casco en pacientes pediátricos.

Abstract: Objectives: Determine the frequency of polytraumatized pediatric patients involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa between 2015 and 2017, as well as to determine the frequency of traumatic brain injuries, thoracic, abdominal, limb injuries, days of hospital stay and mortality. Material and methods: The selected population were patients under 18 years of age who were involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa in a period between January 1st, 2015 and December 31, 2017. Results: The most affected gender was the male with the most frequent age of 14 years, accidents occurred more frequently on Fridays and Saturdays at night. July was the month with the highest frequency of accidents. The number of accidents increased every year. Most of the injured were passengers, 98.4% did not use safety equipment, the most frequent injury was head injury, followed by injuries in lower extremities, upper chest trauma and less frequent abdominal traumatism. Discussion: There is a progressive increase in motorcycle accidents where the pediatric population is involved, the use of helmet is almost zero, most of the patients presented with head trauma, this study serves to see the current situation, as well as being the basis for Subsequent studies and conduct more campaigns for the prevention of motorcycle accidents and encourage the use of helmet in pediatric patients.

Doenças podais em ovinos no estado da Bahia / Foot diseases in sheep in the state of Bahia, Brazil

As doenças dos cascos são as principais causas de claudicação em pequenos ruminantes, causando grande impacto no bem-estar dos animais e provocando sérias perdas econômicas com depreciação e abate de animais afetados. O objetivo do presente estudo foi determinar a ocorrência e caracterizar as doenças podais encontradas em oito rebanhos de ovinos com histórico de doenças podais pertencentes a oito municípios do estado da Bahia. Em cada visita, foram realizadas inspeções do rebanho, aplicação de um questionário de pesquisa e caracterização das doenças. No total, 600 ovinos foram inspecionados, realizando exame do casco em animais doentes para caracterizar as lesões, registrar a quantidade de doenças presentes por animal, o casco afetado e a quantidade de membros afetados. A ocorrência de doença de casco foi de 23,3% (140/600) variando de 12,8 a 55,5% por fazenda. Duzentos e vinte casos envolvendo nove doenças foram registrados. A pododermatite infecciosa foi a doença mais comum com 51,3% dos casos (113/220), 70% correspondente aos estágios avançados e terminais. A dermatite interdigital representou 27,7% dos casos; crescimento excessivo dos cascos 8,6%; doença da linha branca 3,2%; sola dupla 3,2%; granuloma do dígito 2,3%; hiperplasia interdigital 2,3%; úlcera de sola 0,9% e 0,4% de abcesso de pé. Os principais fatores predisponentes envolvidos na ocorrência das doenças foram a alta precipitação pluviométrica, condições de umidade do solo, currais e pastagens, manejo sanitário deficiente e falta de medidas preventivas (pedilúvio, quarentena, isolamento e vacinação), falhas de tratamento e baixa infra-estrutura da maioria das propriedades.(AU)

Foot diseases are the main causes of lameness in small ruminants, causing great impact on animal welfare and important economic losses due to depreciation and culling of affected animals. The aim of the present study was to characterize foot diseases found in eight flocks of sheep with a history of the ailment, that belonged to eight municipalities in the state of Bahia. At each visit, inspection of the flock, survey questionnaire, and characterization of diseases were performed. Altogether 600 sheep were inspected through foot examination in sick animals to characterize the injuries and record the diseases present per animal, as affected hooves and the number of affected limbs. The occurrence of foot disease was 23.3% (140/600) ranging from 12.8 to 55.5% per farm. Two hundred and twenty cases involving nine diseases were recorded. Foot rot was the most common disease with 51.3% of cases (113/220), 70% corresponding to advanced and terminal stages. Interdigital dermatitis represented 27.7% of the cases, excessive hoof growth 8.6%, white line disease 3.2%, double soles 3.2%, toe granuloma 2.3%, interdigital hyperplasia 2.3%, sole ulcers 0.9% and 0.4% foot abscess. The main predisposing factors involved in the genesis of diseases were the high rainfall precipitation, soil moisture conditions, pens and pastures, poor sanitary management and lack of preventive measures (footbath, quarantine, isolation and vaccination), treatment failures and low infrastructure of most properties.(AU)

Avaliação da utilização do capacete e do risco de dependência para utilização de bebidas alcoólicas nos motociclistas internados no Hospital da Restauração / Evaluation of the helmet use and the risk of dependence for the use of alcoholic beverages in the motorcyclists in the Hospital da Restauração

O objetivo deste trabalho foi avaliar o uso do capacete e o risco de dependência para utilização de bebida alcoólica nos motociclistas internados no HR. A metodologia aplicada nessa pesquisa é de natureza epidemiológica, quantitativa, descritiva e prospectiva. As seguintes variáveis foram estudadas: sexo, idade, tipo de capacete, potência da moto, finalidade de uso, ossos e fraturas, complexidade das fraturas e risco de dependência do uso álcool. Foram analisados dados de 100 pacientes, dos quais o sexo mais acometido foi o masculino na faixa etária entre 18-29 anos; a potência da moto disparadamente mais procurada pelos pacientes encontra-se acima de 50 cc, tendo sido o tipo de capacete mais utilizado o integral com viseira, porém com uma deficiência muito grande na utilização de capacete pelos motociclistas; a maior finalidade para o uso da moto pelos pacientes foi para o trabalho. O osso mais fraturado foi o zigomático. A maioria dos pacientes foi classificada com uso de baixo risco do álcool na classificação do AUDIT... (AU)

The purpose of this work was to evaluate the use of helmet and the risk of addiction to the use of alcoholic beverage in motorcyclists admitted at the HR hospital. The methodology applied in this research is epidemiological, quantitative, descriptive and prospective. The following variables were studied: gender, age, type of helmet, motor power, purpose of use, bones and fractures, fracture complexity and risk of dependence on alcohol use. Data from 100 patients were analyzed, in which male was the most affected gender in the age group 18-29 years old; The motorcycle's power most frequently sought by the patients is above 50 cc and the type of helmet most used was the integral with visor, but with a great deficiency in the use of helmets by the motorcyclists; The major purpose for motorcycle use by patients was to work. The most fractured bone was the zygomatic. The majority of patients were classified as having been included in the use of alcohol risk in the AUDIT classification... (AU)

Perfil e tendência dos fatores de risco para acidentes de trânsito em escolares nas capitais brasileiras: PeNSE 2009, 2012 e 2015 / Profile and trend of risk factors for traffic accidents in schoolchildren in Brazilian capitals: PeNSE 2009, 2012 and 2015

RESUMO: Introdução: Os acidentes de transporte terrestre (ATT) são a segunda causa de morte em escolares de 13 a 17 anos. O presente estudo visou descrever os fatores de risco para ATT em escolares da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015 e avaliar a tendência de indicadores selecionados nas três últimas edições da PeNSE. Metodologia: Estudo descritivo sobre fatores de risco para ATT no ano de 2015, com dados da PeNSE e análise de tendência das séries temporais, com testes de regressão ajustados por idade, das edições de 2009, 2012 e 2015, nas capitais brasileiras. Resultados: Em 2015, 26,3% dos escolares do nono ano, na maioria entre 13 e 15 anos, relataram terem sido conduzidos em veículo motorizado dirigido por alguém que consumiu bebida alcoólica e 32,4% relataram terem dirigido veículo motorizado; 30,7% dos adolescentes não usaram cinto de segurança no banco de trás; e 16,8% dos escolares usuários de motocicleta não usaram capacetes. Observou-se ainda tendência de piora dos indicadores entre 2009 e 2015, referentes a dirigir veículo motorizado (1,0 pontos percentuais) e ter sido conduzido em veículo por alguém que consumiu bebida alcoólica (1,1 pontos percentuais). Discussão: A ocorrência de ATT resulta da interação entre vias, veículos e usuários, tendo forte correlação com o comportamento. Conclusões: Os resultados apontam a necessidade de investir em medidas educativas, associadas a fiscalização, a melhoria das vias, pesquisas e aprimoramento da legislação. O monitoramento dos fatores de risco em escolares contribui substancialmente para apoiar intervenções das políticas públicas intersetoriais para a redução de morbimortalidade por trânsito.

ABSTRACT: Introduction: Land transport accidents (LTA) are the second cause of death in schoolchildren aged 13 to 17 years. The study aims to describe the risk factors for LTA in schoolchildren from the National School Health Survey (PeNSE) of 2015 and to evaluate the trend of selected indicators in the last three editions of PeNSE. Methodology: A descriptive study on risk factors for LTA in 2015, with PeNSE data and time series trends analysis, with age-adjusted regression tests of the 2009, 2012 and 2015 editions, in Brazilian capitals. Results: In 2015, 26.3% of ninth grade schoolchildren, mostly between 13 and 15 years of age, reported having been in a motor vehicle driven by someone who consumed alcohol and 32.4% had driven a motor vehicle; 30.7% of adolescents did not use seat belts in the back seat; and 16.8% of schoolchildren who ride motorcycles did not wear helmets. There was also a worsening of the indicators between 2009 and 2015, regarding driving a motor vehicle (1.0 percentage points) and having been driven by vehicle for consumption of alcoholic beverages (1.1 percentage points). Discussion: The LTA occurrence results from the interaction between roads, vehicles and users, and has a strong correlation with behavior. Conclusions: The results show the need to invest in educational measures, associated with supervision, the improvement of road infrastructure, research and improvement of legislation. The monitoring of risk factors in schoolchildren substantially contributes to support intersectoral public policies interventions to reduce morbidity and mortality in traffic.

Perfil Epidemiológico dos Pacientes com Fraturas / Epidemiological Profile of Patients with Fracture

Introdução: Os acidentes motociclísticos estão entre as causas mais frequentes de traumatismos faciais. O fato de a motocicleta ser um veículo leve e de fácil condução e o descumprimento à legislação atual contribuem para o aumento da incidência e da gravidade dessas fraturas. Metodologia: Foram entrevistados 123 pacientes, momento em que foram colhidas as seguintes variáveis: Dependentes: Faixa etária, gênero, local de procedência, uso de capacete, se havia ingerido bebida alcoólica antes do acidente, se possuia habilitação para motocicleta, ossos faciais fraturados e lesões em outras áreas do corpo. As fraturas faciais bem como as fraturas em outras áreas do corpo foram diagnosticadas após exame clínico e imaginológico. Resultados: Houve uma predominância de indivíduos do gênero masculino (85,4%) e de pacientes provenientes de cidades do interior do estado do Ceará (61,8%). Fraturas múltiplas da face ocorreram em 49,6% dos pacientes pesquisados. A maioria dos pacientes não utilizavam capacetes ou não possuíam habilitação (75,6% e 73,2%, respectivamente.), e 38,2% haviam ingerido bebida alcoólica antes do acidente. Foi observado ainda que 20.3% dos pacientes apresentavam fraturas em outros ossos do corpo que não a face. Conclusão: Observa-se que os acidentes motociclísticos correspondem a uma grande parcela das fraturas faciais e que a maior parte desses acidentes estão associados ao descumprimento da legislação... (AU)

Introduction: motorcycle accidents are among the most common causes of facial trauma. The fact that the motorcycle be a light vehicle and within easy driving and breach the current legislation contribute to the increased incidence and severity of these fractures. Methodology: We interviewed 123 patients, at which the following variables were collected: Dependents: age range, gender, place of origin, helmet use, if had been drinking before the accident, it has qualified for motorcycle, fractured facial bones and lesions in other areas of the body. Facial fractures and fractures in other areas of the body were diagnosed after clinical examination and imaginologic. Results: There was a predominance of male (85.4%) and patients from cities in the state of Ceará (61.8%). Multiple facial fractures occurred in 49.6% of patients surveyed. Most patients did not use helmets or had no qualifications (75.6% and 73.2% respectively.) And 38.2% had been drinking before the accident. It was also observed that 20.3% of patients had fractures in other bones of the body other than the face. Conclusion: It is observed that motorcycle accidents account for a large portion of facial fractures and that most of these accidents are associated with the breach of the legislation... (AU)

Hearing Health in Agricultural Aviation Pilots from Cindacta II Wearing Earplugs and a Helmet

Abstract Introduction Agricultural aviation pilots, exposed daily to intense vibration and noise, are likely to develop noise-induced hearing loss (NIHL). Objectives The aim of this study was to investigate the presence of audiograms consistent with NIHL in agricultural aviation pilots who use earplugs and helmets. Methods We conducted a cross-sectional cohort and observational study. The data were taken from the medical records and audiograms of 94 pilots. Results NIHL was identified in 9.5% of individuals with hearing loss by audiograms at 3,000, 4,000, or 6,000 Hz. Normal audiograms were observed in 46.8% of pilots surveyed. Bilateral hearing loss was more frequent than unilateral hearing loss, occurring in 64.8% of cases. Conclusion Although there was a low incidence of audiograms compatible with NIHL in the records of the pilots examined, the disorder still occurs despite the doubled use of individual hearing protection equipment (helmets and earplugs) for agricultural aviation pilots. Nevertheless, even with the use of earplugs and helmets as noise protectors, the data showed that agricultural pilots suffer inner ear damage caused by occupational noise. Prevention and periodic audiologic evaluations must be conducted in noiseexposed occupational groups.

Prevalencia y evolución del uso de casco en ocupantes de motocicletas en una ciudad argentina (Mar del Plata, 2006-2014) / Prevalence and evolution of helmet use in motorcycle riders in an Argentine city (Mar del Plata, 2006-2014)

RESUMEN Los siniestros viales que involucran a motociclistas conforman un problema creciente en los países de ingresos bajos y medios. La medida de protección por excelencia en estos usuarios viales es el casco. Sin embargo, una proporción considerable de motociclistas no lo usa. El objetivo de este trabajo es informar la evolución del uso de casco durante el periodo 2006-2014 en una ciudad de Argentina, y conocer los factores asociados durante el año 2014. La muestra incluye más de 6.900 observaciones de motociclistas, registradas en los años 2006 (n=962), 2008 (n=977), 2012 (n=2.542) y 2014 (n=2.466). Los datos indican un aumento progresivo del uso de casco a través del tiempo, aunque se sostienen las diferencias por género y función. Los factores asociados al uso de casco en conductores durante el año 2014 fueron el uso en pasajeros, el tipo de moto, la presencia de patente y el género. Aunque los resultados son positivos, conviene alertar sobre las consecuencias negativas del aumento del parque de motos.

ABSTRACT Traffic collisions involving motorcyclists are a growing problem in low and middle income countries. Helmet use is the foremost protective measure for this group of road users, however many riders do not wear them. The objective of the present study is to report the changes in helmet use during the period 2006-2014 in an Argentine city and discover associated factors for the year 2014. The sample includes more than 6,900 observations of motorcyclists carried out during the years 2006 (n=962), 2008 (n=977), 2012 (n=2,542), and 2014 (n=2,466). The data indicates a progressive increase in helmet use over time, but differences due to gender and type of rider remain. Factors associated to helmet use in motorcycle drivers during 2014 were: passenger helmet use, motorcycle type, license plate use and gender. Although the results are positive, it is necessary to be attentive to the negative consequences of the growing fleet of motorcycles.

Características de motociclistas envolvidos em acidentes de transporte atendidos em serviços públicos de urgência e emergência / Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services

Resumo As lesões decorrentes dos acidentes com motociclistas constituem importante problema de saúde pública no Brasil. Objetivou-se descrever as características de motociclistas envolvidos em acidentes de transporte, atendidos em serviços públicos de urgência e emergência nas capitais de estado e no Distrito Federal. Estudo transversal com base nos dados do Inquérito sobre Violências e Acidentes em Serviços de Urgência e Emergência (VIVA Inquérito) de 2014. Os dados foram analisados segundo características sociodemográficas, do evento e do atendimento. Diferenças proporcionais entre os sexos foram analisadas pelo teste do qui-quadrado (Rao-Scott) com nível de significância de 5%. Do total de atendimentos de motociclistas, predominaram homens (n = 9.673), (razão de sexo = 3,2), jovens de 20 a 39 anos (65,7%), pretos/pardos (73,6%), com atividade remunerada (76,4%). Uso de capacete foi relatado por 79,1% das vítimas, 13,3% haviam consumido álcool nas seis horas anteriores ao acidente, 41,4% dos eventos estavam relacionados ao trabalho da vítima. Os acidentes foram mais frequentes nos finais de semana, durante a manhã e final da tarde. Estas características pode apoiar o desenvolvimento de políticas públicas de prevenção de acidentes e na promoção da saúde.

Abstract Injuries resulting from motorcycle road traffic accidents are an important public health issue in Brazil. This study aimed to describe the characteristics of motorcyclists involved in traffic accidents attended in public urgent and emergency services in the state capitals and the Federal District. This is a cross-sectional study based on data from the Violence and Accident Surveillance System (VIVA Survey) in 2014. Data were analyzed according to sociodemographic, event and attendance characteristics. Proportional differences between genders were analyzed by chi-square test (Rao-Scott) with 5% significance level. Motorcyclist-related attendances (n = 9,673) reported a prevalence of men (gender ratio = 3.2), young people aged 20–39 years (65.7%), black / brown (73.6%), paid work (76.4%). Helmet use was reported by 79.1% of the victims, 13.3% had consumed alcohol in the six hours prior to the accident, 41.4% of the events were related to the victim's work. Accidents were more frequent on weekends, in the morning and late afternoon. These characteristics can support the development of public accident prevention policies and health promotion.

Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence - a population-based study / Uso de motocicletas no Brasil: perfil dos usuários, prevalência de uso e ocorrência de acidentes de trânsito - estudo de base populacional

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.

Resumo Este estudo buscou descrever o perfil dos usuários de motocicleta e determinar a prevalência de uso desta. Além disso, avaliar a razão para o uso da motocicleta, o risco percebido de acidente de trânsito, o padrão de uso do capacete e o número de acidentes com injúrias ocorridos nos últimos 12 meses. Estudo transversal realizado na cidade de Pelotas com processo de amostragem conduzido em dois estágios. A primeira unidade foi o setor censitário e a segunda a casa dos indivíduos. Foram incluídos 3.004 indivíduos com idades entre 10 e 59 anos, que responderam um questionário estruturado. O desfecho do estudo foi o uso de motocicleta. A prevalência do uso de motocicleta foi de 25,1%. A maioria dos motociclistas foi composta por homens (79%). Indivíduos com idade entre 18 e 35 anos representaram 42% do total de usuários, especialmente como motoristas (24%), e 40% reportaram não usar adequadamente o capacete. A maior parte dos usuários (76%) considerou estar em alto risco para acidentes. A prevalência de acidentes foi de 8%, sendo mais alto entre os homens e entre os indivíduos com idade entre 18 a 35 anos. A motocicleta é amplamente usada nesta população. Usuários estão cientes do risco de acidentes, embora tenham reportado não usar o capacete de forma adequada.

Factores asociados al uso del casco de protección en dos ciudades de Colombia / Factors associated with the use of motorcycle helmets in two Colombian cities

Resumen El objetivo de este estudio fue identificar la prevalencia y algunas características asociadas al uso de casco en dos ciudades en Colombia; se usaron tanto técnicas cuantitativas como cualitativas. La prevalencia de uso de casco en conductores de motocicleta fue mayor en Ibagué (98,1%) que en Valledupar (82,4%); en pasajeros de Valledupar no fue superior a 2%. Los hombres tuvieron 2.1 veces más posibilidad de usar el casco que las mujeres (IC 95: 1,6-2,7). Con las técnicas cualitativas se identificaron factores que explicaron los motivos de uso/no uso del casco (higiénicas, climáticas, estéticas y de seguridad) en Valledupar. El casco es una medida que protege ante un siniestro vial; no obstante, la prevalencia de uso no es la ideal. Es importante que las autoridades de tránsito, salud y la sociedad civil se organicen para diseñar y aplicar medidas orientadas para fortalecer el uso de este elemento de protección personal.

Abstract The aim of this study was to identify the prevalence and some characteristics associated with the use of motorcycle helmets in two Colombian cities. The researcher used quantitative and qualitative techniques. The prevalence of the use of a motorcycle helmet among motorcyclists was greater in Ibague (98.1%) than in Valledupar (82.4%); among passengers in the city of Valledupar, it did not reach 2%. Men were 2.1 times more likely to wear helmets than women (IC 95:1.6-2.7). Using qualitative techniques, the factors explaining the reasons for use/non-use of helmets (being hygienic, climatic, esthetic and safety reasons) were identified for Valledupar. The use of the helmet is a protective measure in the event of traffic accidents; however, the prevalence of usage is not ideal. It is important for traffic and health authorities as well as the civil society to organize, in order to design and implement measures aimed at strengthening the use of this road safety gear.

Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

Factores asociados al trauma fatal en motociclistas en Medellín, 2005-2008 / Factors associated with fatal trauma in Medellín (Colombia) motorcyclists

Introducción. En medio de un cambio en la movilidad vial, en el que la motocicleta se ha generalizado como herramienta de transporte y de trabajo, se da el trauma en motociclistas que genera consecuencias desfavorables para la salud pública, por lo que el conocimiento de sus factores asociados sirve de base para formular estrategias de prevención. Objetivo. Describir las características de persona, tiempo, lugar, vehículo y circunstancias de los accidentes de tránsito en motociclistas y explorar su asociación con trauma fatal en Medellín entre 2005 y 2008. Materiales y métodos. Se hizo un estudio transversal con análisis de caso y controles de datos retrospectivos de la población de la Secretaría de Transporte y Tránsito y de la Secretaría de Salud. Se analizaron 24.062 registros de motociclistas lesionados y 345 fallecidos. Se calculó la razón de momios (odds ratio, OR) (IC95%) para explorar la asociación entre el trauma fatal y las características de exposición, y la OR ajustada (IC95%) mediante un análisis de regresión logística. Resultados. Se encontró una fuerte asociación entre el trauma fatal en motociclistas y el choque contra objeto fijo. Hay mayores posibilidades de morir en los tramos de vía y vías diferentes a intersección o glorieta, vías de dos carriles, en las comunas Robledo, Aranjuez y Guayabal. Los hombres y motociclistas entre 20 y 30 años, entre 40 y 49, y los mayores 50 años, tienen mayores posibilidades de morir e, igualmente, cuando conducen motocicletas de modelo anterior a 1991, o conducen en la madrugada o en horas de alta densidad vehicular. Conclusiones. En Medellín, los motociclistas son un grupo de interés en el sistema vial; por su mayor exposición, la energía que acumulan en los choques contra un objeto fijo es mucho mayor y más letal que la acumulada en otra clase de accidentes, y aunque hay más accidentes de tránsito en glorietas e intersecciones, la mayor posibilidad de morir se presenta en los tramos de vía de doble carril y en otras vías.

Introduction. Motorcycles have come into widespread use as mode of transport and commuting to work. Given the degree of trauma occurring in motorcycle accidents, this increased use has generated adverse consequences for public health. Categorization of factors associated with these events can form the basis for prevention strategies. Objective. The characteristics of person, time, place, vehicle and circumstances of occurrence were described for motorcycle accidents involving rider injury, and the associations were explored with fatal trauma in the city of Medellín, Colombia, in 2005-2008. Materials and methods. A cross-sectional case-control retrospective study was conducted based on population data from the Secretaría de Transporte y Tránsito and Secretaría de Salud. Records were analyzed of incidents involving 24,062 injuries and 345 fatalities. The odds ratio statistic (95% CI) was used to detect significant associations between fatalies and characteristics of trauma exposure; adjusted ORs (95% CI) were obtained by logistic regression analysis. Results. A strong association emerged between fatal trauma and collision with a fixed object. There is a greater chance of dying at railroad crossings, approaches to intersections or roundabouts, and (in the districts of Robledo, Aranjuez and Guayabal) two lane roads. Males, motorcyclists between 20-30 yrs, between 40 and 49 yrs, and >50 yrs were more likely to die. Motorcycle models prior to 1991, travel in early morning hours, or periods of high vehicular density were additional factors of high association. Conclusions. Because motorcyclists have greater exposure, crashes against fixed objects were much more lethal than in other kinds of events. Although an increased mortality occurred at roundabouts and intersections, a greater mortalities occurred at railroad crossings in the sections of single-rail, double-rail and other configurations.

Motorcycle trauma in a St Lucian hospital / Traumas por motocicletas en un hospital de Santa Lucía

OBJECTIVE: A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia. METHOD: This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender, helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment. RESULTS: Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5 % of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured. CONCLUSION: The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets.

OBJETIVO: La motocicleta es un vehículo motor dos ruedas y vía única, usado mundialmente como medio de transporte. El uso de la motocicleta ha traído consigo traumas asociados con una morbilidad y una mortalidad significativas. El objetivo de este estudio es documentar el patrón de accidentes de motocicletas así como la demografía de los ciclistas en Santa Lucía. MÉTODO: Se trata de un estudio prospectivo de 15 meses en torno a pacientes con lesiones de motocicleta. Los heridos acudieron a la sala de emergencias del Hospital Victoria. Se obtuvo información sobre los pacientes - edad, género, uso del casco, consumo de alcohol/drogas antes de montar la moto, y el mecanismo de la lesión. Con la información obtenida una pro forma fue preparada por el médico asistente. A los ingresados se les hizo un seguimiento a fin de conocer la evolución clínica y las complicaciones del tratamiento. RESULTADOS: El número total de pacientes estudiados fue 136 en 115 accidentes. Los varones (M) fueron 127 mientras que las hembras (F) fueron 9, para una proporción M:F de 14.1: 1.0. Hubo 105, 28 y 3 motoristas, pasajeros y peatones respectivamente. El 87.5% de los pacientes estaban por debajo de los 35 años de edad. Cincuenta y tres por ciento de los accidentes ocurrieron durante el fin de semana. Las extremidades fueron principalmente dañadas, constituyendo el 81.9% de las partes del cuerpo lesionadas. CONCLUSIÓN: El estudio reveló que los lesionados en accidentes de motocicletas eran principalmente varones jóvenes y productivos, y que las lesiones eran mayormente en las extremidades. Se halló que más del cincuenta por ciento de los accidentes ocurrieron durante los fines de semana, y más del cincuenta por ciento de los motociclistas no llevaban el casco de protección.

Sistematización de los resultados del II Concurso Nacional de Seguridad Vial: experiencias exitosas contra la inseguridad vial

Se presenta la sistematización de las tres experiencias ganadoras del II Concurso Nacional de Seguridad Vial que organiza cada año la Dirección General de Seguridad Vial del Gobierno de la Ciudad de Buenos Aires. Incluye: la inseguridad vial en la Argentina y las acciones de la Ciudad de Buenos Aires; objetivos y metodología del Concurso; y, las tres experiencias ganadoras (categorías: alcoholemia, cascos y peatones).

Avaliação de padrão irregular dos escudos do casco em Podocnemis expansa e Podocnemis unifilis (Testudines, Podocnemididae) / Evaluation of irregular pattern of the shell scutes in Podocnemis expansa and Podocnemis unifilis (Testudines, Podocnemididae)

O casco de Podocnemis expansa (tartaruga-da-amazônia) e Podocnemis unifilis (tracajá), os maiores quelônios de água doce da América do Sul, é uma estrutura única que diferencia esse grupo dos vertebrados atuais e está associado a alguns padrões comportamentais. O padrão dos escudos que compõem o casco dos quelônios é bastante uniforme, mas variações já foram descritas e analisadas para um grande número de espécies em todas as famílias existentes atualmente. Averiguou-se a incidência de irregularidades do padrão de escutelação no casco dessas espécies, durante os anos de 1999 a 2003 no rio Javaés, entorno do Parque Nacional do Araguaia e da Área de Proteção Ambiental Bananal/ Cantão, oeste do estado do Tocantins. P. expansa se apresenta como uma espécie mais suscetível à ocorrência de anormalidades no casco em relação a P. unifilis. Sendo que, dos 14.378 filhotes avaliados, (13,32 por cento) apresentavam irregularidades no padrão de escutelação enquanto que dos 1.329 filhotes de P. unifilis apenas (4,44 por cento). Em P. expansa, os defeitos ocorreram quase que em sua totalidade na carapaça (98,64 por cento) e em menor número (83,05 por cento) em P. unifilis.

The shell of Podocnemis expansa (Amazonian giant River turtle) and Podocnemis unifilis (Yellow-spotted Amazon River Turtle), the largest South American turtles, is a unique structure that differentiates them from other known vertebrates; and it is associated with some of their behavioral patterns. Their scute pattern is quite uniform however variations have been described and analyzed for a great number of other species of existing families. In the Javaés River, from 1999 to 2003, we observed an occurrence of abnormalities in their scute pattern. This was in the vicinity of the Araguaia National Park and the Bananal/ Cantão Environment Protected Area, west of Tocantins state. Of the both species, P. expansa is more susceptible to shell abnormalities. Of 14.378 P. expansa hatchlings observed, 13.32 percent presented scute pattern abnormalities, while of 1.329 P. unifilis hatchlings, only 4.44 percent. The incidence of abnormalities occurred only in the carapace, namely, 98.64 percent in P. expansa, and 83.05 percent in P. unifilis.

Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência / Profile of motorcycle accident victims treated at a public hospital emergency department

No Brasil, observa-se um aumento dos acidentes envolvendo motocicletas. Este estudo objetivou caracterizar as vítimas desse tipo de acidente atendidas em um serviço de emergência no Piauí. Pesquisa quantitativa com amostra de 430 vítimas. A análise mostrou predominância do sexo masculino, na faixa etária de 15 a 24 anos e procedentes do próprio estado. Observou-se que 301 dessas vítimas eram condutores da motocicleta, 81 passageiros e 48 foram atropelados por moto. Verificou-se que 76,05 por cento das vítimas sofreram acidente de quinta-feira a domingo, 80,75 por cento apresentaram seqüelas temporárias e 52,33 por cento dos acidentes ocorreram no período noturno. Os tipos de lesão corresponderam em 69,3 por cento dos casos a ferimentos; 51,4 por cento a fraturas; 27,44 por cento a hematomas; e 20,7 por cento a traumatismos cranioencefálicos. Entre as vítimas de acidente, condutores da moto e suspeitos de ingestão de álcool, 52,07 por cento não utilizavam capacete no momento do acidente. A maioria das vítimas recebeu alta hospitalar e 14 foram a óbito. Conclui-se que o trauma provocado pelos acidentes envolvendo motocicletas merece atenção, especialmente em relação ao planejamento de ações preventivas, assim como controle de sua ocorrência no estado.

The number of accidents involving motorcycles has increased in Brazil. The objective of this study was to identify the type of victims of these accidents who were treated at an emergency department in Piauí State, Brazil. The sample included 430 such victims in this quantitative study. Most were male, 15-24 years of age, and from the State of Piauí itself. 301 of the victims were drivers of the motorcycles, 81 were passengers, and 48 were struck or run over by the motorcycles. 76.05 percent of the accidents occurred from Thursday to Sunday. 80.75 percent had temporary sequelae, and 53.33 percent of the accidents occurred at night. In 69.3 percent of the cases, victims suffered lacerations; 51.4 percent fractures; 27.44 percent hematomas; and 20.7 percent head trauma. Among the accident victims, motorcycle drivers, and those suspected of alcohol consumption, 52.07 percent were not wearing a helmet at the time of the accident. Most of the victims were discharged from hospital, while 14 died. In conclusion, injuries from motorcycle accidents deserve attention, especially to plan preventive measures to help control their occurrence in the State.