Impact of the program life in traffic and new zero-tolerance drinking and driving law on the prevalence of driving after alcohol abuse in Brazilian capitals: An interrupted time series analysis.

INTRODUCTION: Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals. METHODS: An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016. RESULTS: The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application. CONCLUSION: The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.

Use of prehospital, hospitalization and presence of sequelae and/or disability in road traffic injury victims in Brazil.

OBJECTIVE: To estimate the prevalence and analyze the association between sociodemographic and behavioral variables with the use of prehospital care, hospitalization and sequelae and/or disability in victims of road traffic accidents victims in Brazil. METHODS: Data from the National Health Survey conducted in 2013 in Brazil were used. Data were collected through a direct household survey. The research sample consisted of 1,840 individuals who reported road traffic accidents in the previous 12 months. Poisson regression analysis was used to evaluate the factors associated with the use of prehospital care services, hospitalization, and the presence of sequelae and/or disability. RESULTS: The prevalence of road traffic accidents victims who received prehospital care was 13.0% (95% Confidence Interval [95% CI]: 10.3-16.3) and the factors associated with this outcome were: residing in the Northeast or North region of Brazil; residing in rural areas; and being a motorcycle occupant at the moment of the road traffic accident. The frequency of hospitalization was 7.7% (95% CI: 6.0-10.0) and the associated factors were: age between 40 and 59 years; being a motorcycle occupant or pedestrian and having received on-site care at the moment of the road traffic accident. The prevalence of sequelae and/or disability was 15.1% (95% CI: 12.5-18.2) and the associated factors were: age range between 30 and 39 years or 40 and 59 years; being a motorcycle occupant, being a pedestrian or belonging to other category of modes of transport and having received on-site care at the moment of the road traffic accident. CONCLUSION: The study allowed to evaluate the factors associated with prehospital care, hospitalization and presence of sequelae and/or disability in the victims of road traffic accident and the results can guide the implementation of interventions that prioritize the population exposed to the highest risk of road traffic accident injuries and with less access to prehospital and hospital care services in Brazil.

Syphilis in pregnancy and congenital syphilis and their relationship with Family Health Strategy coverage, Goiás, Brazil, 2007-2014: an ecological study. / Sífilis gestacional e congênita e sua relação com a cobertura da Estratégia Saúde da Família, Goiás, 2007-2014: um estudo ecológico.

OBJECTIVE: to analyze the incidence of syphilis in pregnant women (SPW) and congenital syphilis (CS) and the correlation of these indicators with Family Health Strategy (FHS) coverage in Goiás, Brazil, from 2007 to 2014. METHODS: this was an ecological study using Notifiable Diseases Information System (SINAN) data and data from the Health Ministry's Department of Primary Care; Spearman's correlation was used to evaluate the relationship between FHS coverage and syphilis incidence. RESULTS: SPW incidence increased from 2.8 to 9.5/1,000 live births, while CS incidence increased from 0.3 to 2.5/1,000 live births (p<0.05) in the period 2007-2014; there was a significant increase in CS cases in municipalities with percentage FHS coverage below 75% (p<0.001). CONCLUSION: the concomitant increase in SPW and CS incidence suggests failures in the prevention of vertical transmission of syphilis, especially in regions with lower FHS coverage.

Deaths and serious injuries due to traffic accidents in Goiânia, Brazil - 2013: the magnitude and associated factors. / Óbitos e feridos graves por acidentes de trânsito em Goiânia, Brasil - 2013: magnitude e fatores associados.

OBJECTIVE: to identify the magnitude and factors associated with death and serious injuries among victims of traffic accidents in the urban area of Goiânia, Brazil. METHODS: cross-sectional study with linkage between records of the Mortality Information System (SIM) Hospital Information System of the Brazilian National Health System (SIH/SUS) and occurrences of traffic accidents, from January to June 2013; Poisson regression was used. RESULTS: among 9,795 identified victims, there were 155 deaths and 1,225 serious injuries; cyclists (Incidence ratio [IR]=2.26; 95%CI 1.19;4.30) and pedestrians (IR=2.12; 95%CI 1.26;3.58) had an increased risk of death, while the risk of serious injuries was higher among motorcyclists (IR=2.38; 95%CI 2.01;2.83), cyclists (IR=2.35; 95%CI 1.76;3.13) and pedestrians (IR=2.83; 95%CI 2.27;3.53). CONCLUSION: the study revealed a number of deaths and serious injuries, closer to the real and identified vulnerable groups to plan traffic safety actions.

Óbitos e feridos graves por acidentes de trânsito em Goiânia, Brasil - 2013: magnitude e fatores associados / Muertes y heridos graves por accidentes de tránsito en Goiânia, Brasil - 2013: magnitud y factores associados / Deaths and serious injuries due to traffic accidents in Goiânia, Brazil - 2013: the magnitude and associated factors

Objetivo: identificar a magnitude e fatores associados ao óbito e lesões graves entre vítimas de acidentes de trânsito ocorridos na área urbana de Goiânia, Brasil. Métodos: estudo transversal com linkage entre registros do Sistema de Informações sobre Mortalidade (SIM), Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) e ocorrências de acidentes de trânsito, no período de janeiro a junho de 2013; utilizou-se a regressão de Poisson. Resultados: entre 9.795 vítimas identificadas, houve 155 óbitos e 1.225 feridos graves; ciclistas (razão de incidência [RI]=2,26; IC95% 1,19;4,30) e pedestres (RI=2,12; IC95% 1,26;3,58) tiveram maior risco de morte, enquanto o risco de lesões graves foi superior entre motociclistas (RI=2,38; IC95% 2,01;2,83), ciclistas (RI=2,35; IC95% 1,76;3,13) e pedestres (RI=2,83; IC95% 2,27;3,53). Conclusão: o estudo revelou número de óbitos e feridos graves mais próximo do real e identificou grupos vulneráveis, possível alvo para o planejamento de ações de segurança no trânsito.

Objetivo: identificar la magnitud y factores asociados a muerte y lesiones graves entre víctimas de accidentes de tránsito ocurridos en el área urbana de Goiânia, Brasil. Métodos: estudio transversal con enlace entre registros del Sistema de Información sobre Mortalidad (SIM), Sistema de Información Hospitalaria del Sistema Único de Salud (SIH / SUS), ocurrencias de accidentes de tránsito, entre enero-junio 2013; utilizamos regresión de Poisson. Resultados: entre 9.795 víctimas, hubo 155 muertes y 1.225 heridos graves; ciclistas (razón de incidencia [RI = 2,26], IC95% 1,19, 4,30) y peatones (RI = 2,12, IC95% 1,26, 3,58) tuvieron mayor riesgo de muerte, mientras que el riesgo de lesiones graves fue superior entre motociclistas (RI=2,38; IC95% 2,01;2,83), ciclistas (RI=2,35; IC95% 1,76;3,13) y peatones (RI=2,83; IC95% 2,27;3,53). Conclusión: el estudio reveló un número de muertes y heridos graves más cerca de lo real e identificó grupos vulnerables para la planificación de acciones de seguridad de tránsito.

Objective: to identify the magnitude and factors associated with death and serious injuries among victims of traffic accidents in the urban area of Goiânia, Brazil. Methods: cross-sectional study with linkage between records of the Mortality Information System (SIM) Hospital Information System of the Brazilian National Health System (SIH/SUS) and occurrences of traffic accidents, from January to June 2013; Poisson regression was used. Results: among 9,795 identified victims, there were 155 deaths and 1,225 serious injuries; cyclists (Incidence ratio [IR]=2.26; 95%CI 1.19;4.30) and pedestrians (IR=2.12; 95%CI 1.26;3.58) had an increased risk of death, while the risk of serious injuries was higher among motorcyclists (IR=2.38; 95%CI 2.01;2.83), cyclists (IR=2.35; 95%CI 1.76;3.13) and pedestrians (IR=2.83; 95%CI 2.27;3.53). Conclusion: the study revealed a number of deaths and serious injuries, closer to the real and identified vulnerable groups to plan traffic safety actions.

Sífilis gestacional e congênita e sua relação com a cobertura da Estratégia Saúde da Família, Goiás, 2007-2014: um estudo ecológico / Sífilis gestacional y congénita y su relación con la cobertura de la Estrategia Salud de la Familia, Goiás, Brasil, 2007-2014: un estudio ecológico / Syphilis in pregnancy and congenital syphilis and their relationship with Family Health Strategy coverage, Goiás, Brazil, 2007-2014: an ecological study

Objetivo: analisar a incidência de sífilis em gestante (SG) e sífilis congênita (SC) e a correlação desses indicadores com a cobertura da Estratégia Saúde da Família (ESF) em Goiás, Brasil, de 2007 a 2014. Métodos: estudo ecológico utilizando dados do Sistema de Informação de Agravos de Notificação (Sinan) e do Departamento de Atenção Básica (DAB)/Ministério da Saúde; utilizou-se a correlação de Spearman para avaliar a relação entre cobertura da ESF e a incidência de sífilis. Resultados: a incidência de SG passou de 2,8 para 9,5/mil nascidos vivos, e a de SC, de 0,3 para 2,5/mil nascidos vivos (p<0,05), no período 2007-2014; houve aumento significativo de casos de SC nos municípios que apresentaram percentuais de cobertura da ESF inferiores a 75% (p<0,001). Conclusão: o aumento concomitante da incidência de SG e de SC sugere falhas na prevenção da transmissão vertical da sífilis, sobretudo nas regiões com menor cobertura da ESF.

Objetivo: analizar la incidencia de sífilis en gestante (SG) y sífilis congénita (SC) y la correlación de esos indicadores con la cobertura de la Estrategia Salud de la Familia (ESF) en Goiás, Brasil, de 2007 a 2014. Métodos: estudio ecológico utilizando datos del Sistema de Información de Agravamientos de Notificación (Sinan) y del Departamento de Atención Básica (DAB)/Ministerio de la Salud; se utilizó la correlación de Spearman para evaluar la relación entre la cobertura de la ESF y la incidencia de sífilis. Resultados: la incidencia de SG pasó de 2,8 a 9,5/1.000 nacidos vivos, y la de SC, de 0,3 a 2,5/1.000 nacidos vivos (p<0,05) en el período 2007-2014; hubo un aumento significativo de casos de SC en los municipios que presentaron un porcentaje de cobertura de la ESF inferior al 75% (p<0,001). Conclusión: el aumento concomitante de la incidencia de SG y de SC sugiere fallas en la prevención de la transmisión vertical de la sífilis, sobre todo en las regiones con menor porcentaje de cobertura de la ESF.

Objective: to analyze the incidence of syphilis in pregnant women (SPW) and congenital syphilis (CS) and the correlation of these indicators with Family Health Strategy (FHS) coverage in Goiás, Brazil, from 2007 to 2014. Methods: this was an ecological study using Notifiable Diseases Information System (SINAN) data and data from the Health Ministry's Department of Primary Care; Spearman's correlation was used to evaluate the relationship between FHS coverage and syphilis incidence. Results: SPW incidence increased from 2.8 to 9.5/1,000 live births, while CS incidence increased from 0.3 to 2.5/1,000 live births (p<0.05) in the period 2007-2014; there was a significant increase in CS cases in municipalities with percentage FHS coverage below 75% (p<0.001). Conclusion: the concomitant increase in SPW and CS incidence suggests failures in the prevention of vertical transmission of syphilis, especially in regions with lower FHS coverage.

Qualifying information on deaths and serious injuries caused by road traffic in five Brazilian capitals using record linkage.

INTRODUCTION: Road traffic crashes (RTC) are an important public health problem, accounting for 1.2 million deaths per year worldwide. In Brazil, approximately 40,000 deaths caused by RTC occur every year, with different trends in the Federal Units. However, these figures may be even greater if health databases are linked to police records. In addition, the linkage procedure would make it possible to qualify information from the health and police databases, improving the quality of the data regarding underlying cause of death, cause of injury in hospital records, and injury severity. OBJECTIVE: This study linked different data sources to measure the numbers of deaths and serious injuries and to estimate the percentage of corrections regarding the underlying cause of death, cause of injury, and the severity injury in victims in matched pairs from record linkage in five representative state capitals of the five macro-regions of Brazil. METHODS: This cross-sectional, population-based study used data from the Hospital Information System (HIS), Mortality Information System (MIS), and Police Road Traffic database of Belo Horizonte, Campo Grande, Curitiba, Palmas, and Teresina, for the year 2013 for Teresina, and 2012 for the other capitals. RecLink III was used to perform probabilistic record linkage by identifying matched pairs to calculate the global correction percentage of the underlying cause of death, the circumstance that caused the road traffic injury, and the injury severity of the victims in the police database. RESULTS: There was a change in the cause of injury in the HIS, with an overall percentage of correction estimated at 24.4% for Belo Horizonte, 96.9% for Campo Grande, 100.0% for Palmas, and 33.2% for Teresina. The overall percentages of correction of the underlying cause of death in the MIS were 29.9%, 11.9%, 4.2%, and 33.5% for Belo Horizonte, Campo Grande, Curitiba, and Teresina, respectively. The correction of the classification of injury severity in police database were 100.0% for Belo Horizonte and Teresina, 48.0% for Campo Grande, and 51.4% for Palmas after linkage with hospital database. The linkage between mortality and police database found a percentage of correction of 29.5%, 52.3%, 4.4%, 74.3 and 72.9% for Belo Horizonte, Campo Grande, Palmas, Curitiba and Teresina, respectively in the police records. CONCLUSIONS: The results showed the importance of linking records of the health and police databases for estimating the quality of data on road traffic injuries and the victims in the five capital cities studied. The true causes of death and degrees of severity of the injuries caused by RTC are underestimated in the absence of integration of health and police databases. Thus, it is necessary to define national rules and standards of integration between health and traffic databases in national and state levels in Brazil.

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

BACKGROUND: In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions. METHODS: We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants. RESULTS: The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1). CONCLUSIONS: There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

Mycobacterium tuberculosis and human immunodeficiency virus coinfection in a tertiary care hospital in Midwestern Brazil.

Infection with human immunodeficiency virus (HIV) increases the risk of tuberculosis (TB), and HIV TB coinfection is associated with higher mortality. This study aimed to characterize patients coinfected with Mycobacterium tuberculosis and HIV in a reference centre for cases involving complications or drug resistance in TB. This retrospective cohort study was conducted at a Hospital for Tropical Diseases in the state of Goiás, Midwestern Brazil. Patients' medical records were reviewed between January 2008 and December 2009. Sixty-one cases of TB/HIV coinfection were evaluated, and 54 HIV-seronegative TB cases were selected as controls. The prevalence of TB HIV coinfected patients in 2008/2009 was 23%. Coinfection was more prevalent in men (75.4%), with a mean age of 37.1 years. Pulmonary disease (50.8%) was the most frequent clinical form of TB in coinfected patients, followed by disseminated disease (32.8%). Anaemia, malnutrition and low levels of CD4 T lymphocytes were found in about 80% of coinfected patients. Bilateral pulmonary infiltrates were the most common radiographic finding in coinfected patients (51.8%), and pulmonary cavitation was the rarest event (5.4%). The mortality rate was 2.8 times higher in the TB HIV coinfected group (39.3%) than in TB patients without HIV (18.5%). Actions targeting the TB HIV-coinfected population, based on national and international recommendations, are necessary to improve prognosis and outcomes in TB and HIV infection in the institution.