Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015. / Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015.

Objective To investigate the epidemiological profile of snakebite accident cases, their determinants and risk areas in the state of Tocantins. Methods This was an ecological study using data from the Notifiable Health Conditions Information System, from 2007 to 2015. Multiple linear regression and the Mann-Whitney and Kruskal-Wallis tests were used. Results A total of 7,764 snakebite accidents were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were population density (Coeff.=1.36, 95%CI 0.72;1.99), farming work (Coeff.=0.02, 95%CI 0.01;0.03), municipal human development index (Coeff.=2.99 - 95%CI 0.60;5.38), area planted with cassava (Coeff.=8.49 - 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 - 95%CI 0.00; 0.04), proportion of illiterate people (Coeff.=4.70 - 95%CI 0.61;8.79) and employed people (Coeff.=3.00 - 95%CI 0.93;5,06), which together accounted for 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Mid-North Araguaia health regions. Conclusion Municipal socioeconomic and demographic aspects were associated with snakebites.

Associated factors from loss productivity among people involved in road traffic accident: a prospective study. / Fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito: um estudo prospectivo.

OBJECTIVE: To study associated factors with loss productivity in people involved road traffic accidents (RTA). METHODS: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. RESULTS: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). CONCLUSION: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.

OBJETIVO: Estudar fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito (AT). MÉTODOS: Realizou-se uma coorte prospectiva de base comunitária no município de Jequié, Bahia, Brasil, entre 2013 e 2015. Foi aplicado instrumento de coleta em forma de formulário em participantes que se envolviam em AT, seguido de entrevistas a cada quatro meses. Investigou-se, por meio da análise bivariada e multivariável, a associação entre perda de produtividade e variáveis sociodemográficas e ocupacionais, condições de saúde e gravidade das lesões. RESULTADOS: Observaram-se incidência cumulativa de perda de produtividade de 61,1% e densidade de incidência geral de 7,45 casos/100 pessoas/mês. A análise multivariável demonstrou associação com perda de produtividade para quem utilizava o veículo como instrumento de trabalho (razão de densidade de incidência - RDI = 4,23; intervalo de confiança de 95% (IC95%) = 2,90 - 6,17) e aqueles que apresentaram lesão corporal (RDI = 2,80; IC95% = 1,62 - 4,85). CONCLUSÃO: São necessárias políticas públicas que assegurem a segurança no trânsito a fim de minimizar os efeitos dos AT sobre a produtividade, além da realização de novos estudos na área para ampliar o conhecimento sobre o tema.

Productivity costs among people involved in traffic accidents. / Custos de produtividade entre pessoas envolvidas em acidentes de trânsito.

This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Este artigo objetivou caracterizar os custos de produtividade de pessoas envolvidas em acidente de trânsito (AT) em um município de médio porte. Um estudo longitudinal de base domiciliar foi realizado entre 2013 e 2015. Neste período, foram entrevistados e acompanhados indivíduos com AT e calculados os custos de produtividade. Os valores mensurados e estimados foram considerados para cálculo dos valores brutos e per capita e ajudaram a constituir os custos de perda de produtividade (dias sem trabalhar) e custos de retorno à produtividade (profissionais de saúde, medicamentos, transporte, dispositivos auxiliares e reparo de veículos). Demonstrou-se que os custos de perda foram maiores em relação aos custos de retorno. Entre os itens que compõem os de retorno à produtividade, observaram-se maiores custos em homens, adultos jovens, condutores, usuários de veículos de duas rodas, pessoas com vínculo público, em faixas etárias intermediárias e lesões do tipo fratura. São necessárias a avaliação e o direcionamento nos estágios de recuperação dos envolvidos a fim de minimizar o ônus social gerado por estes eventos.

Factors associated with traffic accidents among drivers: findings from a population-based study. / Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional.

This study aimed to identify associated factors with drivers' involvement in traffic accidents (TA). Thus, in 2013, a household survey was conducted with 1,406 drivers in Jequié, Bahia, Brazil. A hierarchical conceptual model was established and consisted of four blocks of exposure factors, considering the proximal-distal relationships between them and the outcome. Multilevel logistic regression was applied to estimate the Odds Ratio (OR) and 95% Confidence Intervals (95%CI). Higher TA probability was observed among drivers aged 15-29 years (OR=3.15; 95%CI 1.24-8.02), with black or brown skin color (OR=1.56; 95%CI 1.03-2.35), motorcyclists (OR=1.73; 95%CI 1.15-2.60), with a history of traffic tickets (OR=1.75; 95%CI 1.04-2.94), who reported drinking and driving (OR=1.68; 95%CI 1.12-2.53) and used cell phone while driving (OR=1.63; 95%CI 1.09-2.43). Proximal factors changed the exposure association measures concerning higher levels of determination of the hierarchical model, mainly regarding the gender variable. The results emphasize the behavioral factors and reaffirm the TAs' preventable potential due to the occurrence of avoidable conditions associated with the outcome.

O estudo teve por objetivo identificar fatores associados ao envolvimento em acidentes de trânsito (AT) entre condutores de veículos. Para isso, realizou-se inquérito domiciliar na cidade de Jequié, Bahia, em 2013, com 1.406 condutores. Elaborou-se um modelo conceitual hierarquizado composto por quatro blocos de fatores de exposição, considerando as relações proximais-distais entre estes e o desfecho. Foi empregado modelo de regressão logística multinível para as estimativas de Razão de Chances (RC) e Intervalos de Confiança a 95% (IC95%). Observou-se maior chance de AT entre condutores de 15 a 29 anos (RC=3,15; IC95% 1,24-8,02); de cor da pele preta ou parda (RC=1,56; IC95% 1,03-2,35); motociclistas (RC=1,73; IC95% 1,15-2,60); com antecedentes de multa no trânsito (RC=1,75; IC95% 1,04-2,94); que referiram beber e dirigir (RC=1,68; IC95% 1,12-2,53) e usar telefone celular durante a condução (RC=1,63; IC95% 1,09-2,43). Os fatores proximais modificaram as medidas de associação das exposições dos níveis superiores do modelo hierarquizado, principalmente da variável sexo. Os resultados enfatizam os fatores comportamentais e ratificam o potencial de prevenção dos AT, em virtude da ocorrência de condições evitáveis associadas ao desfecho.

Traffic accidents among drivers: incidence and differences between motorcyclists and car drivers in population-based study. / Acidentes de trânsito com condutores de veículos: incidência e diferenciais entre motociclistas e motoristas em estudo de base populacional.

OBJECTIVES: To estimate the incidence of traffic accidents among land vehicle drivers and to verify differences between motorcyclist and car driver accident victims. METHODS: A household survey was conducted in Jequié city, Bahia, Brazil, in 2013, with 1,406 drivers who were selected by cluster sampling strategy. Estimates of the cumulative incidence of traffic accidents were weighted by the sample design and, to compare groups of drivers, incidence rates (IR) and 95% confidence intervals were calculated with Poisson Regression. The Chi-Square test were used with Rao-Scott correction (p ≤ 0.05) to evaluate differentials of the event between motorcyclists and car driver victims. RESULTS: Involvement in traffic accidents in the last 12 months before the interview was reported by 10.6% of the drivers. The cumulative incidence was 4.3% for accidents that caused injuries. Motorcyclists had double the risk of being involved in accidents (IR = 2.03; 95%CI 1.40 - 2.94) and higher proportions of injuries (p < 0.001), interruption in daily life activities (p = 0.003) and use of emergency services (p = 0.008). Factors related to time and place of accident were not different between groups. CONCLUSION: Higher incidence of traffic accidents and higher proportions of injuries and others repercussions of these events were seen in motorcyclists. These findings reaffirm the vulnerability of this group and explains the different impact that a preventable cause of morbidity and mortality has on each driver group.

OBJETIVOS: Estimar incidências de acidentes de trânsito entre condutores de veículos a motor e verificar diferenciais do evento entre as vítimas motociclistas e motoristas de automóvel. MÉTODOS: Foi conduzido um inquérito domiciliar no município de Jequié, Bahia, em 2013, com 1.406 condutores selecionados por amostragem por conglomerado. As estimativas de incidência cumulativa de acidentes de trânsito foram ponderadas pelo desenho amostral e, para comparação entre categorias de condutores, foram estimadas razões de incidência (RI) e intervalos de confiança de 95% (IC95%) com regressão de Poisson. Diferenciais do evento entre vítimas motociclistas e motoristas foram avaliados com teste do χ2 de Rao-Scott (p ≤ 0,05). RESULTADOS: O envolvimento em acidentes de trânsito nos 12 meses anteriores à entrevista foi referido por 10,6% dos condutores. Para acidentes que causaram lesão física, a incidência foi de 4,3%. Motociclistas apresentaram o dobro do risco de envolvimento em acidentes (RI = 2,03; IC95% 1,40 - 2,94) e maiores proporções de lesões (p < 0,001), de interrupção de atividades habituais de vida (p = 0,003) e de atendimento em serviços de emergência (p = 0,008). Fatores relacionados ao tempo e local de ocorrência não se diferenciaram entre grupos. CONCLUSÃO: Maior incidência de acidentes e proporções mais elevadas de lesões e de outras repercussões desses eventos recaíram sobre motociclistas. Tais achados reafirmam a condição de vulnerabilidade desse grupo e explicitam diferentes impactos que uma causa prevenível de morbimortalidade apresenta em cada grupo de condutores.

Exclusive breast-feeding is associated with reduced pacifier sucking in children: Breast-feeding and pacifier-sucking habit.

BACKGROUND: Studies suggest that when children do not achieve the emotional satiety and adequate stimulus provided by breast-feeding, they exhibit sucking behaviors. This study aimed to estimate the association from 4 through 6 months of exclusive breast-feeding (EB) postpartum and pacifier-sucking behavior at 12 months of life. METHODS: A cohort study was conducted with 1,037 infants, born alive and monitored up to 12 months. At 4 and 6 months after birth, the children were classified according to the type of breast-feeding they had received: exclusive, predominant, complementary, or none. The prevalence of pacifier-sucking behavior was calculated, and the association between the 2 events was estimated. Mothers' socioeconomic-demographic characteristics, delivery features, and prenatal care, as well as the biological characteristics of the children, were determined. Relative risk (RR) and 95% confidence intervals (95% CI) were calculated. RESULTS: In comparison with EB infants, the RR of pacifier-sucking behavior at 12 months of life was higher in children receiving complementary breast-feeding or no breast-feeding for both 4 months (RRadjusted, 1.68 [95% CI, 1.39 to 2.02] and RRadjusted, 2.67 [95% CI, 2.24 to 3.17], respectively) and 6 months (RRadjusted, 1.43 [95% CI, 1.03 to 2.00] and RRadjusted, 3.30 [95% CI, 2.40 to 4.54], respectively). CONCLUSIONS AND PRACTICAL IMPLICATIONS: EB for 6 months postpartum is associated with reduced pacifier-sucking behavior, adjusted for maternal color, number of prenatal consultations, and family income. Promotion of EB may reduce the use of pacifiers and their potential deleterious effects on oral health. Dental health care professionals should consider discussing the importance of breast-feeding with their patients with regard to the possible development of sucking habits in their children.

[Characteristics of individuals and care delivered at the psychosocial care centers for children and adolescents]. / Caracterização dos usuários e dos serviços prestados por centros de atenção psicossocial infanto-juvenil.

This study aimed to provide an understanding of diagnosis, demographic characteristics, and treatment procedures for children and adolescents attending Psychosocial Care Centers (CAPSIS) in Brazil, 2003. It was a cross-sectional descriptive study using secondary data. The analysis considered three groups of variables related to: (a) the nature of the services; (b) patient profile; and (c) types of care. Seven CAPSIS that had recorded their procedures during all 12 months of 2003 participated in the study. The units involved treated 1,456 individuals, 62.8% of whom were males 11-13 years of age. Nearly half (49.3%) were treated in non-intensive care. The most frequent diagnoses were behavioral and emotional disorders (44.5%). There was no record of treatment related to use of psychoactive substances. The proportion of severe disorders was 19.4%. The CAPSIS operate in similar fashion to older outpatient units, but treat a variety of problems, creating a record according to types of activities. These services fill a historical gap in public mental health care for children and adolescents.

[Traffic accidents in a metropolitan area in Brazil, 1991-2000]. / Evolução dos acidentes de trânsito em um grande centro urbano, 1991-2000.

A time series study described the trend in motor vehicle accidents from 1991 to 2000, using data from the State Transit Department in Salvador, Bahia State, Brazil. Rates were calculated for total motor vehicle accidents, number of casualties, and standardized mortality based on population and number of vehicles, comparing two periods (1991-1994 and 1995-2000), before and after the adoption of safety measures including compulsory seat belt use and the new National Transit Code (NTC). Vehicle accident and casualty rates were high and showed little variation during the study period. The mortality rate decreased from 25.7/100,000 inhabitants in 1995 to 18.1/100,000 in 1998 and remained stable thereafter. The only significant difference (p < 0.001) was in the mean motor vehicle accident mortality rate before and after the intervention. The case fatality rate decreased from 10.7% (1995) to 7% (2000). Although still representing a major public health problem in this important metropolitan area, the decrease in motor vehicle accident mortality was possibly due to interventions in 1995 and expanded NTC measures in 1998. Greater efforts to change driver and pedestrian behavior could further decrease the high number of accidents and related mortality.

Risk factors for caries-free time: longitudinal study in early childhood.

OBJECTIVE: To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease. METHODS: The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time. RESULTS: Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27-2.77), category of day care (HR = 3.88, 95%CI 2.04-7.38), age (HR = 1.77, 95%CI 1.15-2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04-2.51), presence of active white spots (HR = 2.70, 95%CI 1.07-6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02-2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80-7.42) was found for previous caries experience. CONCLUSIONS: Social variables were considered as of high risk for the development of dental caries.

Incorporation of information technology in Primary Care of SUS in North-eastern Brazil: expectations and experiences.

The incorporation of information technology (IT) via an electronic record of health data in primary care is transforming the organization of labor and professional practices in Brazil. The scope of this study is to establish the expectations and experiences of incorporating IT in the primary health care of the Unified Health System (SUS) with the implementation of the National Health Card System (SCNS). It involved qualitative research with 50 interviews and 96 questionnaires comparing the opinion of health professionals about technological innovation in locations with the SCNS and where it has not yet been incorporated in the cities of João Pessoa and Aracaju, respectively. The expectation was that IT would speed up the work schedule, which was not confirmed at the location where the SCNS had been incorporated. IT can improve labor organization, the flow of data and information and enable the digital insertion of the professional. The "light" technology of health care cannot be expedited by IT, as it is necessary to impart knowledge to the professionals. However, it can improve working conditions by data gathering and organization, giving immediate feedback to the professional recording the data and enhance the ability to manage health policies.

[Decentralization of epidemiological surveillance in Pernambuco State, Brazil]. / Descentralização das ações de vigilância epidemiológica em Pernambuco, Brasil.

The study aimed to analyze the relationship between decentralization of the Brazilian Unified National Health System (SUS) and the development of epidemiological surveillance activities in municipalities (counties) in Pernambuco State, Brazil. This was an exploratory descriptive qualitative and quantitative study, including a document search, completion of semi-structured interviews by key informants, and an ecological spatial and time trend study of selected health indicators, covering a 10-year period (2001-2010). The study showed that municipalities adhered to the decentralization process, which was making progress in Pernambuco, but with inequalities and weaknesses in its development. There was also a fluctuation in the time series for the selected indicators. Thus, even though the decentralization of epidemiological surveillance is still incipient in some municipalities, their protagonist role in implementing the activities promotes empowerment at the local level by producing key information for decision-making.

Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015 / Ofidismo en Tocantins: análisis ecológico de determinantes y áreas de riesgo, 2007- 2015 / Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015

Objetivo: Investigar o perfil dos casos de acidentes ofídicos, seus determinantes e áreas de risco no estado do Tocantins. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação do período 2007-2015. Empregou-se regressão linear múltipla e os testes Mann-Whitney e Kruskal-Wallis. Resultados: Foram notificados 7.764 acidentes ofídicos (incidência de 62,1/100 mil habitantes; letalidade de 0,5%). As variáveis associadas ao ofidismo foram densidade demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabalho agropecuário (Coef.=0,02 - IC95% 0,01;0,03), índice de desenvolvimento humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de mandioca (Coef.=8,49 - IC95% 1,66;15,32), população indígena (Coef.=0,02 - IC95% 0,00;0,04), proporção de população analfabeta (Coef.=4,70 - IC95% 0,61;8,79) e população empregada (Coef.=3,00 - IC95% 0,93;5,06), que explicaram 64,48% da variação. As áreas de alto risco foram as regiões de saúde Amor Perfeito, Cantão, Cerrado Tocantins Araguaia e Médio Norte Araguaia. Conclusão: Aspectos socioeconômicos e demográficos municipais associaram-se ao ofidismo.

Objetivo: Investigar el perfil de accidentes ofídicos, sus determinantes y áreas de riesgo, en el estado de Tocantins. Métodos: Estudio ecológico con datos del Sistema de Información de Enfermedades de Agravamiento de Notificación, 2007-2015. Se utilizaron pruebas de regresión lineal y pruebas de Mann-Whitney y Kruskal-Wallis. Resultados: Se reportaron 7.764 accidentes ofídicos (incidencia: 62,1/100.000 hab.; letalidad: 0,5%). Las variables relacionadas al ofidismo fueron densidad demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabajo agrícola (Coef.=0,02 - IC95% 0,01;0,03), índice de desarrollo humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de yuca (Coef.=8,49 - IC95% 1,66;15,32), población indígena (Coef.=0,02 - IC95% 0,00;0,04), proporción de la población analfabeta (Coef.=4,70 - IC95% 0,61;8,79) y empleados (Coef.=3,00 - IC95% 0,93;5,06), explicando 64,48% de la variación. Las áreas de alto riesgo fueron las regiones de salud Amor Perfecto, Cantão, Cerrado Tocantins Araguaia y Medio Norte Araguaia. Conclusión: Aspectos socioeconómicos y demográficos municipales se asociaron con el ofidismo.

Objective: To investigate the epidemiological profile of snakebite accident cases, their determinants and risk areas in the state of Tocantins. Methods: This was an ecological study using data from the Notifiable Health Conditions Information System, from 2007 to 2015. Multiple linear regression and the Mann-Whitney and Kruskal-Wallis tests were used. Results: A total of 7,764 snakebite accidents were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were population density (Coeff.=1.36, 95%CI 0.72;1.99), farming work (Coeff.=0.02, 95%CI 0.01;0.03), municipal human development index (Coeff.=2.99 - 95%CI 0.60;5.38), area planted with cassava (Coeff.=8.49 - 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 - 95%CI 0.00; 0.04), proportion of illiterate people (Coeff.=4.70 - 95%CI 0.61;8.79) and employed people (Coeff.=3.00 - 95%CI 0.93;5,06), which together accounted for 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Mid-North Araguaia health regions. Conclusion: Municipal socioeconomic and demographic aspects were associated with snakebites.

Fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito: um estudo prospectivo / Associated factors from loss productivity among people involved in road traffic accident: a prospective study

RESUMO: Objetivo: Estudar fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito (AT). Métodos: Realizou-se uma coorte prospectiva de base comunitária no município de Jequié, Bahia, Brasil, entre 2013 e 2015. Foi aplicado instrumento de coleta em forma de formulário em participantes que se envolviam em AT, seguido de entrevistas a cada quatro meses. Investigou-se, por meio da análise bivariada e multivariável, a associação entre perda de produtividade e variáveis sociodemográficas e ocupacionais, condições de saúde e gravidade das lesões. Resultados: Observaram-se incidência cumulativa de perda de produtividade de 61,1% e densidade de incidência geral de 7,45 casos/100 pessoas/mês. A análise multivariável demonstrou associação com perda de produtividade para quem utilizava o veículo como instrumento de trabalho (razão de densidade de incidência - RDI = 4,23; intervalo de confiança de 95% (IC95%) = 2,90 - 6,17) e aqueles que apresentaram lesão corporal (RDI = 2,80; IC95% = 1,62 - 4,85). Conclusão: São necessárias políticas públicas que assegurem a segurança no trânsito a fim de minimizar os efeitos dos AT sobre a produtividade, além da realização de novos estudos na área para ampliar o conhecimento sobre o tema.

ABSTRACT: Objective: To study associated factors with loss productivity in people involved road traffic accidents (RTA). Methods: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. Results: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). Conclusion: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.

Custos de produtividade entre pessoas envolvidas em acidentes de trânsito / Productivity costs among people involved in traffic accidents

Resumo Este artigo objetivou caracterizar os custos de produtividade de pessoas envolvidas em acidente de trânsito (AT) em um município de médio porte. Um estudo longitudinal de base domiciliar foi realizado entre 2013 e 2015. Neste período, foram entrevistados e acompanhados indivíduos com AT e calculados os custos de produtividade. Os valores mensurados e estimados foram considerados para cálculo dos valores brutos e per capita e ajudaram a constituir os custos de perda de produtividade (dias sem trabalhar) e custos de retorno à produtividade (profissionais de saúde, medicamentos, transporte, dispositivos auxiliares e reparo de veículos). Demonstrou-se que os custos de perda foram maiores em relação aos custos de retorno. Entre os itens que compõem os de retorno à produtividade, observaram-se maiores custos em homens, adultos jovens, condutores, usuários de veículos de duas rodas, pessoas com vínculo público, em faixas etárias intermediárias e lesões do tipo fratura. São necessárias a avaliação e o direcionamento nos estágios de recuperação dos envolvidos a fim de minimizar o ônus social gerado por estes eventos.

Abstract This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Fatores associados a acidentes de trânsito entre condutores de veículos: achados de um estudo de base populacional / Factors associated with traffic accidents among drivers: findings from a population-based study

Resumo O estudo teve por objetivo identificar fatores associados ao envolvimento em acidentes de trânsito (AT) entre condutores de veículos. Para isso, realizou-se inquérito domiciliar na cidade de Jequié, Bahia, em 2013, com 1.406 condutores. Elaborou-se um modelo conceitual hierarquizado composto por quatro blocos de fatores de exposição, considerando as relações proximais-distais entre estes e o desfecho. Foi empregado modelo de regressão logística multinível para as estimativas de Razão de Chances (RC) e Intervalos de Confiança a 95% (IC95%). Observou-se maior chance de AT entre condutores de 15 a 29 anos (RC=3,15; IC95% 1,24-8,02); de cor da pele preta ou parda (RC=1,56; IC95% 1,03-2,35); motociclistas (RC=1,73; IC95% 1,15-2,60); com antecedentes de multa no trânsito (RC=1,75; IC95% 1,04-2,94); que referiram beber e dirigir (RC=1,68; IC95% 1,12-2,53) e usar telefone celular durante a condução (RC=1,63; IC95% 1,09-2,43). Os fatores proximais modificaram as medidas de associação das exposições dos níveis superiores do modelo hierarquizado, principalmente da variável sexo. Os resultados enfatizam os fatores comportamentais e ratificam o potencial de prevenção dos AT, em virtude da ocorrência de condições evitáveis associadas ao desfecho.

Abstract This study aimed to identify associated factors with drivers' involvement in traffic accidents (TA). Thus, in 2013, a household survey was conducted with 1,406 drivers in Jequié, Bahia, Brazil. A hierarchical conceptual model was established and consisted of four blocks of exposure factors, considering the proximal-distal relationships between them and the outcome. Multilevel logistic regression was applied to estimate the Odds Ratio (OR) and 95% Confidence Intervals (95%CI). Higher TA probability was observed among drivers aged 15-29 years (OR=3.15; 95%CI 1.24-8.02), with black or brown skin color (OR=1.56; 95%CI 1.03-2.35), motorcyclists (OR=1.73; 95%CI 1.15-2.60), with a history of traffic tickets (OR=1.75; 95%CI 1.04-2.94), who reported drinking and driving (OR=1.68; 95%CI 1.12-2.53) and used cell phone while driving (OR=1.63; 95%CI 1.09-2.43). Proximal factors changed the exposure association measures concerning higher levels of determination of the hierarchical model, mainly regarding the gender variable. The results emphasize the behavioral factors and reaffirm the TAs' preventable potential due to the occurrence of avoidable conditions associated with the outcome.

[Infant mortality in Brazil during recent periods of economic crisis]. / Mortalidade infantil no Brasil em períodos recentes de crise econômica.

OBJECTIVE: To analyze time trends in infant mortality in Brazil during a recent period of economic crisis (1980-1998). METHODS: Time-series study based on the Ministry of Health's Mortality Information System, IBGE Foundation and Funda o Nacional de Sa de (National Health Institute database. Serial parameters were described using autoregressive integrated moving average (ARIMA) models, and the association between infant mortality rates and a number of determinants was evaluated using Spearman correlation coefficients. RESULTS: Infant mortality showed a declining trend (-59.3%) and a strong correlation with most of the indicators analyzed. However, only correlations between infant mortality rate and total pregnancy and birth rates presented a significant difference between the two decades. CONCLUSIONS: Variations in pregnancy rate were the main cause for the persistent decline in infant mortality in the 1980's. In the subsequent period, causes related to living conditions, especially healthcare, may have been more important.

Low birth weight and the delay on the eruption of deciduous teething in children / Baixo peso ao nascer e atraso na erupção de dentes decíduos em crianças

Abstract Objectives: To analyze the association between low birth weight (LBW) and the occurrence of the delay on the eruption of deciduous teething (DEDT) in children from 04 to 30 months, living in Salvador, Bahia. Methods: A cross-sectional study involved 520 children at four to thirty months of age, from public, private and philanthropic daycares from two districts in Salvador. A descriptive analysis and unconditional logistic regression were done to estimate the odds ratios (ORs), using the Confidence Interval of 95% as a criterion for accepting associations. Poisson regression was used as an analytical strategy to obtain the prevalence ratio. Results: the prevalence of the delay on the eruption was 10.29%. There was a positive association between LBW and occurrence of DEDT among children with less than 24 months, both in the unadjusted model (PR=2.07, 95%CI= 0.96 4.44) as in the adjusted (adjusted PR=2, 27, 95%CI= 1.02 5.07). Conclusions: the variables of development and nutritional at birth and during the early life may be important predictors of the chronology of eruption. Further investigations should be carried out towards the adequate evaluation of the LBW role in the occurrence of the delay on the eruption.

Resumo Objetivos: analisar a associação entre o Baixo Peso ao Nascer (BPN) e a ocorrência de atraso na erupção da dentição decídua (AED) em crianças de 04 a 30 meses, residentes em Salvador-BA. Métodos: estudo transversal envolvendo 520 crianças que frequentavam creches públicas, privadas e filantrópicas de dois Distritos Sanitários de Salvador-Ba. Procedeu-se a análise descritiva e regressão logística não-condicional para estimação da oddsratios (ORs), empregando-se o Intervalo de Confiança a 95% como critério para aceitar as associações. A regressão de Poisson foi utilizada como estratégia analítica para obtenção da Razão de Prevalência. Resultados: a prevalência de atraso na erupção foi de 10,29%. Verificou-se uma associa-ção positiva entre BPN e ocorrência de AED entre as crianças com menos de 24 meses no modelo bruto (RP=2,07, IC95%= 0,96 4,44) e ajustado (RP ajustada=2,27, IC95%= 1,02 5,07). Conclusões: variáveis de desenvolvimento e nutricionais ao nascimento e durante a vida precoce podem ser importantes preditores do tempo de erupção, sendo necessárias outras investigações para uma adequada avaliação desta associação.

Traffic deaths: recent evolution and regional differences in Bahia State, Brazil.

This study describes the temporal evolution of mortality due to traffic accidents in regions within Bahia State, Brazil, from 1996 to 2007, using data from the Brazilian Mortality Information System. We calculated overall rates of mortality due to traffic accidents and specific rates by type of victim. Temporal evolution was analyzed by means of correlations between rates and years of study, as well as polynomial regression models to evaluate trends. During the study period, the regions analyzed accounted for 60% of deaths due to traffic accidents in Bahia. Excess mortality among males and superior percentage of deaths in young individuals were observed. Overall, the evolution of global rates showed decreases beginning in 1998, but growth resumption in 2000, although the trend was not statistically significant. Regional differences were more marked when analyzing rates according to type of victim. However, a growing trend was observed in most locations for rates of accidents involving motorcyclists, which, in conjunction with other findings, substantiates concerns regarding the current situation of increased deaths involving motorcycles in Brazil.

[Perinatal mortality in the municipality of Salvador, Northeastern Brazil: evolution from 2000 to 2009]. / Mortalidade perinatal no município de Salvador, Bahia: evolução de 2000 a 2009.

OBJECTIVE: To describe and analyze the evolution of perinatal mortality with regards the scale and extent of the problem. METHODS: A descriptive time trend study with 10,994 perinatal deaths to mothers living in Salvador, Bahia, Northeastern Brazil, with a gestational age of ≥ 22 weeks, newborn age of up to six days and birth weight of 500 grams or more, recorded from 2000 to 2009. Data from the Information Systems on Live Births and Mortality of DATASUS/Ministry of Health available on the website were used. Rates of perinatal and fetal mortality per 1,000 births and early neonatal mortality per 1,000 live births were calculated. The Pearson's Qui-square test for differences in proportions, sequence (runs) test, the calculation of moving averages and linear coefficient of determination (R²) were used for trend analysis. The Wigglesworth classification of causes of death was used. RESULTS: The rates of perinatal mortality showed a decreasing trend, of -42.0% in the period (from 33.1 (2000) to 19.2 (2009)), with a greater share of rates of neonatal mortality (-56.3%). Fetal mortality accounted for a large proportion (61.9%) of rates of perinatal mortality in 2009. The classification of deaths showed the following most frequent causes of perinatal deaths: intrapartum asphyxia (8.8/1,000), immaturity (7.1/1,000) and congenital malformations (1.3/1,000). CONCLUSIONS: Perinatal mortality remains high despite the downward trend, and the predominance of fetal mortality indicates recent changes in the profile of causes of death and impact on prevention activities. The quality of prenatal care with risk control and improving care during the delivery may reduce the occurrence of preventable causes of death.

[Publications committee of a multicenter study and computerized support system--publiELSA]. / Comitê de publicações em estudo multicêntrico e sistema informatizado de apoio ­ publiELSA.

The publications committee of a multicenter study has the aim of organizing the proposals for articles, so as to ensure wide-ranging access to the data, quality and precedence. An online information and management system for study proposals (publiELSA) was developed, composed of three modules: (i) submission and approval of proposals; (ii) follow-up of approved proposals; and (iii) consolidated reports. The first module allows any interested party to search for and become acquainted with articles that have already been published or are in progress and submit new proposals. The approval process and data transfer to the researcher responsible is organized at this stage. In the second module, the aim is to monitor proposals approved until they are finally published. The third module enables searching for and viewing proposals and articles. The system has innovative characteristics, especially with regard to encouraging cooperation between different researchers, through circulation of information on each proposal submitted. In this manner, interaction between different viewpoints and experiences involved in the research is stimulated.