Violence and injuries in Brazil: the effect, progress made, and challenges ahead.

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100,000 people and traffic-related mortality was 23·5 per 100,000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

[Linking of information from health and security databases on homicides]. / Informações sobre homicídios e sua integração com o setor saúde e segurança pública.

OBJECTIVE: Increased homicide rates in the city of Sao Paulo, Brazil, in the last two decades points out to the need for better understanding this subject. The purpose of the present study was to link information about homicide from different sources of data. METHODS: Homicide data from death certificates, medical examiners and police records of residents in the city of Sao Paulo was linked for the second semester of 2001. Variables about victims, risk factors and homicide circumstances were analyzed using absolute numbers, proportions and coefficients. Statistical differences were tested using Pearson's Chi-square test. RESULTS: Homicide crude rate was 57.2/100,000. Higher rates were observed among men aged 15 to 29 years (56.0% of all cases). The proportion of firearm-related homicides was 88.6%, higher among men than women. Most injuries were to the head (68.9%). Among the victims who underwent to drug screening, 42.5% had high blood alcohol concentrations (44.0% for men and 24.0% for women). Most events occurred at night during weekends and it was found a high correlation (74.6%) between the victim's place of residence and event location. CONCLUSIONS: The study findings highlight that linking information provides better quality of data and allows for better understanding of homicides.

[Injury among the elderly: the challenge to integrate preventive activities in public and individual levels]. / Mortes e internações por causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e atenção individual.

BACKGROUND: In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil. SETTING: Brazil, the last year available was 2000. METHODS: The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals). RESULTS: The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents. CONCLUSIONS: It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.