Consumo de bebida alcoólica por estudantes de medicina: um panorama global / Alcohol consumption by medical students: a global overview / Consumo de alcohol por estudiantes de medicina: una visión global

O consumo de bebidas alcoólicas representa um dos principais fatores de risco de envolvimento em acidentes de trânsito. Objetivou-se analisar o panorama geral de consumo de bebida alcoólica por estudantes de medicina e as implicações nos acidentes de trânsito. Foram consultadas as bases de dados SciELO, PubMed e Biblioteca Virtual em Saúde e incluídos dez artigos completos disponíveis entre 2010 e 2022, em língua portuguesa e inglesa. Resultou que o consumo de bebidas alcoólicas pelos estudantes variou de 76,6% a 81,2%, e que ingerir bebidas alcoólicas expõe os motoristas ao envolvimento em acidentes de trânsito 68% maior do que os que não estão expostos a tal fator. Concluiu-se que os estudantes de medicina, população jovem, apresentam um alto índice de consumo de bebidas alcoólicas, e os motivos envolvidos apontam para o nível de pressão do curso, alta carga horária, períodos do curso mais avançados, festas acadêmicas e morar sem os pais.

The consumption of alcoholic drinks represents one of the main risk factors for the involvement in traffic accidents. The objective of this study was to analyze the general panorama of alcohol consumption by medical students and the implications for traffic accidents. SciELO, PubMed and Virtual Health Library databases were consulted, and ten full articles available between 2010 and 2022, in Portuguese and English, were included. The results obtained were that the consumption of alcoholic drinks by students ranged from 76.6% to 81.2%, and that alcohol drinking exposes drivers to involvement in 68% more traffic accidents than those who are not exposed to such factor. It was concluded that medical students, a young population, have a high rate of consumption of alcoholic beverages, and the reasons involved point to the level of pressure of the medical school, high workload, seniority in the program, academic parties, and living without the parents

El consumo de bebidas alcohólicas representa uno de los principales factores de riesgo de implicación en accidentes de tráfico. El objetivo de este estudio fue analizar el panorama del consumo de alcohol por los estudiantes de medicina y las implicaciones en los accidentes de tránsito. Se consultaron las bases de datos SciELO, PubMed y Biblioteca Virtual en Salud y se incluyeron diez artículos completos disponibles entre 2010 y 2022, en portugués e inglés. Los resultados obtenidos fueran que el consumo de bebidas alcohólicas osciló entre 76,6% y 81,2%, y que el expone a los conductores a involucrarse en accidentes de tráfico un 68% más que aquellos que non están expuestos a tal factor. Se concluyó que los estudiantes de medicina, una población joven, tienen un alto índice de consumo de bebidas alcohólicas, y los motivos involucrados apuntan para el nivel de presión del curso, alta carga horaria, períodos más avanzados del curso, fiestas académicas y morar sin los padres

Intervención del helicóptero sanitario de Aragón en los accidentes de tráfico antes y durante la pandemia por covid-19 / Intervention of the Aragon medical helicopter in traffic accidents before and during the covid-19 pandemic

Objetivo: Describir la prevalencia y características de los accidentes de tráfico atendidos por helicópteros sanitarios en un periodo de 5 años y durante el año de confinamiento. Método: Estudio descriptivo transversal sobre la actividad asistencial en los accidentes de tráfico de los Helicópteros Sanitarios del 112 Aragón entre el 1 de enero de 2013 y el 31 de diciembre de 2017 y su comparación con 2020, año de la pandemia por COVID-19. Resultados: De los 1.375 pacientes atendidos durante el periodo 2013-2017, 259 fueron por accidentes de tráfico, siendo aproximadamente el 76% hombres y el 24% mujeres. La media de edad fue de 45 años (± 19,15). Un 93,4% de estos avisos fueron primarios y el 21,2% requeridos por otros servicios extrahospitalarios. El tiempo de respuesta fue, en el 49,6% de los casos, de 30 o menos minutos. La patología más frecuente fue la traumatológica, con un 97,6% de pacientes. El 45,9% de accidentes se produjeron en carreteras comarcales o locales. Durante el año 2020, se atendieron 25 casos por accidentes de tráfico, de un total de 274. La mayoría de pacientes atendidos fueron hombres (92%). La edad media fue de 46,7 años (± 15,25). En el 56% de los casos, los pacientes fueron atendidos en un máximo de 30 minutos, siendo la patología más frecuente la traumatológica, con un 96% de casos. La mitad de accidentes se produjeron en carreteras comarcales y locales. Conclusiones: La utilización del helicóptero sanitario en accidentes de tráfico permite auxiliar a sus víctimas en su mayoría antes de 30 minutos. El tiempo medio de respuesta del helicóptero fue significativamente inferior al tiempo por carretera. La pandemia por COVID-19 redujo el porcentaje de las intervenciones en accidentes de tráfico en relación a las totales del helicóptero y aumentó la atención a hombres frente a mujeres. (AU)

Objective: To describe the prevalence and characteristics of traffic accidents attended by medical helicopters. Method: Describe the prevalence and characteristics of traffic accidents attended by medical helicopters in a period of 5 years and during the year of confinement. Results: Out of the 1,376 patients attended during this period, 259 were due to traffic accidents, with approximately 76% men and 24% women. The mean age was 45 years (± 19,15). 93.4% of these transfers were primary and 21.2% requiered by other out-of-hospital services. The response time was, in the 49.6% of the cases, 30 minutes or less. The most frequent pathology was trauma, with 97.6% of patients. 45.9% of accidents occurred on county or local roads. During the year 2020, 25 cases of traffic accidents were attended, out of a total of 274. The majority of patients attended were men (92%). The mean age was 46.7 years (± 15.25). In 56% of the cases, the patients were treated in a maximum of 30 minutes, the most frequent pathology being traumatology, with 96% of cases. Half of the accidents occurred on county and local roads. Conclusion: The use of the sanitary helicopter in traffic accidents allows to assisting their victims in their majority before 30 minutes. Helicopter mean response time was significantly less than road time. The COVID-19 pandemic reduced the percentage of interventions in traffic accidents in relation to the total number of helicopters and increased attention to men compared to women. (AU)

Traumatic brain injury in the new millennium: new population and new management.

INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population. MATERIALS AND METHODS: We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome. RESULTS: We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12 years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes. CONCLUSION: The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

El traumatismo craneoencefálico severo en el nuevo milenio. Nueva población y nuevo manejo / Traumatic brain injury in the new millennium: A new population and new management

Introducción: El TCE es una de las principales causas de muerte y discapacidad a nivel mundial. Presentamos este estudio con el objetivo de detallar el cambio epidemiológico de la población que sufre TCE severo, su influencia en el tipo de tratamiento ofrecido y analizar alternativas que mejoren los resultados ante el nuevo tipo de población que afrontamos. Material y métodos: Se ha realizado un análisis descriptivo, transversal y retrospectivo de los pacientes que sufrieron TCE severo en nuestro hospital en los periodos 1992-1996 y 2009-2013. Se analizaron datos demográficos como edad, sexo, mortalidad, etiología, anticoagulación, tratamiento realizado y resultados funcionales. Resultados: Se revisaron 220 pacientes. En la segunda cohorte el número de pacientes con TCE severo disminuyó un 40%, eran de media 12 años mayores, más frecuentemente anticoagulados y las intervenciones se redujeron a la mitad. Varió la etiología, predominando en el primer grupo los accidentes de tráfico y en el segundo las caídas casuales y los atropellos. No hubo diferencias en la mortalidad de ambos grupos, y sí en su situación funcional. Conclusión: En este estudio encontramos un envejecimiento de la población que ingresa por TCE severo. Ello hace que, en la actualidad, la principal causa de TCE severo en nuestra población sean las caídas casuales en pacientes anticoagulados mayores. A pesar de ser traumatismos de poca energía, los pacientes presentan peores condiciones basales y son menos candidatos a cirugía, sin que mejoren la mortalidad ni la situación funcional. (AU)

Introduction: Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population. Materials and methods: We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome. Results: We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12 years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes. Conclusion: The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes. (AU)

Associação entre doenças cardiometabólicas autorreferidas, violência e uso de drogas em caminhoneiros / Association between self-reported cardiometabolic diseases, violence and drug use in truck drivers / Asociación entre enfermedades cardiometabólicas autoinformadas, violencia y consumo de drogas en conductores de camiones

Objetivo: analisar a associação entre doenças cardiometabólicas, violência sofrida e uso de drogas em caminhoneiros. Método: estudo transversal que envolveu 235 motoristas que estiveram em um posto de combustível no município de Uberlândia (MG), Brasil. Os dados foram coletados por meio de entrevistas autorrelatadas e aplicados os Testes de Qui Quadrado e Regressão Logística, adotando-se um nível de significância de 0,05 para todas as variáveis. Resultados: observou-se uma relação entre os eventos violentos no trânsito e algumas doenças cardiometabólicas, especialmente a doença vascular periférica (OR=6,00 (IC 95% 2,47-14,56) e a obesidade (OR=2,56 (IC 95% 1,42-4,62); sendo que também o abuso de álcool (OR=4,16 (IC 95% 1,53-11,29) e tabaco (OR=2,68 (IC 95% 1,10-6,51) se relacionaram com essas patologias. Conclusão: exposição a assaltos e acidentes de trânsito, e uso de álcool e tabaco foram associados a uma maior chance de prevalência das doenças cardiometabólicas entre caminhoneiros.

Objective: to analyze the association between cadiometabolic diseases, violence and drug use in truck drivers. Method: cross-sectional study, that involved 235 truck drives that were in a gas station in the city of Uberlândia (MG), Brazil. Data were collected through self-reported interviews and the Chi-Square and Logistic Regression tests were applied, adopting a significance level of 0.05 for all variables. Results: there was a relationship between violent traffic events and some cardiometabolic diseases, especially peripheral vascular disease (OR=6.00 (95% CI 2.47-14.56) and obesity (OR=2.56 (CI 95% 1.42-4.62); and also, alcohol abuse (OR=4.16 (95% CI 1.53-11.29) and tobacco (OR=2.68 (95% CI 1, 10-6.51) were related to these pathologies. Conclusion: exposure to robberies and traffic accidents, and the use of alcohol and tobacco were associated with a greater chance of prevalence of cardiometabolic diseases among truck drivers.

Objetivo: analizar la asociación entre enfermedades cardiometabólicas, violencia y consumo de drogas en camioneros. Método: estudio transversal, que involucró 235 camionetas que se encontraban en una gasolinera de la ciudad de Uberlândia (MG), Brasil. Los datos se recolectaron a través de entrevistas autoinformadas y se aplicaron las pruebas de Chi-Cuadrado y Regresión Logística, adoptando un nivel de significancia de 0.05 para todas las variables. Resultados: hubo relación entre eventos de tráfico violento y algunas enfermedades cardiometabólicas, especialmente enfermedad vascular periférica (OR = 6,00 (IC 95% 2,47-14,56) y obesidad (OR = 2,56 (IC 95% 1,42-4,62); y también, alcohol el abuso (OR = 4,16 (IC 95% 1,53-11,29) y el tabaco (OR = 2,68 (IC 95% 1, 10-6,51) se relacionaron con estas patologías. Conclusión: exposición a robos y accidentes de tráfico, y consumo de alcohol y el tabaco se asoció con una mayor probabilidad de prevalencia de enfermedades cardiometabólicas entre los conductores de camiones.

Gravidade e lesões traumáticas em vítimas de acidente de trânsito internadas em um hospital público / La gravedad y las lesiones traumáticas en las víctimas de accidente de tráfico de pacientes internados en un hospital público / Severity and traumatic injuries in traffic accident victims in a public hospital

Objetivo: Identificar as principais lesões das categorias de vítimas em acidentes de trânsito e sua gravidade. Método: Estudo quantitativo, transversal, com 276 vítimas internadas e, a partir de dados de prontuários e entrevistas, foi realizada associação logística para análises. Resultados: Houve maior frequência do sexo masculino (78,9%), na faixa etária de 21 a 39 anos (50,3%) e motociclistas (74,6%). A lesão mais comum: fratura fechada (44,5%) em membros inferiores (41,9%). A ocorrência de lesão cerebral, lesão torácica e idade aumentam a chance de trauma grave, enquanto o estado civil casado diminui a chance, independente do sexo. Conclusão: Assim, vale destacar que os dados apresentados são fundamentais, para o processo de enfermagem no trauma, visto que as lesões de membros inferiores com fraturas são destaques na categoria de motociclistas e que juntamente com as lesões cerebrais e torácicas incrementam a mortalidade nessas ocorrências(AU)

Objective: To identify the main injuries and their severity in the categories of traffic accidents victims. Method: This is a quantitative, cross-sectional study, with 276 hospitalized victims, based on data from medical records and interviews, with a logistical association for analysis. Results: There was a higher frequency of males (78.9%), aged 21 to 39 years (50.3%) and motorcyclists (74.6%). The most common injury: closed fracture (44.5%) in the lower limbs (41.9%). The occurrence of brain injury, chest injury and age increase the chance of serious trauma, while married marital status decreases the chance, regardless of sex. Conclusion: These data are fundamental for the nursing process in trauma, since lower limb injuries with fractures are the most common in the category of motorcyclists and that, together with brain and thoracic injuries, increases mortality in these occurrences.(AU)

Objetivo: Identificar las principales lesiones de las categorías de víctimas en accidentes de tráfico y su gravedad. Método: Estudio cuantitativo, transversal, con 276 víctimas hospitalizadas, basado en datos de historias clínicas y entrevistas, con una asociación logística para análisis. Resultados: Hubo una mayor frecuencia de hombres (78,9%), de 21 a 39 años (50,3%) y motociclistas (74,6%). La lesión más común: fractura cerrada (44,5%) en miembros inferiores (41,9%). La aparición de lesiones cerebrales, lesiones en el pecho y la edad aumentan la posibilidad de un traumatismo grave, mientras que el estado civil casado disminuye la posibilidad, independientemente del sexo. Conclusión: Por lo tanto, cabe destacar que los datos presentados son fundamentales para el proceso de enfermería en traumatismo, ya que las lesiones en las extremidades inferiores con fracturas se destacan en la categoría de motociclistas y que junto con las lesiones cerebrales y torácicas aumentan la mortalidad en estos sucesos(AU)

Contribuições da pós-graduação sobre educação para o trânsito / Postgraduate contributions on traffic education / Contribuciones del Postgrado sobre educación para el tránsito

Os acidentes de trânsito permanecem causando elevada morbimortalidade, mas são previsíveis e preveníveis, como apontam as políticas públicas. A temática da educação para o trânsito é indicada para ser desenvolvida em todos os níveis de educação e é sugestiva para a prevenção destes acidentes. O objetivo desse trabalho foi investigar estudos pós-graduados brasileiros relacionados à temática da educação para o trânsito. Foi realizada busca no portal da Biblioteca Digital Brasileira de Teses e Dissertações (BDTD). Foram estabelecidos como critérios de inclusão: estudos pós-graduados relacionados à temática educação para o trânsito, realizados em ambientes de educação formal, com estudantes, que se referissem ao país e que estivessem disponíveis integralmente no ambiente virtual. Foram encontrados 32 estudos e selecionados para análise seis dissertações e três doutorados. Verificou-se que o ano de 2015 concentrou mais publicações (4), predominaram estudos ligados a Programas de Engenharia Urbana (4), a região sudeste se destacou em relação ao número trabalhos (5) e todo os trabalhos estiveram voltados à contribuição para a prevenção de acidentes no trânsito. Concluiu-se que houve pequeno número de estudos pós-graduados no país diante de temática tão importante para a sociedade, indicando a necessidade de novos trabalhos, principalmente com o acompanhamento de ações realizadas e avaliação de seus impactos.

Traffic accidents remain causing high morbimortality, but they are predictable and preventable, as pointed out by public policies. The theme of traffic education is indicated to be developed at all levels of education and is suggestive for the prevention of these accidents. The objective of this work was to investigate Brazilian postgraduate studies related to traffic education. A search was carried out on the website of the Brazilian Digital Library of Theses and Dissertations (BDTD). The inclusion criteria established were: postgraduate studies related to the theme of traffic education, carried out in formal education environments, with students, who referred to the country and were fully available in the virtual environment. This search found 32 studies, from which six dissertations and three doctorates were selected for analysis. It was noted that the year 2015 concentrated more publications (4), and that studies related to Urban Engineering Programs predominated (4), as well as the southeast region stood out regarding to the number of works (5) and that all works were focused on contributing to the prevention of traffic accidents. It was concluded that there was a small number of postgraduate studies in the country regarding such an important topic for society, indicating the need for new work, mainly with the monitoring of actions carried out and the evaluation of their impacts.

Los accidentes de tránsito permanecen causando elevada morbimortalidad, pero son previsibles y prevenibles, como apuntan las políticas públicas. La temática de la educación para el tránsito es indicada para ser desarrollada en todos los niveles de educación y es sugestiva para la prevención de estos accidentes. El objetivo de este trabajo fue investigar estudios postgraduados brasileños relacionados con la temática de la educación para el tránsito. Se realizó una búsqueda en el portal de la Biblioteca Digital Brasileña de Tesis y Disertaciones (BDTD). Utilizando criterios de exclusión e inclusión, se identificaron ocho disertaciones. Se verificó que las disertaciones adoptaron diferentes delineamientos, en especial trabajos de naturaleza descriptiva. El público objetivo fue diversificado, siendo cuatro trabajos con jóvenes de la enseñanza fundamental. En todos los trabajos la educación fue identificada como una herramienta de prevención. En cinco trabajos los autores eligieron como objeto principal de estudio el comportamiento del conductor. La región sudeste quedó en evidencia, con la producción de cinco trabajos. Se concluyó que hubo un pequeño número de estudios posgraduados en el país ante una temática tan importante para la sociedad, indicando la necesidad de nuevos trabajos, principalmente con el seguimiento de acciones realizadas y evaluación de sus impactos.

Tecnologias de prevenção dos acidentes por motocicletas no Ceará, Brasil: análise de campanhas midiáticas / Technologies for the prevention of motorcycle accidents in Ceará, Brazil: analysis of media campaigns / Tecnologías para la prevención de accidentes de motocicleta en Ceará, Brasil: análisis de campañas mediáticas

Objetivo: analisar as campanhas midiáticas acerca das tecnologias de prevenção dos acidentes por motocicletas no C.eará, Brasil. Método: Trata-se de um estudo exploratório, onde foi realizada uma pesquisa documental através do site institucional, sobre tecnologias educativas desenvolvidas pelo DETRAN-CE para a prevenção de acidentes de moto no Ceará. Resultados: As campanhas educativas na mídia cearense são divulgadas pelo Departamento Estadual de Trânsito do Estado do Ceará - DETRAN-CE, órgão que regulamenta o trânsito no estado. O DETRAN-CE divulga as preventivas através de mensagens e orientações sobre condutas corretas no trânsito, no sentido de mudar o comportamento do homem na via pública e reverter o quadro de violência, reduzindo o número de acidentes, mortes e feridos. O público alvo são os condutores, passageiros, ciclistas, motociclistas e pedestres, que são ao mesmo tempo agentes e vítimas da violência, já que estudos apontam o homem como responsável por 90% dos acidentes no trânsito no país. Conclusão: Em virtude do número crescente de acidentes de trânsito no Ceará, verificou-se à inexistência de uma tecnologia atualizada e eficaz, para a prevenção de acidentes com motociclistas, o que pressupõe a ineficácia do desenvolvimento de uma ferramenta atualizada aplicada para a segurança no trânsito.

Objective: to assess media campaigns about motorcycle accident prevention technologies in Ceará, Brazil. Method: This is an exploratory study, where a documentary research was carried out through the institutional website, on educational technologies developed by DETRAN-CE for the prevention of motorcycle accidents in Ceará, through the institutional website. Results: According to the body that regulates traffic in the state, since August 2004 the State Traffic Department - DETRAN-CE, is linked to the Secretariat of Infrastructure, which develops educational campaigns in the Ceará media. The traffic agency reports that the messages are for guidance on correct behavior in traffic, in order to change the behavior of men on public roads and reverse the situation of violence, reducing the number of accidents, deaths and injuries. The target audience is drivers, passengers, cyclists, motorcyclists and pedestrians, who are both agents and victims of violence, since studies have pointed out that men are responsible for 90% of traffic accidents in the country, according to data provided by the institutional website of DETRAN-CE. Conclusion: There was a lack of up-to-date and effective technology for the prevention of accidents involving motorcyclists in the state of Ceará, which presupposes the ineffectiveness of developing an updated tool applied to traffic safety.

Objetivo: Analizar campañas mediáticas sobre tecnologías de prevención de accidentes de motocicletas en Ceará, Brasil. Método: Este es un estudio exploratorio, donde se realizó una investigación documental a través del sitio web institucional, sobre tecnologías educativas desarrolladas por DETRAN-CE para la prevención de accidentes de motocicleta en Ceará, a través del sitio web institucional. Resultados: Según el organismo que regula el tráfico en el estado, desde agosto de 2004, el Departamento de Tráfico del Estado - DETRAN-CE, está vinculado a la Secretaría de Infraestructura, que desarrolla campañas educativas en los medios de comunicación de Ceará. La agencia de tráfico informa que los mensajes son orientativos sobre el comportamiento correcto en el tráfico, con el fin de cambiar el comportamiento de los hombres en las vías públicas y revertir la situación de violencia, reduciendo el número de accidentes, muertes y lesiones. El público objetivo son los conductores, pasajeros, ciclistas, motociclistas y peatones, que son agentes y víctimas de la violencia, ya que los estudios han señalado que los hombres son responsables del 90% de los accidentes de tráfico en el país, según datos proporcionados por el web institucional de DETRAN-CE. Conclusión: faltaba una tecnología actualizada y efectiva para la prevención de accidentes con motociclistas en el estado de Ceará, lo que presupone la ineficacia de desarrollar una herramienta actualizada aplicada a la seguridad vial.

Traumatic brain injury in the new millennium: A new population and new management. / El traumatismo craneoencefálico severo en el nuevo milenio. Nueva población y nuevo manejo.

INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population. MATERIALS AND METHODS: We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome. RESULTS: We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes. CONCLUSION: The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

[Effectiveness of educational interventions on primary care physicians in the prevention of traffic accidents in the elderly]. / Eficacia de las intervenciones formativas sobre médicos de atención primaria en la prevención de accidentes de tráfico en ancianos.

The objective of this study was to assess the effect of the implementation of training programs for Primary Care Physicians for improving their clinical practice as regards the prevention of traffic accidents in the elderly. To do this, a systematic review was carried out following the PRISMA strategy. A total of 1,677 works were reviewed, of which only 5 were included because they met the inclusion criteria. Although none of the works was of an experimental type with a control group, it can be concluded that there is evidence that an adequate training in this subject by physicians improves their skills in the identification of elderly risk drivers, due to their pathologies and/or the use of drugs, as well as their level of confidence to communicate to the elderly and/or their families the need for restriction or, if necessary, the definitive cessation of driving.

Analysis of mobile emergency response unit times in attending traffic accidents in Extremadura, Spain. / Análisis de tiempos de las unidades medicalizadas de emergencia en la atención a los accidentes de tráfico en Extremadura.

OBJECTIVES: To analyze the time mobile emergency response units took to attend casualties due to traffic accidents in Extremadura from 2012 to 2015. MATERIAL AND METHODS: Retrospective descriptive study of information in the records of the emergency response coordination center 112 (ERCC-112) related to traffic accidents attended by mobile units. We compared care times in different situations, taking into consideration the seriousness of casualties. RESULTS: The ERCC-112 mobile units attended 5572 traffic accidents, with 113 deaths. Half the accidents required the attendance of a mobile response unit (activation rate of 0.51). There was an inverse relationship between intervention duration and the population of the city or town where the accident took place. The shortest times were recorded in the 2 provincial capitals of Extremadura. The longest times were recorded in less densely populated areas. The mean (SD) duration required for interventions recorded for the fleet of units overall was longer in fatal accidents (45.5 [21.5] minutes) than in nonfatal accidents (28.6 [15.9] minutes) (P<.001). Likewise times were longer in critical cases with poorer prognosis (35.6 [20.2] minutes) than in less serious ones (27.3 [14.5] minutes) (P<.001). CONCLUSION: Mobile emergency unit attendance at traffic accidents took longer in less densely populated geographic areas. Units also took longer to attend accidents that caused serious casualties or deaths.

OBJETIVO: Analizar los intervalos temporales de las unidades medicalizadas de emergencia (UME) en la atención prestada a los accidentes de tráfico en Extremadura durante el periodo 2012-2015. METODO: Estudio descriptivo retrospectivo de la información registrada en el Centro Coordinador de Urgencias y Emergencias-112 (CCU-112) relativa a la asistencia prestada por las UME en los accidentes de tráfico. Se realizó un análisis comparativo de los diferentes intervalos temporales empleados por las UME, incluyendo el pronóstico de las víctimas. RESULTADOS: Un total de 5.572 accidentes de tráfico requirieron atención al CCU-112 con un total de 113 muertes. La tasa de activación de las UME por accidentes de tráfico fue de 0,51 (uno de cada dos accidentes). Los tiempos de intervención presentaron una relación inversa con el volumen de población del núcleo donde se ubica cada UME, con tiempos medios de intervención menores en las dos capitales de provincia y mayores en las áreas más extensas, con mayor dispersión geográfica y menor densidad de población. El tiempo de actuación del conjunto de las UME fue mayor en la asistencia a accidentes con víctimas mortales (45,5 ± 21,5 frente a 28,6 ± 15,9 minutos, p < 0,001) y con pronóstico grave o crítico (35,6 ± 20,2 frente a 27,3 ±14,5 minutos, p < 0,001). CONCLUSIONES: Los intervalos temporales empleados por las UME fueron más prolongados en las áreas con menor densidad de población, mayor dispersión geográfica y en accidentes con víctimas graves o mortales.

Acidentes de transporte terrestre entre crianças, adolescentes e jovens: estudo epidemiológico / Transporte de accidente entre los niños, adolescentes y young: estudio epidemiológicos / Transportation accidents among children, adolescents and young people: epidemiological study

Objetivo: analisar acidentes de trânsito ocorridos com pessoas na faixa etária de 0 a 24 anos, atendidas no Pronto Socorro Municipal de Cuiabá em 2013. Método: Estudo transversal com dados capturados por meio de um formulário fechado. A análise dos dados foi feita por meio do Epi Info. Resultados: Dos 2.122 atendimentos, 67,9% foram do sexo masculino, com idade entre 15 e 24 anos (82,1%), e 49,7% ocorreram nos finais de semana, sendo que 9,6% ocorreram em dezembro, destacando-se os acidentes com motocicleta/triciclo (71,0%), prevalecendo trauma de membros superiores (30,4%) com sequela física imediata em 0,5% das vítimas. Em relação ao desfecho (95,7%), recebeu alta após o atendimento, e houve sete óbitos (0,3%). Conclusão: A ocorrência significativa de acidentes de trânsito atendidos pelo serviço de urgência e emergência em pauta, envolvendo a população do estudo, evidencia a necessidade de políticas e estratégias de prevenção específicas.

Objective: to analyze traffic accidents occurred in the age group 0-24 years treated at the Emergency Room of City Cuiabá in 2013. Method: Cross-sectional study with data captured through a closed form. Data analysis was done using Epi Info. Results: Of the 2,122 calls, 67.9% were males aged 15-24 years (82.1%) and 49.7% occurred on weekends, and 9.6% occurred in December, highlighting the accidents with motorcycle/tricycle (71.0%), prevailing trauma of the upper limbs (30.4%) with immediate physical sequelae in 0.5% of the victims. Regarding the outcome, (95.7%) were discharged after treatment, and there were 7 deaths (0.3%). Conclusion: The significant occurrence of traffic accidents attended by the emergency service and emergency at hand, involving the study population, highlights the need for specific policies and prevention strategies.

Objetivo: analizar los accidentes de tráfico se produjo en el grupo de edad de 0-24 años atendidos en la sala de emergencias de la ciudad de Cuiabá, en El año 2013. Método: Estudio transversal con datos capturados a través de una forma cerrada. El análisis de datos se realizó usando Epi Info. Resultados: De las 2.122 llamadas, el 67,9% fueron varones de 15-24 años (82,1%) y el 49,7% se produjeron los fines de semana, y corrieron 9,6% en diciembre, destacando- si los accidentes con motocicleta / triciclo (71,0%), predominando el trauma de las extremidades superiores (30,4%) con secuelas físicas inmediata en El 0,5% de las víctimas. En cuanto a los resultados (95,7%) fueron dados de alta después del tratamiento, y no hubo 7 muertes (0,3%). Conclusión: La presencia significativa de los accidentes de tráfico atendidos por el servicio de emergencia y de emergencia a la mano, con la participación de la población de estudio, pone de relieve la necesidad de políticas específicas y estrategias de prevención.

Internações hospitalares por lesões decorrentes de acidente de transporte terrestre no Brasil, 2013: permanência e gastos / Hospitalizaciones por lesiones por accidentes de tránsito terrestre en Brasil, 2013: estancia y gastos / Hospitalization due to road traffic injuries in Brazil, 2013: hospital stay and costs

Objetivo: descrever as taxas de internação por acidente de transporte terrestre (ATT) no Brasil em 2013, estimar gastos hospitalares e tempo de permanência das internações. Métodos: estudo ecológico com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Resultados: em 2013, houve 170.805 internações por ATT financiadas pelo Sistema Único de Saúde, sendo 78,2% de indivíduos do sexo masculino, 48,6% na faixa etária de 20 a 39 anos e 51,9% motociclistas; a taxa de internação por ATT foi de 85,0 por 100 mil habitantes; o gasto total dessas internações alcançou R$231.469.333,13, com 1.072.557 dias de permanência e média de 6,3 dias de internação por paciente. Conclusão: a magnitude das internações decorrentes de ATT foi elevada; as vítimas internadas foram predominantemente homens, jovens e motociclistas; o tempo médio das internações foi de quase uma semana, implicando gastos expressivos.

Objetivos: describir las tasas de hospitalización por accidente de transporte terrestre (ATT) en Brasil en 2013, y estimar los gastos hospitalarios directos y tiempo de estadía. Métodos: estudio ecológico con datos del Sistema Nacional de Información Hospitalaria del Sistema Único de Salud (SIH/SUS). Resultados: en 2013, hubieron 170.805 hospitalizaciones por ATT financiadas por el Sistema Único de Salud, 78,2% eran varones, 48,6% con edades comprendidas entre los 20-39 años, 51,9% eran ciclistas; la tasa de hospitalización para ATT fue 85,0 hospitalizaciones/100 mil habitantes; los gastos de estas hospitalizaciones alcanzó los R$231 469 333.13, con 1.072.557 días de permanencia y estancia media de 6,3 días por paciente. Conclusión: la magnitud de las hospitalizaciones derivadas de ATT fue alta; las víctimas hospitalizadas eran sobre todo hombres, jóvenes y ciclistas; el tiempo medio de estancia fue alrededor de una semana, generando un gasto significativo

Objetivo: to describe hospitalization rates and to estimate hospital costs and time spent in hospital due to road traffic accidents (RTA) in Brazil, in 2013. Methods: this is an ecological study conducted using data from the Brazilian National Hospital Information System. Results: in 2013, 170,805 hospitalizations due to RTA were funded by the Brazilian National Health System; 78.2% of the individuals were male, 48.6% were from 20 to 39 years old, and 51.9% were motorcyclists; RTA hospitalization rate was of 85.0 hospitalizations/100,000 inhabitants; total cost was BRL 231,469,333.13, with 1,072,557 hospital inpatient days and average stay of 6.3 days in hospital. Conclusion: the magnitude of hospitalization due to RTA was high; victims hospitalized were mainly men, young adults and motorcyclists; average stay in hospital was almost a week, implying significant costs.

Accidentes de tránsito con heridos en Colombia según fuentes de información: caracterización gene-ral y tipologías de accidentes / Road traffic accidents with injured in Colombia according to information sources: General characterization and accident typologies

El objetivo de esta investigación es conocer las dinámicas sociales de la accidentalidad vial -formas de ocurrencia, tipos de consecuencias, tipos de víctimas- y su relación con variables socio-demográficas. Se analizan datos procedentes de dos fuentes: una encuesta de victimización vial (accidentalidad subjetiva) a una muestra no aleatoria de estudiantes de ciclos superiores de 20 ciudades capitales (n=2292) de Colombia y estadísticas oficiales de heridos en tránsito (accidentalidad objetiva) en Bogotá en el año 2009 (n=2300). Mediante un análisis de clasificación jerárquica y combinando características del vehículo, del daño causado y del conductor -edad, sexo- y otros actores de la vía, los resultados mostraron cuatro tipologías de accidentes: 1) conductor particular, atropello, víctima peatón de 61 años o más, 2) víctima peatón de 0 a 10 años por atropello y lesión por trauma facial, 3) víctima pasajero o mujer, por caída desde el automóvil o bus de transporte público, y lesiones en el cuello, 4) víctima conductor de moto o cicla, entre 21 y 30 años, varón, por colisión, y daños en las extremidades. Las implicaciones de los resultados se discuten con relación a políticas de prevención de la accidentalidad vial.

The aim of this paper is to describe the social dynamics of road traffic accidents - occurrence forms, consequences of accidents, victim typologies - and their relations with socio demographic variables. Data of two types were analyzed: the driving victimization survey (subjective traffic acci-dents) by a non-randomized sample of high school students (n =2292) from 20 main Colombian cities and official statistics of traffic injured (objective traffic accidents) in Bogotá during 2009 (n=2300). Through a cluster analysis and combining vehicle characteristics, caused damage and driver age- sex- and other actors of the road, the results showed four types of accidents: 1) per-sonal vehicle driver, 61 year-old or older pedestrian fatality. 2) Pedestrian victim from 0 to 10 years old, injury by facial trauma. 3) Passenger or woman victim from public transportation or vehicle falling, neck injuries. 4) 21-30 year-old driver man of moto or bicycle, crash victim, leg and hand injured.

[Road traffic injuries in Catalonia (Spain): an approach using the minimum data set for acute-care hospitals and emergency resources]. / Lesiones por accidente de tráfico: aproximación desde el conjunto mínimo básico de datos de urgencias y hospitalización de agudos de Cataluña.

OBJECTIVE: To verify the usefulness of the minimum data set (MDS) for acute-care hospitals and emergency resources for the study of road traffic injuries and to describe the use of health resources in Catalonia (Spain). METHODS: The study population consisted of patients treated in any kind of emergency service and patients admitted for acute hospitalization in Catalonia in 2013. A descriptive analysis was performed by age, gender, time and clinical variables. RESULTS: A total of 48,150 patients were treated in hospital emergency departments, 6,210 were attended in primary care, and 4,912 were admitted to hospital. There was a higher proportion of men (56.2%), mainly aged between 20 and 40 years. Men accounted for 54.9% of patients with minor injuries and 75.1% of those with severe injuries. Contusions are the most common injury (30.2%), followed by sprains (28.7%). Fractures mostly affected persons older than 64 years, internal injuries particularly affected men older than 64 years, and wounds mainly affected persons younger than 18 years and older than 64 years. In the adult population, the severity of the injuries increased with age, leading to longer length of stay and greater complexity. Hospital mortality was 0.2%. Fractures, internal injuries and wounds were more frequent in the group of very serious injuries, and sprains and contusions in the group of minor injuries. CONCLUSIONS: MDS records (acute hospitals and emergency resources) provide information that is complementary to other sources of information on traffic accidents, increasing the completeness of the data.

[Spatial analysis of road traffic accidents with fatalities in Spain, 2008-2011]. / Análisis espacial de los accidentes de tráfico con víctimas mortales en carretera en España, 2008-2011.

OBJECTIVE: To estimate the areas of greatest density of road traffic accidents with fatalities at 24 hours per km(2)/year in Spain from 2008 to 2011, using a geographic information system. METHODS: Accidents were geocodified using the road and kilometer points where they occurred. The average nearest neighbor was calculated to detect possible clusters and to obtain the bandwidth for kernel density estimation. RESULTS: A total of 4775 accidents were analyzed, of which 73.3% occurred on conventional roads. The estimated average distance between accidents was 1,242 meters, and the average expected distance was 10,738 meters. The nearest neighbor index was 0.11, indicating that there were aggregations of accidents in space. A map showing the kernel density was obtained with a resolution of 1 km(2), which identified the areas of highest density. CONCLUSIONS: This methodology allowed a better approximation to locating accident risks by taking into account kilometer points. The map shows areas where there was a greater density of accidents. This could be an advantage in decision-making by the relevant authorities.

[Mortality due to traffic injuries and its impact on life expectancy: a comparison between Mexico and Spain]. / Mortalidad por lesiones de tráfico y su impacto en la esperanza de vida: comparativa entre México y España.

OBJECTIVE: To determine the impact of mortality due to motor vehicle traffic injuries (MVTI) compared with other causes of death on life expectancy in Mexico and Spain during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. METHODS: Based on official death and population data, abridged life tables in Mexico and Spain were constructed for the three-year periods studied. Temporary life expectancy and YLEL for persons aged 15 to 75 years were calculated by selected causes (MVTI, diabetes mellitus, malignant neoplasms and ischemic heart diseases) and age groups in each three-year period. RESULTS: In Spain, YLEL decreased in both sexes from all the causes studied, especially MVTI; this reduction was greater in the younger ages. In addition, temporary life expectancy increased. In Mexico, YLEL due to MVTI increased in men, mainly in young people, and remained unchanged among women. Temporary life expectancy declined in men but increased slightly among women. CONCLUSIONS: The reduction in YLEL due to MVTI in Spain has contributed to increased life expectancy. By contrast, the increase in YLEL due to MVTI among Mexican men has contributed to the decline in male life expectancy.

Disability related to road traffic crashes among adults in Spain.

BACKGROUND: Road traffic accidents cause substantial morbidity and disease burden; few studies have examined their impact on disability. OBJECTIVE: To estimate the magnitude and distribution of disability due to road traffic accidents according to socio-demographic variables, and its main socioeconomic and health determinants. METHODS: A cross-sectional study was conducted in community-dwelling participants in the "2008 Spanish National Disability Survey", a representative sample of 91,846 households with 20,425 disabled persons older than 15 years; 443 had disability due to road traffic accidents. RESULTS: The prevalence was 2.1 per 1000 inhabitants (95% CI:1.8-2.3), with no differences by sex. Risk was highest among persons aged 31 to 64 years, and onset of disability showed a sharp inflection point at age 16 years in both sexes. Odds ratios (ORs) were higher (OR=1.3; 95% CI:1.1- 1.7) for participants with secondary education than for those with the lowest educational levels and were lower (OR: 0.5; 95% CI:0.3-0.8) for participants with the highest household income levels than for those with lowest. Only 24% of disabled participants were gainfully employed. As compared to other sources of disability, traffic crashes caused greater disability in terms of mobility (OR=3.1;p<0.001), a greater need for health/social services (OR=1.5;p=0.003), and more problems with private transportation (OR=1.6;p<0.001), moving around outside the home (OR=1.6;p<0.001) and changes in economic activity (OR=2.4;p<0.001). CONCLUSIONS: The prevalence of disability due to road traffic accidents in Spain is lower than in other developed countries, with middle-aged and socio-economically underprivileged persons being the most affected. Disability due to road traffic accidents is related to a greater demand for social/health care support, problems of accessibility/commuting, and major changes in economic activity.

[Epidemiology of maxillofacial fractures due to traffic accidents in Medellin (Colombia)]. / Epidemiología de las fracturas maxilofaciales por accidente de tráfico en Medellín (Colombia).

OBJECTIVE: To characterize maxillofacial fractures due to traffic accidents in patients attending the Hospital Universitario San Vicente Fundación (Medellin-Colombia) from 1998 to 2010. METHODS: A descriptive study (n =1609) was carried out with information from the medical records of patients meeting the inclusion criteria established by the general objective of the study. The variables consisted of sex, age, year, type and number of fractures, and type of vehicle. A descriptive analysis of the variables was performed and the frequency of fractures due to traffic accidents was calculated according to year and sex. Crude and adjusted odds ratios (aOR) were estimated to establish associations among age, type of vehicle, and the presence of two or more fractures with stratification by sex. RESULTS: The frequency of maxillofacial fractures due to traffic accidents increased in 2007 (men: n=198, women: n=35) and decreased from 2008 to 2010 in both sexes. Fractures were more frequent in persons aged <35 years (80%) and in men (82%). The highest frequency of fractures was observed in motorists. Male users of motorcycles (aOR=1.41; confidence interval 95% [95%CI]: 1.02- 1.94) and bicycles (aOR=1.61; 95%CI: 1.01- 2.56) were more likely to report two or more fractures compared with pedestrians, after adjustment for other variables. CONCLUSIONS: Most maxillofacial fractures occurred in men and in motorists. Future studies should analyze other determinants affecting the epidemiology of maxillofacial fractures. Strategies should be designed to improve the use of protective elements and drivers' knowledge and practices.

Características clínicas e epidemiológicas de motociclistas com trauma cranioencefálico atendidos em hospital de referência / Clinical and epidemiological characteristics of motorcyclists with traumatic brain injuries treated at a referral hospital / Características clínicas y epidemiológicas de motociclistas con trauma craneoencefálico atendidos en hospital de referencia

Pesquisa com o objetivo de descrever as características clínicas e epidemiológicas de motociclistas com trauma cranioencefálico (TCE). Estudo descritivo, retrospectivo e documental realizado em hospital público de referência do Estado de Pernambuco. Foram analisados 564 prontuários de motociclistas atendidos no hospital, no período de novembro a dezembro de 2012. A maioria dos motociclistas era do sexo masculino (84,05%), solteira (86,87%), na faixa etária de 15-34 anos (72,8%). A queda foi o principal tipo de impacto com 292(51,6%) ocorrências. Quanto ao tipo de TCE, a maioria foi considerada leve - 415(73,60%). O óbito ocorreu em cerca de 5% dos casos e 465(82,44%) tiveram alta clínica. Conclui-se que essas informações podem auxiliar na organização da rede de urgência e emergência e na implantação de estratégias de prevenção de acidentes.

This descriptive study of clinical and epidemiological features of motorcyclists with traumatic brain injury (TBI) analyzed data from 564 medical records of motorcyclists treated at a public referral hospital in Pernambuco State from November to December 2012. Most of the motorcyclists were male (84.05%), single (86.87%), and aged 15-34 years (72.8%). The main impact type was falls (292; 51.6%) and most TBIs were mild (415; 73.60%). Death occurred in about 5% of cases, and 465(82.44%) were discharged from the clinic. It was concluded that this information can assist in organizing emergency care services and implementing accident prevention strategies.

Investigación con el fin de describir las características clínicas y epidemiológicas de motociclistas con trauma craneoencefálico (TCE). Estudio descriptivo, retrospectivo y documental realizado en hospital público de referencia de Pernambuco. Se analizaron 564 historias clínicas de los motociclistas atendidos en el hospital durante el período de noviembre a diciembre de 2012. La mayoría de los motociclistas era del sexo masculino (84,05%), solteros (86,87%) entre 15 y 34 años de edad (72,8%). La caída fue el principal tipo de impacto: 292(51,6%) eventos. Respecto al tipo de TCE, la mayoría se consideró como liviano: 415 (73,6%). El óbito se produjo en cerca del 5% de los casos y 465(82,44%) recibieron alta clínica. Se concluye que esta información puede ayudar en la organización de la red de atención de urgencia y la puesta en marcha de estrategias de prevención de accidentes.