Work overload and risk behaviors in motorcyclists / Sobrecarga de trabajo y comportamientos de riesgo en motociclistas / Sobrecarga de trabalho e comportamentos de risco em motociclistas

ABSTRACT Objective: to analyze the association between work overload and risk behaviors adopted by motorcyclists. Method: a cross-sectional study of injured motorcycle drivers hospitalized at the Hospital da Restauração Governador Paulo Guerra in the city of Recife, PE, from May to September 2016. A questionnaire was applied containing sociodemographic variables related to work overload and risk behaviors adoption. Odds Ratio (OR) and 95% Confidence Interval were used to analyze the association between the variables. Results: there was a predominance of males (97.6%), mean age 31.44 years (SD = 9.50). There was an association of sleep/fatigue at the accident time with difficulties carrying out work tasks (OR = 3.7), feeling tired during work (OR = 4.6) and feeling under pressure to carry out work tasks (OR = 3.5). Conclusion: work overload was associated with risk behaviors adoption. It is believed that this fact can have an impact on the occurrence and severity of accidents.

RESUMEN Objetivo: analizar la asociación entre sobrecarga de trabajo y comportamiento de riesgo adoptado por los motociclistas. Método: El estudio transversal con trabajadores accidentados conductores de motocicletas, internados en el Hospital da Restauração Governador Paulo Guerra en Recife-PE, en el período de mayo a septiembre de 2016. Se aplicó un cuestionario que contenía variables sociodemográficas relacionadas con la sobrecarga de trabajo y la adopción de comportamientos de riesgo. Para el análisis de la asociación entre las variables, se utilizó el Odds Ratio (OR) y el Intervalo de Confianza del 95%. Resultados: se observó predominio del sexo masculino (97,6%), con media de edad 31,44 años (DE = 9,50). Se observó una asociación de sueño/fatiga en el momento del accidente con dificultades en realizar tareas de trabajo (OR = 3,7), sentirse cansado durante el trabajo (OR = 4,6) y sentirse presionado a realizar tareas de trabajo (OR = 3,7) OR = 3,5). Conclusión: la sobrecarga de trabajo se asoció a la adopción de comportamiento de riesgo. Se cree que tal hecho puede repercutir en la ocurrencia y gravedad de los accidentes.

RESUMO Objetivo: analisar a associação entre sobrecarga de trabalho e comportamento de risco adotado por motociclistas. Método: estudo transversal com trabalhadores acidentados condutores de motocicletas, internados no Hospital da Restauração Governador Paulo Guerra no Recife-PE, no período de maio a setembro de 2016. Aplicou-se um questionário contendo variáveis sociodemográficas relacionadas à sobrecarga de trabalho e adoção de comportamentos de risco. Para análise da associação entre as variáveis, utilizou-se Odds Ratio (OR) e Intervalo de Confiança de 95%. Resultados: observou-se predomínio do sexo masculino (97,6%), com média de idade 31,44 anos (DP = 9,50). Houve associação de sono/fadiga no momento do acidente com dificuldades em realizar tarefas de trabalho (OR = 3,7), sentir-se cansado durante o trabalho (OR = 4,6) e sentir-se pressionado a realizar tarefas de trabalho (OR = 3,5). Conclusão: a sobrecarga de trabalho associou-se à adoção de comportamento de risco. Acredita-se que tal fato pode repercutir na ocorrência e gravidade dos acidentes.

Repercussões dos acidentes de trânsito: uma revisão integrativa / Repercussions of traffic accidents: an integrative review / Repercusiones de los accidentes de tránsito: una revisión integrativa

Objective: The aim of this review is to map the research on the main repercussions of traffic accidents in Brazil. Methods: This is an integrative review of the literature. LILACS and SciELO databases were searched using the descriptor "traffic accident" combined with "rehabilitation", "disabilities", "side-effects", and "quality of life". Results: 12 articles matched the inclusion criteria producing four categories: "Morbimortality due to traffic accidents in Brazil; "Traffic accidents and the return to work; "Impacts of traffic accidents on quality of life"; "Repercussions of traffic accidents in for the family and society"; "Suggested and/or adopted measures". Conclusion: Traffic accidents in Brazil negatively impact the physical and psychological well-being of victims and their families, worsening their quality of life and work performance, with repercussions for society and economy

Objetivo: Analisar o que versam as produções científicas sobre os acidentes de trânsito no Brasil, no que tange as suas principais repercussões. Métodos: Revisão integrativa de literatura, cujos dados foram coletados nas bases de dados LILACS e SCIELO, por meio do descritor acidente de trânsito inter-relacionado com os descritores reabilitação, incapacidades, sequelas e qualidade de vida. Resultados: 12 artigos atenderam aos critérios de inclusão desta revisão, dos quais emergiram cinco categorias: Morbimortalidade por acidentes de trânsito no Brasil; Acidente de trânsito e retorno ao trabalho; Impactos dos acidentes de trânsito na qualidade de vida; Implicações dos acidentes de trânsito na estrutura familiar e social e; Medidas sugeridas e/ ou adotadas. Conclusões: Os acidentes de trânsito no Brasil repercutem negativamente no bem-estar físico e psicológico das vítimas e de seus familiares, com redução na qualidade de vida e na capacidade desses indivíduos para o trabalho, com reflexos nos setores econômico e social

Objetivo: Analizar lo que versan las producciones científicas sobre los accidentes de tránsito en Brasil, en lo que se refiere a sus principales repercusiones. Métodos: Revisión integrativa de literatura, cuyos datos fueron recolectados en las bases de datos LILACS y SCIELO, por medio del descriptor accidente de tránsito interrelacionado con los descriptores rehabilitación, incapacidades, secuelas y calidad de vida. Resultados: 12 artículos atendieron a los criterios de inclusión de esta revisión, de los cuales surgieron cinco categorías: Morbimortalidad por accidentes de tránsito en Brasil; Accidente de tránsito y retorno al trabajo; Impactos de los accidentes de tránsito en la calidad de vida; Implicaciones de los accidentes de tránsito en la estructura familiar y social; Medidas sugeridas y/o adoptadas. Conclusiones: Los accidentes de tránsito en Brasil repercuten negativamente en el bienestar físico y psicológico de las víctimas y de sus familiares, con reducción en la calidad de vida y en la capacidad de esos individuos para el trabajo, con reflejos en los sectores económico y social

Déficit de atención e hiperactividad: su relación con accidentes de tránsito en motocicletas / Attention-deficit/hyperactivity disorder and motorcycle accidents

Los Accidentes de Tránsito (AT) son un problema mundial de salud pública. Existe evidencia de que los individuos que presentan Trastorno por Déficit de Atención e Hiperactividad (TDAH) tienen mayor riesgo de experimentar AT. Objetivos: determinar la presencia del TDAH y evaluar su relación sobre la incidencia de accidentes motociclísticos en pacientes lesionados por esta causa. Método: Estudio de casos transversal, con muestra pareada por sexo y edad con relación 2.1. La población estuvo conformada por pacientes de 18-63 años de cualquier género, ingresados en el área de emergencia u hospitalización debido a accidente en motocicleta y por causa diferente a AT. Fue un estudio de casos, transversal, analítico, basado en la historia clínica de los pacientes, a quienes se aplicó el test de TDAH según el DSM5 y se dividieron entre pacientes que asistían o no por accidentes de motocicleta. Tratamiento estadístico: se realizó estadística descriptiva y para las comparaciones se calculó el riesgo relativo (OR) con intervalos de confianza 95% y se aplicó chi cuadrado. Resultados: 47 fueron casos y 94 controles, se obtuvo una media de 33 ± 11,74 años. El 93,6% de la población fue masculina. Se evi- denció mayor proporción de manifestaciones aso- ciadas a TDAH en los casos respecto a los contro- les (OR=3,00, IC: 95%, p<0,05), siendo el TDAH inatento el más frecuente. Discusión: Los estudios mundiales demuestran una relación entre el TDAH y los accidentes de tránsito en motorizados, lo cual coincide con los hallazgos obtenidos en la presen- te investigación. Conclusión: Existe una asocia- ción positiva entre la presencia de TDAH y una mayor ocurrencia de accidentes de moto. Es importante el conocimiento y diagnóstico precoz de esta patología para contribuir en la prevención de AT en personas que presentan esta condición(AU)

Traffic accidents (TA) are a public health issue worldwide. Every year the mortality rate increases due to these events. It has been demonstrated that individuals with Attention Deficit Hyperactivity Disorder (ADHD) are at greater risk of having TA than healthy individuals. Objectives: to determine the presence of ADHD and evaluate its effect on motorcycle accident's incidence in injured patients due to these acci- dents. Methods: Prospective, transverse, case-control study with sample matched by sex and age; we evaluated 141 patients between 18-63 years-old. The population included patients who were admitted to the emergency ward or hospitalization areas due to motorcycle accidents (cases), and those who were admitted due to a cause different from AT (controls). Results: there were 47 cases and 94 controls. The mean age was 33 ± 11,74 years and 93,6% were men. It was evident that the cases had more ADHD manifestations than the controls (OR=3,00, IC: 95%, p<0,05) being the inattentive ADHD subtype the most frequent findings. Conclusion: There's a positive relationship between having ADHD and a greater motorcycle accident frequency(AU)

Errores humanos autorreferenciados por automovilistas de la ciudad de Bahía Blanca, Argentina / Human errors self-reported by automobilists from bahia blanca, Argentina

OBJETIVO: Describir los tipos de errores que referencian los conductores de automóviles que circularon en la ciudad de Bahía Blanca durante el período septiembre 2014 y abril de 2015. MÉTODO: Estudio descriptivo de corte transversal de tipo cuantitativo. Se definió una muestra por conveniencia y se confeccionó una encuesta en formato digital, de tipo estructurada, dirigida a los automovilistas, teniendo como base el "Driver Behaviour Questionnaire" en la versión traducida al español. Luego fue validada mediante el método Delphi. Se analizó con software estadístico SPSS. RESULTADOS: El 30% al realizar un giro, estuvo a punto de chocar con una bicicleta o moto. Un 36,3% sostuvo que por ir distraído, se dio cuenta tarde de que el vehículo de adelante redujo su velocidad debiendo frenar bruscamente para evitar el choque, el 25,3% se olvida de utilizar el guiñe antes de girar o cambiar de carril. El 80,2% usa siempre el cinturón de seguridad. El 11,4% pasa los semáforos en rojo. Un 43,9% utiliza el celular mientras maneja y el 22,9% de los encuestados reconoce que alguna vez condujo por encima del límite legal de alcohol. El 38% se impacienta y acelera bruscamente a la salida de un semáforo y un 62,7% se impacienta y se adelanta de forma arriesgada a un vehículo lento. CONCLUSIONES: El manejo es una situación compleja que requiere de múltiples habilidades pero fundamentalmente una conciencia de respeto y solidaridad sumado a un enfático control punitorio sobre errores voluntarios graves.

OBJECTIVE: To describe the types of errors reported by drivers who commuted in the city of Bahia Blanca between September 2014 and April 2015. METHOD: Quantitative descriptive cross-sectional study. A convenience sample was defined, and a structured digital survey, based on the Spanish-translated version of the "Driver Behaviour Questionnaire", was constructed and then validated using the Delphi method. Data were analyzed with SPSS statistical software. RESULTS: Of the automobilists surveyed, 30% reported having nearly colliding with a bicycle or motorcycle while making a turn; 36.3% said they have had to brake suddenly to avoid a collision because they were distracted and did not realize the vehicle in front of them had slowed down; and 25.3% had forgotten to use the turn signal before turning or changing lanes. In addition, only 80-2% of respondents always wear a seat belt; 11-4% do not respect red lights; 43.9% use their phones while driving; and 22.9% admit driving while intoxicated over the legal alcohol limit. Finally, 38% report being impatient and accelerating out of a traffic light, while 62.7% have riskily passed a slower vehicle, due to impatience. CONCLUSIONS: Driving an automobile is a complex situation that requires multiple skills and, most fundamentally, a sense of respect and solidarity with other drivers, coupled with punitive control of serious yet preventable human errors.

High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil

Objective: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Method: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. Results: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. Conclusions: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

Desempenho em inteligência, atenção concentrada e personalidade de diferentes grupos de motoristas / Performance in intelligence, focused attention and personality in different groups of drivers / Rendimiento en inteligencia, atención concentrada y personalidad de diferentes grupos de conductores

Este estudo buscou identificar diferenças no desempenho entre grupos de motoristas infratores, não infratores e envolvidos em acidentes nos construtos Inteligência, Atenção Concentrada e Personalidade, avaliando-se ainda a influência do nível de escolaridade dos participantes. Motoristas em processo de renovação de CNH ou adição de categoria, em um total de 319, de ambos os sexos, escolaridade do ensino fundamental, médio e superior, com idades variando entre 18 a 77 anos (M = 40,62, DP =10,8) fizeram parte da amostra. Os resultados demonstraram que a variável Grupo (infrator, não infrator e envolvidos em acidentes) não se mostrou significativa para nenhuma das medidas consideradas, tendo-se encontrado, por outro lado, influência significativa da variável Nível de escolaridade nas medidas de produtividade (Palográfico) e inteligência (R1). Os resultados apontam dificuldades em diferenciar grupos de motoristas de acordo com o desempenho deles nos instrumentos considerados.

This study attempted to identify differences in performance between groups of offending drivers, not offenders and drivers involved in accidents in intelligence, personality and focused attention, still evaluating the influence of the education level of the participants. Drivers in the process of renovation or addition of CNH category, a total of 319, of both sexes, with elementary school, high school and college, with ages ranging from 18 to 77 years (M = 40.62, SD = 10.8) comprised the sample. The results showed that the group variable (offenders, non offenders and involved in accidents) showed not significant for any of the measures considered, having been found significant influence of school level on measures of productivity (Palográfico) and intelligence (R1). The results suggest difficulties in differentiating group of drivers according to their performance on the instruments considered in this study.

Este estudio trata de encontrar diferencias de rendimiento entre grupos de conductores infractores, no infractores e involucrados en accidentes de tránsito, en los constructos inteligencia, atención concentrada y personalidad, teniendo en cuenta también la influencia del nivel educativo de los participantes. Participaron de la muestra un total de 319 conductores en proceso de renovar o aumentar la categoría de la libreta de conductor (CNH), de ambos sexos, con enseñanza primaria, secundaria y universitaria, con edades comprendidas entre 18 y 77 años (M = 40.62, DT = 10.8). Los resultados mostraron que la variable grupo (infractor, no infractor e involucrados en accidentes) no se mostró significativa en las medidas consideradas. Por otra parte, se encontró influencia significativa de la variable nivel educativo en las medidas de productividad (Palográfico) e inteligencia (R1). Los resultados indicaron dificultades en la diferenciación de grupos de conductores de acuerdo con el rendimiento de los mismos en los instrumentos considerados.

Escala de autoeficácia para dirigir: construção e avaliação preliminar das propriedades psicométricas / Driving self-efficacy scale: construction and preliminary evaluation of psychometric properties

Este trabalho relata a construção da Escala de Autoeficácia para dirigir e a verificação preliminar de suas propriedades psicométricas. Na primeira etapa, procedeu-se com o levantamento sobre o tema culminando na elaboração de 20 itens, os quais foram ampliados após avaliação de juízes. A etapa seguinte consistiu no estudo piloto com a aplicação dos 25 itens resultantes em 40 motoristas. Os resultados indicaram a necessidade de algumas adequações e a construção de mais dez itens. Na última etapa, o instrumento foi aplicado em 500 motoristas em processo de renovação da Carteira Nacional de Habilitação, com idades entre 23 e 78 anos, sendo 60,40% deles do sexo masculino. Após a análise fatorial, a escala foi reduzida para 15 itens alocados em um único fator, com variância explicada de 41,75% e fidedignidade adequada (α = 0,91). Sugere-se que sejam realizados novos estudos com a escala a fim de ampliar as evidências de validade.

This paper reports the construction of the Driving Self-efficacy Scale and the preliminary evaluation of its psychometric properties. Initially, the topic was thoroughly investigated and 20 items were created; the number of items was increased after evaluation of judges. The next step consisted of carrying out a pilot study applying the 25-item scale to 40 drivers. The results indicated the need for some adjustments and the creation of ten more items. In the last step, the instrument was applied to 500 drivers, aged 23-78 years, 60.40% male, who were getting their driving license renewed. Factor analysis was conducted, and the scale was then reduced to 15 items allocated to a single factor; with 41.75% of variance explained and good reliability (α = 0.91). Further studies are necessary to confirm the validity of the scale.

Hazards for Women and Children in Rural Settings / Peligros para las mujeres y niños en el ámbito rural

Objectives a) To identify possible risk factors associated with rural accidents in women, b) to describe women's knowledge about zoonosis, c) to describe women's risk perception about farming, d) to describe mother´s risk perception about children's activities in rural settings, e) to estimate the initial age of exposure to the rural setting and its dangers, and f) to identify possible risk factors associated with rural accidents in children. Materials and Methods: Cross-sectional design. Women with children that live in the countryside were surveyed (n=24). Structured questionnaire. Statistical analyses: χ2, Student's t-test, Pearson's correlation coefficient and logistic regression. Results Many women had suffered an accident in the countryside (65.6 %). Farm worker usually did not use personal protective equipment (PPE). Hearing protection, gloves, and safety goggles were rarely used. Working women showed a high risk perception for urban driving, the handling of agrochemicals, and driving on main roads (85.7 %, 70 % and 66.7 %). There was no significant association between risk perception and PPE use. Most mothers (87.5 %) thought that was good for children to learn how to perform farm chores starting at a young age. Children started to drive a tractors at 9 years of age; 12.23 years on average. More than 7 % of the children (7.14 %) have suffered an accident on the farm. The most frequent accidents were being trapped in machinery (60 %). No association was found between the independent variables and the dependent variable; farm-related accidents in children (p>0.2). Conclusions Risk communication is necessary to inform people involved and to reduce exposure.

Objetivos a) identificar posibles factores de riesgo asociados a accidentes rurales en mujeres, b) describir el conocimiento sobre zoonosis de las mujeres, c) describir la percepción de riesgos de las mujeres acerca de las actividades realizadas en el campo, d) describir la percepción de riesgos de las madres sobre las actividades de los niños en el campo, e) estimar la edad de exposición inicial de los niños al ambiente rural y sus peligros y f) identificar potenciales factores de riesgo asociados a accidentes rurales en niños. Materiales y Métodos Diseño transversal. Fueron encuestadas las mujeres con hijos que vivían en el campo (n= 24). Cuestionario estructurado. Análisis estadístico: χ2, T Student, coeficiente de correlación de Pearson y Regresión Logística. Resultados Muchas de las mujeres sufrieron un accidente en el campo (65,6 %). Las trabajadoras rurales generalmente no usaban elementos de protección personal (EPP). Protección auditiva, guantes y antiparras eran escasamente utilizados. Las trabajadoras demostraron tener una percepción del riesgo alta sobre el manejo de vehículos en zonas urbanas, manipulación de agroquímicos y manejo de vehículos en rutas (85,7 %, 70 % y 66,7 %). No se encontró asociación significativa entre percepción de riesgos y uso de EPP. Muchas madres (87,5 %) pensaban que era bueno para los niños que aprendieran a realizar tareas del campo desde muy pequeños. Los niños comenzaban a manejar un tractor desde los 9 años, 12,23 años en promedio. Más del 7% de los niños (7,14 %) sufrieron un accidente en el campo. Los más frecuentes fueron atrapamiento por maquinaria (60 %). No se encontró asociación significativa entre las variables independientes y la variable dependiente accidente en un niño (p>0,2). Conclusiones Es necesaria la comunicación de los riesgos para informar a los involucrados y reducir la exposición.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil / Desigualdades em saúde: condições de vida e mortalidade infantil em região do nordeste do Brasil

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue. .

OBJETIVO Analisar a variação da mortalidade infantil por condição de vida no meio urbano. MÉTODOS Estudo ecológico realizado com dados de óbitos registrados de menores de um ano, residentes em Aracaju, SE, Nordeste do Brasil, de 2001 a 2010. As desigualdades na mortalidade infantil foram avaliadas pela distribuição espacial do Índice de Condições de Vida estabelecido para os bairros, classificados em quatro estratos. Foram comparadas as taxas de mortalidade infantil médias de 2001 a 2005 e 2006 a 2010 pelo teste t Student. RESULTADOS A taxa de mortalidade infantil média declinou de 25,3 de 2001 a 2005 para 17,7 óbitos/1.000 nascidos vivos, de 2006 a 2010. Apesar da queda nas taxas em todos os estratos na década, a desigualdade no risco de morte infantil aumentou nos bairros com piores condições de vida em relação àqueles de melhores condições. CONCLUSÕES A mortalidade infantil em Aracaju apresentou declínio, mas com importante assimetria entre os bairros. A averiguação sob a ótica das condições de vida pode justificar as diferenças no risco de óbito infantil no espaço urbano, destacando as desigualdades em saúde na mortalidade infantil como fenômeno multidimensional. .

Validity and reliability of a health care service evaluation instrument for tuberculosis / Validação e confiabilidade: instrumento para avaliação de serviços que tratam tuberculose

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the ...

OBJETIVO Analisar a validade e confiabilidade de instrumento de avaliação da estrutura dos serviços de atenção básica para o tratamento da tuberculose. MÉTODOS Estudo transversal com amostragem aleatória simples para 1.037 profissionais de saúde de cinco municípios (Natal, RN; Cabedelo, PB; Foz do Iguaçu, PR; São José do Rio Preto, SP e Uberaba, MG) em 2011. Foram identificados e validados indicadores estruturais, considerando as diferentes modalidades de organização do sistema de saúde de municípios de diferentes portes populacionais. A “estrutura” correspondeu aos recursos existentes para a execução dos serviços: físicos (equipamentos, materiais de consumo e instalações); humanos (número e qualificação); e fontes para manutenção da infraestrutura e da tecnologia existente, entendida como organização do serviço de saúde. Os procedimentos estatísticos utilizados no processo de validação foram análise de confiabilidade, análise fatorial exploratória e confirmatória. RESULTADOS O processo de validação determinou a retenção de cinco fatores com 85,9% de variância total explicada, consistência interna entre 0,6460 e 0,7802 e qualidade de ajustamento da análise confirmatória de 0,995 para o goodness-of-fit index. Os fatores retidos compuseram os cinco indicadores estruturais: profissionais envolvidos com o atendimento de tuberculose; capacitação; acesso a instrumentos de registro; disponibilidade de insumos; e articulação do serviço de saúde com outros níveis de atenção. O indicador com melhor desempenho foi disponibilidade de insumos, com menor coeficiente de variação nos serviços avaliados. Os indicadores de avaliação dos recursos humanos e articulação com outros níveis de serviços apresentaram percentuais satisfatórios; entretanto, este último apresentou o maior coeficiente de variação. Os indicadores de capacitação e acesso a instrumentos de registro apresentaram percentuais de avaliação inferiores aos demais. CONCLUSÕES O ...

Economic analysis of surgical treatment of hip fracture in older adults / Análise econômica do tratamento cirúrgico de fratura do quadril em idosos

OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients. METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk. RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results. CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery. .

OBJETIVO Analisar a razão custo-utilidade incremental do tratamento cirúrgico da fratura do quadril de pacientes idosos. MÉTODOS Estudo de coorte retrospectiva, com amostra sistemática de pacientes operados por fratura do quadril em hospital polo de macrorregião de Minas Gerais, entre 2009 e 2011. Foi realizada análise da criação de árvore de decisão, considerando os custos diretos médicos. A perspectiva foi do provedor de cuidado e o horizonte temporal de um ano. A efetividade foi medida pelo tempo decorrido entre o trauma e a cirurgia, sendo criados dois grupos maiores: o da estratégia precoce e o da tardia. A utilidade foi obtida de forma transversal e indireta por meio do questionário genérico Euro QOL-5D e transformada em número cardinal utilizando-se a normativa nacional criada pelo Centro de Desenvolvimento e Planejamento Regional de Minas Gerais. A amostra contou com 110 pacientes, 27 alocados no grupo precoce e 83 no tardio. Os grupos foram controlados por idade, sexo, tipo de fratura, tipo de cirurgia e risco anestésico. RESULTADOS O custo direto médico mostrou-se aumentado de forma estatisticamente significativa entre os pacientes da alternativa tardia (p < 0,005), principalmente devido aos custos de enfermaria (p < 0,001). A mortalidade intra-hospitalar foi maior no grupo da cirurgia tardia (7,4% contra 16,9%). A árvore de decisão mostrou a dominância da estratégia da cirurgia precoce em relação à tardia, com R$9.854,34 (U$4,387.17) contra R$26.754,56 (U$11,911.03) por ano de vida ajustado por qualidade, respectivamente. O teste de sensibilidade de extremos comprovou robustez dos resultados. CONCLUSÕES Após controle de variáveis confundidoras, a estratégia de cirurgia precoce para fratura do quadril em idosos mostrou-se dominante, pois apresentou menor custo e melhores resultados em relação à tardia. .

Aportaciones a las ciencias de la salud: el comportamiento peatonal arriesgado de chilenos y brasileros / Contributions to the health sciences: the risky pedestrian behavior of chileans and brazilians

Los peatones son causantes y víctimas de accidentes de tránsito en el mundo y muy especialmente en América latina. Un modelo de comportamiento riesgoso en conductores es aplicado a peatones en dos países del Cono Sur de América: Brasil con la mayor tasa de mortalidad por accidentes de tránsito, y Chile, la menor. Una muestra accidental -463 participantes, 223 chilenos y 240 brasileros, de 17 a 40 años de edad- respondió la Escala de Comportamiento Peatonal controlándose sexo, edad, licencia de conducir y participación en accidentes de tránsito. Contribuyendo a explicar la contrastante mortalidad, los chilenos realizan significativamente menos transgresiones, ligeramente menos errores y lapsus al transitar por la ciudad, que los brasileños. Los hombres de ambos países son más transgresores que las mujeres. Se discute la utilidad del modelo utilizado y de los resultados, entregándose algunas recomendaciones para la salud pública en este ámbito.

Pedestrians are causative and victims of traffic accidents in the world and very especially in Latin America. A model originally built for drivers risk behavior is applied to pedestrians in two contrasting countries in the Southern Cone of America: Brazil has the highest mortality rate for traffic accidents and Chile the lowest. An accidental sample -463 participants, 223 Chileans and 240 Brazilians of 17 to 40 years of age-, answered an instrument containing the scale of pedestrian behavior (ECP, 1999) and information relating to sex, age, licensed drivers and participation in traffic accidents was collected. Contributing to explain the contrasting mortality, Chileans reported to perform significantly less pedestrian's transgressions, fewer errors and lapses than Brazilian pedestrians. Men in both countries are more transgressors than women. We discuss the utility and the results of the model used giving some recommendations for public health in this area.

Riesgos psicosociales en conductores de transporte de carga y pasajeros urbanos e interurbanos, y su asociación con la autopercepción de salud y siniestralidad laboral / Psychosocial risks in freight and passengers, urban and intercity drivers and its association with Self-Rated Health and workplace accidents

La exposición a factores de riesgo psicosociales presentes en el lugar de trabajo constituye un tema prioritario para la salud ocupacional. El OBJETIVO del estudio es estimar la asociación entre factores de riesgo psicosocial presentes en el trabajo, y autopercepción de salud y siniestralidad laboral, en conductores de vehículos de transporte de carga y pasajeros, urbanos e interurbanos, de empresas afiliadas a la Asociación Chilena de Seguridad. Se aplicaron 4 cuestionarios a una muestra de 356 conductores de 4 empresas de transporte, en que 100% fue hombre con una edad promedio de 45,4 ± 9,7 años; el 70,8% transporta pasajeros, con jornadas de 11,4 horas/día. Todas las dimensiones de ISTAS-21 resultaron con promedios inferiores a la referencia salvo "trabajo activo y desarrollo de habilidades". El 93,8% se reportó como "sin alteraciones de salud mental". Se demostraron asociaciones estadísticamente significativas entre dimensiones del ISTAS 21 con, GHQ-12 y participación en accidentes de tránsito (sólo compensaciones), aun después de ajustar por variables de confusión. Esto permitió el diseño de intervenciones, consensuadas con las empresas, a fin de controlar/eliminar estas exposiciones para mejorar la salud y calidad de vida de los trabajadores y reducir las enfermedades profesionales y accidentes del trabajo relacionados.

Exposure to psychosocial risk factors present in the workplace is a priority topic for occupational health. The AIM of the study is to estimate the association between psychosocial risk factors present at work, and self-rated health and occupational accidents in drivers of passenger and freight transport, urban and intercity, of companies affiliated with the Chilean Safety Association. Four questionnaires were applied to a sample of 356 drivers from 4 Transport companies, in which 100% were male with a average age of 45,4 ± 9,7 years; 70,8% carry passengers, with working days of 11,4 hours / day. All dimensions of ISTAS-21 resulted with lower averages to the reference except for "active job and skill development." 93,8% was reported as "no mental health disorders". Statistically significant associations between dimensions of ISTAS 21, GHQ-12 and involvement in traffic accidents (just compensation), even after adjusting for confounding variables were demonstrated. This allowed the design of interventions, agreed with the companies, in order to control/eliminate these exposures to improve the health and quality of life of workers and reduce occupational diseases and work-related accidents.

Representaciones sociales de normas de tránsito, agresividad, facilidad percibida en la conducción, accidentes y multas en conductores de Bogotá, D. C. / Social representations of traffic rules, aggressiveness, easiness perceivedin driving, accidents, and traffic tickets involving drivers in Bogota, D. C. / Representações sociais de normas de trânsito, agressividade, facilidadepercebida na condução, acidentes e multas nos motoristas de Bogotá, D. C.

El objetivo principal de este trabajo fue conocer las representaciones sociales sobre normas de tránsito, y su relación con la agresividad y con la accidentalidad, y multas de tránsito autoinformadas en conductores de Bogotá. Se aplicó una encuesta basada en casos (Mamontoff, 2010) con elementosgráficos (Abric, 1993), a una muestra no aleatoriade conductores infractores o en proceso de renovación dela licencia de conducción. Como resultados se identificaron cuatro clases de conductores: dos grupos más dispuestos a consumir alcohol y exceder límites de velocidad (1.ª clase)o no respetar semáforos en rojo y otras señalizaciones (2.ªclase), otro grupo menos de acuerdo con consumir alcohol antes de conducir, pero favorable a superar límites de velocidad(3.ª clase) y otro grupo favorable a no violar ninguna norma de conducción (4.ª clase). Una actitud más favorable a consumir alcohol en la conducción se asoció con atribución de los accidentes a factores externos a los conductores, con haber sido multado más veces en el pasado y con más daños en accidentes. Una mayor agresividad se asoció, asimismo,con una intención de conducta más imprudente.

The main objective in this work consisted of getting to know the social representations about traffic rules and their connection with self-reported aggressiveness, accident rates and fines for traffic offenses by drivers in Bogota. A case-based survey (Mamontoff, 2010) with graphic elements (Abric,1993) was applied to a non-random sample of driving offenders or drivers undergoing their driving license renewal process. As results, four classes of drivers were identified: Two groups more likely to: abuse alcohol and exceed speed limits (1st class), pass through red or yellow lights and disregar dother traffic signs (2nd class); another group that was more cautious about drinking alcohol before driving, but not with regard to exceeding speed limits (3rd class), and another group with a willingness to comply with all driving rules (4th class). A more lenient attitude towards drinking alcohol before or while driving was associated to attributing accidents to factors external to the driver, or with a higher record of fines or sanctions in the past, and having suffered more damages in road-traffic. Likewise, a more far-reaching aggressiveness was associated with an intended less prudent or cautious conduct.

O objetivo principal deste trabalho era conhecer as representações sociais sobre as normas de trânsito, e a sua relação com a agressividade e a acidentalidade, e as multas de trânsito autoinformadas nos motoristas de Bogotá. Uma pesquisa baseada em casos (Mamontoff, 2010) com elementos gráficos (Abric, 1993) foi aplicada a uma amostra não aleatória de motoristas infratores ou em processo da renovação da carteira de motorista. Como resultados identificaram-se quatro classes de motoristas: dois grupos mais prontos para consumir o álcool e exceder limites de velocidade (1°classe)ou não respeitar semáforos em vermelho e outra sinalização(2° classe), um outro grupo menos de acordo com o consumo de álcool antes de dirigir, mas favorável para exceder limites de velocidade (3° classe) e um outro grupo favorável para não infringir nenhuma norma da condução (4° classe). Uma atitude mais favorável para consumir o álcool ao dirigir foi associada com a atribuição dos acidentes aos fatores externos aos motoristas, por ser multado mais vezes no passado e com mais danos nos acidentes. Uma maior agressividade foi associada, também, com uma intenção da conduta mais imprudente.

Road Traffic Accidents - Throwing Care and Caution to the Wind.

It was observed, for last ten years, that the Road Traffic Accidents causing morbidity and mortality has increased significantly in rural area. The economic growth in this area along with development of SHIRDI and SHANI- SHINGANAPUR was noted. Objectives: We were interested to know the incidence of trauma and any remediable factors that could be suggested and implemented. The aim was to document the predominant mechanism of injury and to determine temporal relationship between the final outcome, types of injury, and time taken since injury to hospitalization. Methods: The study, carried out in rural area, hospital based included 2,154 patients of polytrauma, who were admitted, diagnosed and treated out of a total number of 4,638 patients of polytrauma who visited the causality of the hospital. Proforma was designed and data recorded and analyzed. Results: Predominantly young male population was affected by trauma. There was a gross delay in arrival to the hospital in considerable number of patients. Mortality was 32.66% when patients reached hospital within two hours of injury. Mortality increased to 51.51% when patients reached the hospital after eight hours of injury! Conclusions: In majority of patients the mechanism of injury was the result of motor vehicle accident. The patients who have multi-system involvement have poorer outcome to our country due to accidents amounts to Rs.5000 crores annually2. In a developing country like India, public health facilities are scarce. Only 0.9% of GDP is spent on public medical services6. In higher income countries, RTA are already among the top ten leading causes of disease burden in 1998 as measured in DALY (Disability–Adjusted Life Years). According to a WHO / World Bank report, “The Global Burden of Disease’’, deaths from non communicable diseases are expected to climb from 28.1 million a year in 1990 to 49.7 million by 2020 and RTA being the main cause of this rise. On an average in the industrialized countries and also in many developing countries, one hospital bed in ten is occupied by trauma victim7. Member countries of South East Asia region, during the past two decades, are passing through significant Urbanization, Motorization, Industrialization and changes in the socio - economic values of societies. Injuries on roads, at homes and in the work place have increased due to lack of safety related policies and programmes. Children saved today from nutritional and infectious diseases are killed and/or maimed by injuries tomorrow. In fact RTA injuries are ranked as number one cause of burden of diseases among children in 2000. This heavy burden at such an early age has long – term implication on the qualities of life and economy of the nation8.

Ensaio: Homenagem ao Professor Reinier Rozestraten / Essay: A tribute to Professor Reinier Rozestraten

Trata-se de uma homenagem póstuma ao Professor Doutor Reinier Rozestraten. O texto apresenta, suscintamente, o percurso acadêmico do nomeado professor, em especial a sua passagem pela Psicologia do Trânsito. Paralelamente discorre sobre sua principal obra na área, que, de certo modo introduz o discurso psicológico sobre o comportamento de trânsito em perspectiva nacional, juntamente com sua preocupação em imprimir um caráter científico ao tema e introduzi-lo no contexto da academia e na sociedade em perspectivas teórica e prática. A obra escolhida é considerada um marco para o estabelecimento teórico da disciplina da psicologia do trânsito no Brasil. A homenagem foi originalmente escrita por ocasião dos cinco anos de falecimento do professor Reinier.

This is a posthumous tribute to Professor Reinier Rozestraten. The text presents succinctly the academic route by the appointed professor, and in particular his passage through Traffic Psychology. Parallel it talks about his main work in the area, which somehow introduces the psychological discourse about the traffic behavior in national perspective, with his concern for printing a scientific character to the theme and introducing it in the context of academia and society at theoretical and practical perspectives. The chosen work is considered a milestone for the establishment of the theoretical discipline of traffic psychology in Brazil. The tribute was originally written in occasion of the fifth death aniversary of Professor Reinier Rozestraten.

Educación vial como aporte al compromiso y responsabilidad ciudadana con la seguridad en el tránsito / Road education as contribution to the commitment and civil responsibility with the safety in the traffic

El presente trabajo pretende dar a conocer los lineamientos de una investigación UBACyT 2010-20121. El proyecto se enfrenta con la situación problemática de evaluar la eficacia de los cursos de Educación Vial y la incidencia en el comportamiento de los conductores que transgreden la normativa de tránsito. El universo de esta investigación está conformado por los sujetos que demandan la recuperación de puntos perdidos por infracciones (scoring). Como recurso metodológico utilizamos la triangulación de los datos obtenidos por encuestas y entrevistas grupales y a informantes claves.Se hará un seguimiento de los sujetos que han perdido puntos en el scoring y desean recuperarlos realizando el curso para tal fin.Concibiendo la educación desde la “pedagogía de la autonomía” de Paulo Freire. Según esta concepción pedagógica quien enseña aprende al enseñar y quien aprende enseña al aprender (Freire, 1996), es decir, enseñar no existe sin aprender y viceversa, por esta razón, buscamos relevar el conocimiento de la experiencia presentado por los asistentes y las estrategias de afrontamiento implementadas en situaciones de riesgo, transformando esta experiencia por la vía de la enseñanza, como aporte epistemológico para los programas de los cursos de educación vial. Nuestra expectativa apunta a que los resultados sean transferidos a los organismos de planificación de políticas públicas como prevención de siniestralidad, contando con la sensibilización de los medios para difundir los hallazgos.

This work aims at divulging the features of a research conducted by the Investigation UBACyT 2010-2012. This project faces the problematic situation of assessing the eficiency of Driving Courses and their incidence in the behavior of drivers who break driving regulations. Its general objective is that citizens commit to being the rules that reinforce trafic safety in order to reduce the rate of morbidity and mortality caused by trafic accidents. The subjects of this research are people who ask for a restitution of the points that they lost due to infractions (scoring system). The methodology consists of the triangulation of data that come from surveys, group interviews and interviews to key informers. The behavior of the subjects that attend the course in order to have their points back will also be analyzed. Regarding education from the point of view of autonomy pedagogy, as stated by Paulo Freire, we seek to favor a dialectic movement by revealing both the knowledge from experience that attendants have and the facing strategies that they put to use in risk involving situations. This project aims at turning these experiences into epistemological contributions to the trafic safety education training programs. Our expectations are that whit the help of the media results will be transferred to the society at large as a means of preventing trafic accidents.

[Interventional approaches in order to reduce injuries from car accidents]

Damages and injuries, which are about 12% of all kinds of diseases, are the third important reason of fatality in the age of 1 to 40 that mostly results from traffic accidents. According to World Health Organization data, 25 percent of total mortality belongs to death in roads. This study aims to study and to review all current approaches in order to reduce mortality of road accidents. In this review article, all relevant studies were searched and studied by using Medline and Cochrane library databank in1990-2009 and also some Persian papers with key words such as road injuries, road accident, driving behavior, effective human factors related to road accidents, psychology of accidents, and interventional approaches. The necessary interventions summarized in the four categories: 1] the emphasis on rules implementation and support; 2] providing coordination between drivers, vehicles and executives; 3] strengthening the infrastructure, information and management systems; 4] communication, public participation and education Attempt to organize multi-dimensional approaches depends on effective factors in accidents regarding the cultural, social and psychological states in the region. Effective intervention arises from a conceptual understanding of all factors involved in driving. Complex issues should be taken into consideration comprehensively. So, a detailed theoretical framework should be provided in order to design the necessary interventions. For this reason, the available instructions for the involved actors in controlling traffic accidents require public cooperation and collaboration

Perspectivas para a Psicologia do Trânsito / Perspectives on Traffic Psychology

Este artigo aborda a Psicologia de Trânsito, a partir das atividades desenvolvidas pelo Núcleo de Psicologia do Trânsito da Universidade Federal do Paraná (NPT-UFPR), que propiciaram a criação da Linha de Pesquisa Psicologia do Trânsito: Avaliação e Prevenção. A centralidade exercida pela avaliação psicológica é referenciada, bem como a indicação da ampliação de perspectivas de investigação, a partir de novas pesquisas e intervenções integradas. A abordagem sistêmica permite a compreensão do comportamento humano no trânsito, indicando a complexidade das interações que se estabelecem entre insumos e processos que resultam na adoção de comportamentos de risco, que geram danos a si e aos outros. A tomada de decisão no trânsito se torna um dos aspectos centrais, demandando investigações que elucidem a maneira como ocorre e como pode ser orientada, a partir do estudo de fatores que contribuem para comportamentos mais seguros e que incorporem a dimensão coletiva intrínseca ao trânsito. Destaque especial é dado às pesquisas que aprofundam a compreensão do comportamento humano em situação de trânsito a partir do referencial da percepção de riscos

This paper focuses on Traffic Psychology, based on the activities carried out in the Traffic Psychology Laboratory at the Federal University of Paraná, Brazil. Those activities lead to the creation of the research program “Traffic Psychology: Evaluation and Prevention”. The present paper refers to the psychological evaluation process extensively used in Brazil nowadays, as well as it shows the need of widening the studies perspectives, through new interrelated research and intervention. The General System Theory approach allows the understanding of human behavior in traffic situations, showing the complexity of the interactions between inputs and processes that result in risk behavior which provides damages to oneself and to the others. The decision making process in traffic situations becomes one of the main points, demanding investigations on how it occurs and how it can be oriented, studying the factors that contribute to safer behaviors, focused on the collective dimension of traffic. Special attention is given to research that deepen the understanding of human behavior in traffic situations, under the risk perception point of view