Two innovative Brazilian programs relating to road safety prevention. A case study

ABSTRACT BACKGROUND: The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO aims to reduce road traffic deaths in order to meet goal number 3.4 of the sustainable development goals. OBJECTIVES: To describe two Brazilian road safety prevention programs, presented at the WHO 2017 Global Conference: São Paulo Traffic Safety Movement (Movimento Paulista de Segurança no Trânsito) and Safe Life Program of Brasília (Programa Brasília Vida Segura), along with their governance structures, models and results. DESIGN AND SETTING: This was a descriptive case study conducted in São Paulo and Brasilia from 2015 to 2018. These programs aimed to reduce the number of deaths caused by road accidents to 8.3 deaths per 100,000 inhabitants in São Paulo by 2020 and in Brasília by 2016; and to reduce harmful use of alcohol by 10% by 2020. METHODS: These two initiatives were designed, managed and operated to bring together government and civil society, i.e. industry, academia, non-governmental organizations (NGOs), etc., around the common goal of saving lives. They were collaborative and guided by sharing of best practices, learning and information, thereby making it possible to attain more and better results. Their format enables reproduction in cities across all Brazilian regions. RESULTS: The results attest to the efficacy of the programs implemented in these two cities. In Brasília, the initiative helped reduce the number of traffic-related deaths by 35% (2017). In the same year in the state of São Paulo, 7,600 deaths were avoided. CONCLUSION: Both programs are innovative public policies that deal with health issues caused by the external agents that ultimately account for the rapid increase in days lost to disability. Prevention of external causes of deaths and injuries, such as traffic violence, strongly correlates with changes in habits and actions, especially excessive consumption of alcohol, and with NCDs in Brazil.

Perfil de mortalidade por causas externas entre Adventistas do Sétimo Dia e a população geral / Profile of mortality from external causes among Seventh-day Adventists and the general populations

Resumo Este estudo teve por objetivo comparar o perfil de mortalidade por causas externas entre Adventistas do Sétimo Dia e população geral do Espírito Santo no período de 2003 a 2009. Realizou-se busca dos Adventistas no banco nominal do Sistema de Informação sobre Mortalidade de posse das informações dos Adventistas fornecidas pelas sedes administrativas da instituição. Os óbitos por causas externas ocorridos no período estudado foram então separados em dois grupos: Adventistas e população geral. Os Adventistas apresentaram menor mortalidade proporcional por causas externas (10%) que a população geral (19%), sendo o sexo masculino o principal responsável por essa diferença. Em ambos os grupos os óbitos predominaram na faixa de 20 a 29 anos. As mortes por causas acidentais foram mais expressivas entre os Adventistas (68,08%) enquanto as mortes por causas intencionais relacionadas às agressões e lesões autoprovocadas foram mais significativas na população geral (53,67% de todas as mortes). A razão de mortalidade padronizada para as causas externas foi 41,3, sendo assim ser Adventista reduziu a mortalidade em 58,7%. Acredita-se que o benefício dos Adventistas verificado em relação à mortalidade por causas externas possa estar relacionado à recomendação de abstinência do consumo de álcool por esse grupo.

Abstract This paper aimed to compare the profile of mortality from external causes among Seventh-day Adventists and the general population of Espírito Santo from 2003 to 2009. A search of Adventists was performed in the nominal database of the Mortality Information System containing data on Adventists provided by the administrative offices of the institution. Deaths from external causes occurred during the study period were then divided into two groups: Adventists and the general population. Adventists had lower proportional mortality from external causes (10%) than the general population (19%), and males were the main reason for this difference. In both groups, deaths prevailed in the 20-29 years age group. Deaths from accidental causes were most significant among Adventists (68.08%), while deaths from intentional causes related to assault and self-inflicted injuries were more significant in the general population (53.67% of all deaths). The standardized mortality ratio for external causes was 41.3, thus, being Adventist reduced mortality by 58.7%. It is believed that the benefit of Adventists observed for mortality from external causes is related to this group's abstinence from alcohol consumption.

Años de Vida Perdidos (AVP) atribuibles al consumo de alcohol en la ciudad de México / Years of life lost (Yll) attributable to alcohol consumption in Mexico city

Resumen El objetivo de este artículo es estimar los AVP atribuibles al consumo de alcohol en la Ciudad de México durante 2006 – 2012. Se utilizaron las estadísticas vitales de mortalidad del INEGI atribuibles al consumo de alcohol para obtener los AVP, se obtuvieron ademas promedios de edad de muerte respecto a intervalos de edad por sexo. Se estimaron 168,607 AVP, con una pérdida promedio de 18.32 años para los hombres y 17.54 en mujeres. Se encontró una mayor proporción de AVP en hombres que en mujeres. De acuerdo a la CIE-10 se observó que las enfermedades del hígado atribuibles al alcohol, aportan más del 80% de los AVP al total. Existe una tendencia cíclica en los AVP entre 2006 a 2012. Los AVP atribuibles al alcohol apuntan a que el consumo es un problema de salud pública que implican pérdidas en la productividad y costos económicos, mientras la baja en los AVP podría ser explicada por una disminución en el ingreso provocada por la crisis económica de 2008 al igual que el aumento por la mejoría en el 2012.

Abstract The aim of this study was to estimate the YLL attributable to alcohol consumption in Mexico City from 2006 – 2012. Vital statistics on mortality attributable to alcohol consumption from the INEGI (Instituto Nacional de Estadística y Geografía) were used to determine YLL as well as the average age of death in relation to different age ranges by sex. A total estimate of 168,607 YLL was obtained, with an average loss of 18.32 years being observed for men and 17.54 years for women. Men accounted for a higher proportion of the YLL than women. According to the ICD-10 (Tenth Revision of International Classification of Diseases), liver disease attributable to alcohol consumption was found to be responsible for more than 80% of the total YLL. There was a cyclical trend in YLL from 2006 to 2012. The YLL attributable to alcohol suggest that alcohol consumption is a public health problem that involves losses in productivity and economic costs, and the decline in YLL could be explained by the decrease in income caused by the economic crisis of 2008, just as the increase could be explained by economic improvement in 2012.

Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

Substance Dependence in a Tribal District.

Introduction: Retrospective study was carried out with an aim to understand the status of substance dependence in Adilabad which is a tribal district of Telangana region and to know the possible reasons behind it. Material and Methods: Records from September 2009 to August 2010 was collected and analysed from patients of RIMS Adilabad. Cases of single substance dependence or polysubstance dependence and associated disorders were included in the study. Parameters were incidence, socio-demographics, age, sex, polysubstance dependence, alcohol dependence, comorbidity, management of substance dependence and hospital stay. Results: A total of 157 patients included in the study. Significant (p<0.05) seasonal variations were observed. Villagers 57.32%, Hindus 92.36%, Muslims 6.37% with mean age of 37 years was observed. Female to male ratio was 0.05:1. 86% females were from tribal villages, chronic beedi smokers and all had family history. Polysubstance dependence (3.18%) included alcohol 100% and cannabis 2.55%. Chronic alcoholics 44.59%, moderate quantity in 76%, consciousness in 53%, handmade liquor in 18% and alcohol without food in 7.64% observed. Associated comorbidity seen in 70.70% cases. Death occurred in 3.18% cases. Ranitidine and ampicillin were mainly given. Mean hospital stay was 2.26 days. Conclusion: Productive age group and handmade liquor is common but polysubstance dependence is negligible. Comprehensive strategy involving education, counselling, treatment and rehabilitation programs are needed to fight against substance dependence in the region.

Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do estado de São Paulo / Spatial analysis of deaths due to traffic accidents, before and after the Brazilian Drinking and Driving Law, in micro-regions of the state of São Paulo, Brazil

OBJETIVO: Identificar aglomerados espaciais de microrregiões segundo taxas de óbito por acidentes de trânsito, no Estado de São Paulo, 1 ano antes e 1 ano após a Lei Seca. MÉTODOS: Estudo ecológico e exploratório, no período de 2007 e 2009, em 63 microrregiões do Estado de SP, Brasil. Utilizaram-se ferramentas de geoprocessamento com dados do DATASUS; analisando óbitos decorrentes de acidentes de trânsito em taxas por 100 mil habitantes, construindo coropletes. Nova estatística foi obtida subtraindo-se a taxa de 2009 de 2007, observando regiões de melhora ou piora. RESULTADOS: Em 2007, ocorreram 5.204 óbitos, com média de 83 óbitos/microrregião, variando entre 1 e 1.440. Já 2009 obteve 5.065 óbitos com a média de 80 óbitos/microrregião, variando entre 1 e 1.453. O coeficiente de Moran em 2007 foi I = 0,09 (p = 0,04) com correlação espacial positiva e 2009 obteve I = 0,04 (p = 0,16), sem correlação. A diferença entre as taxas obteve I = 0,23 (p = 0, 007), indicando associação espacial. Em 2007, Presidente Prudente, Rio Claro, Campinas, Bragança Paulista, Osasco e São Paulo tiveram altas taxas de óbito. Dessas regiões citadas, somente Osasco não se destacou em 2009. Ribeirão Preto, Ourinhos e Avaré obtiveram piora em 2009. A diferença entre as taxas de 2009 e 2007 mostrou que Amparo, Bragança Paulista e Campinas tiveram melhora, e Presidente Prudente e Ourinhos apresentaram piora. CONCLUSÃO: Foi possível identificar os locais com as maiores taxas de mortalidade, apontando locais onde as ações de fiscalização devem ser revisadas.

OBJECTIVE: To identify special micro-region clusters according to mortality rates resulting from traffic accident in the state of São Paulo, Brazil, during the period of one year before and one year after the enactment of the Brazilian Drinking and Driving Law. METHODS: Ecological and exploratory study in the period of 2007 and 2009 in 63 micro-regions of the state of São Paulo. Geoprocessing tools were used with data from DATASUS (Database of the Brazilian Unified Health System), in order to analyze deaths resulting from traffic accidents at rates per 100,000 inhabitants and to build choropleth maps. New statistics were obtained by subtracting the 2009 rate from the 2007 rate, and regions with improvement or deterioration were observed. RESULTS: In 2007, there were 5,204 deaths, averaging 83 deaths/micro-region, and ranging from 1 to 1,440. In 2009, there were 5,065 deaths, averaging 80 deaths/micro-region, and ranging from 1 to 1453. In 2007, the Moran's coefficient was I = 0.09 (p = 0.04), with positive spatial correlation; in 2009, the coefficient was I = 0.04 (p = 0.16), with no correlation. The difference between rates was I = 0.23 (p = 0.007), indicating spatial association. In 2007, Presidente Prudente, Rio Claro, Campinas, Bragança Paulista, Osasco, and São Paulo presented high mortality rates. Of these regions, only Osasco did not stand out in 2009. Ribeirão Preto, Ourinhos, and Avaré deteriorated in 2009. The difference between the 2009 and 2007 rates showed that Amparo, Bragança Paulista, and Campinas improved, and that Presidente Prudente and Ourinhos deteriorated. CONCLUSION: It was possible to identify the places with higher mortality rates, pointing out locations where enforcement actions should be reviewed.

Impacto da Lei seca na mortalidade por acidentes de trânsito / Impact of the Drink-driving law on mortality from traffic accidents / El impacto de la Ley seca en la mortalidad por accidentes de tráfego

Estudo descritivo que objetivou verificar a frequência da mortalidade por acidentes de trânsito no município do Rio de Janeiro do mês de julho de 2007 comparada à do mês de julho de 2008, além de caracterizar os acidentes e o perfil sociodemográfico de suas vítimas fatais relativos ao último período citado. Os dados das vítimas fatais foram coletados de seus prontuários no Instituto Médico Legal do município do Rio de Janeiro e os dados populacionais foram coletados do DATASUS, sendo ambos compilados e tabulados no programa estatístico Epi-Info 2000. Observou-se redução da mortalidade por acidentes de trânsito de 12,9% em julho de 2008 quando comparada a do mês de julho de 2007, considerando a taxa bruta da população no período. Esse resultado alerta para a importância de medidas preventivas e ainda de fiscalização contínua e efetiva para o cumprimento da lei todo o tempo.

This descriptive study aimed to determine the frequency of mortality from traffic accidents in the municipality of Rio de Janeiro in July 2007 as compared with July 2008, and to characterize the traffic accidents and the socio-demographic profile of fatal casualties in July 2008. Data were collected from victims’ medical records at the Rio de Janeiro municipal forensic institute. Demographic data were collected from the national health service data base (DATASUS), and were compiled and tabulated using the statistics program Epi-Info 2000. Mortality from traffic accidents was around 12.9% lower in July 2008 than in July 2007, in terms of the gross population rate for the period. This result underscores the importance not only of preventive measures, but of effective, direct surveillance for ongoing law enforcement.

Se realizó un estudio descriptivo que tuvo como objetivo determinar la frecuencia de mortalidad por accidentes de tráfico en el município de Rio de Janeiro-Brasil; ocurridos en julio de 2007, en comparación con julio de 2008, para caracterizar los accidentes de tráfico y el perfil sociodemográfico de las personas que han sido muertas en el mes de julio de 2008. Los datos fueron obtenidos de los registros médicos de las víctimas en el Instituto Médico Forense del municipio de Río de Janeiro. Se recogieron datos demográficos en el DATASUS y fueron compilados y tabulados por el programa estadístico Epi-Info 2000. Hubo reducción de la mortalidad por accidentes de tráfico de 12,9% en julio de 2008 en comparación con julio de 2007, teniendo en cuenta la tasa bruta de población durante el período. Eso resultado nos recuerda la importancia de medidas preventivas e incluso una vigilancia directa y efectiva para la aplicación de la ley todo el tiempo.

Impact of Individual and Combined Health Behaviors on All Causes of Premature Mortality Among Middle Aged Men in Korea: The Seoul Male Cohort Study / 예방의학회지

OBJECTIVES: The aim of this study was to evaluate and quantify the risk of both individual and combined health behaviors on premature mortality in middle aged men in Korea. METHODS: In total, 14 533 male subjects 40 to 59 years of age were recruited. At enrollment, subjects completed a baseline questionnaire, which included information about socio-demographic factors, past medical history, and life style. During the follow-up period from 1993 to 2008, we identified 990 all-cause premature deaths using national death certificates. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of each health risk behavior, which included smoking, drinking, physical inactivity, and lack of sleep hours. Using the Cox model, each health behavior was assigned a risk score proportional to its regression coefficient value. Health risk scores were calculated for each patient and the HR of all-cause premature mortality was calculated according to risk score. RESULTS: Current smoking and drinking, high body mass index, less sleep hours, and less education were significantly associated with all-cause premature mortality, while regular exercise was associated with a reduced risk. When combined by health risk score, there was a strong trend for increased mortality risk with increased score (p-trend < 0.01). When compared with the 1-9 score group, HRs of the 10-19 and 20-28 score groups were 2.58 (95% confidence intervals [CIs], 2.19 to 3.03) and 7.09 (95% CIs, 5.21 to 9.66), respectively. CONCLUSIONS: Modifiable risk factors, such as smoking, drinking, and regular exercise, have considerable impact on premature mortality and should be assessed in combination.

Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados / Traffic accidents in Brazil from 1998 to 2010: many changes and few effects / Accidentes de tránsito en Brasil de 1998 a 2010: muchos cambios y pocos resultados

O artigo descreve a situação dos acidentes de trânsito no Brasil, desde a implementação do Código de Trânsito Brasileiro de 1998 até o ano de 2010. Foi realizada análise dos principais trabalhos científicos e publicações não acadêmicas nacionais. A revisão de literatura incluiu periódicos indexados, não indexados, relatórios técnicos, busca específica por autores, referências bibliográficas de artigos e contato com pesquisadores. Os principais problemas do trânsito brasileiro identificados foram aumento do número absoluto de mortos e das taxas de mortalidade, ampliação da frota de motocicletas e o uso de álcool. Foram identificados autores influentes e ilhas de produção de conhecimento nas áreas pesquisadas. Os autores apresentam algumas possíveis soluções e sugerem que o poder público não tem assumido a responsabilidade que lhe cabe no controle e redução dos acidentes de trânsito.

The paper describes the situation of road traffic accidents in Brazil since 1998, when a new Brazilian traffic law was approved, up to the year 2010. A review of both academic and non-academic literature was carried out, including journals (both indexed and non-indexed), technical reports, author searches, searches in paper reference lists and direct contact with researchers. The main problems related to road traffic accidents in Brazil identified were the increase in the absolute number of deaths and in the mortality rates, a rapid increase in the number of motorcycles, and drink & driving. Influent authors in the field and centers of expertise were identified. Some potential solutions are presented by the authors, who suggest that the public offices related to traffic regulation and control are not taking suitable measures for control and reduction of road traffic accidents.

El articulo describe la situación de los accidentes de tránsito en Brasil, desde la implementación del Código de Transito Brasileño de 1998 hasta el año de 2010. Se realizó análisis de los principales trabajos científicos y publicaciones no académicas nacionales. La revisión de literatura incluyó periódicos indexados, no indexados, informes técnicos, búsqueda especifica por autores, referencias bibliográficas de artículos y contacto con investigadores. Los principales problemas de tránsito brasileño identificados fueron aumento del número absoluto de muertos y de las tasas de mortalidad, ampliación de la flota de motocicletas y el uso de alcohol. Se identificaron autores influyentes e islas de producción de conocimiento en las áreas investigadas. Los autores presentaban algunas posibles soluciones y sugieren que el poder público no ha asumido la responsabilidad que le cabe en el control y reducción de los accidentes de tránsito.

Muerte prematura por consumo de alcohol: estimaciones basadas en datos del Instituto de Medicina Legal / Premature death due to alcohol consumption: estimates based on data from the Institute of Forensic Medicine

El consumo de drogas es un problema que cada vez alcanza dimensiones de repercusión mundial. En el Perú, no existen estudios de mortalidad prematura por consumo de alcohol. Objetivo: cuantificar los años de vida potencialmente perdidos debido a muerte prematura por consumo de alcohol, y hacer estimaciones económicas de dicha muerte prematura. Material y métodos: el estudio fue de corte trasversal. Se analizó la base de datos del Instituto de Medicina Legal de Lima del 2007/2008. Se calculó años de vida potencialmente perdidos utilizando tres métodos diferentes: la sustracción de la edad de la muerte de la expectativa de vida al nacer, de la expectativa de vida de cada región del país y de la expectativa al nacer de la época en que nacieron los sujetos. Los años de vida productivos potencialmente perdidos fueron calculados a partir del Modelo de Inversión-Producción-Consumo de Gardner y Sanborn. Resultados: el consumo de alcohol ocasiona 30 años de vida potencialmente perdidos, tomando en cuenta la base de datos IML. En la región Madre de Dios se pierde 42,70 años en promedio. Sin embargo, en la región Cusco presentó más casos de personas que fallecieron en el periodo de inversión. En el periodo de producción hubo 100 casos en la región Lima y, en el periodo de consumo, la mayor cantidad de casos se produjo en la región Ancash. En las mujeres pierden en promedio más años de vida que los varones, aunque la diferencia entre uno y otro sexo es solo de dos años. Conclusiones: el consumo de alcohol ocasiona muerte prematura, y una pérdida de años de vida de aproximadamente tres décadas, afectando la vida productiva de las personas específicamente en la etapa de producción y consumo.

Dug consumption is a problem of world impact dimension. In Perú, doesnÆt exist studies of premature death by alcohol consumption. Objective: Quantify year potential life lost by premature death by alcohol consumption, and to do itÆs economics estimations. Material and methods: Study was cross sectional. Be analyzed mortality data of the Legal Medicine Institute of Lima (2007/2008). Were analyzed to estimate the potentially years of life lost (PYLL) and potentially productive years of life lost (PYLL). Years of potential life lost was calculated using three different methods: subtraction of the age of death from the life expectancy at birth, from the life expectancy of each region of the country and from the life expectancy at birth at the times subjects were born. The potentially productive years of life lost were calculated from the Model Investment-Production-Consumption, Gardner and Sanborn. Results: Alcohol consumption causes 30 years life lost, take a count data base of IML. In Msdre de Dios region was lost 42,70 years in average. However, Cusco region presented more casos of people was death in the inversion period. In the production period had 100 cases in Lima region and, in consumption period, most cases was produced in Ancash region. Woman lost in average more years of life that man, although differences between both are just in two years. Conclusions: the alcohol consumption causes premature death, and a loss of years life of approximately 3 decades, affecting the productive life of the persons specially in the period of production and consumption.

Alcohol use and mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer (JACC).

Alcohol use was examined for its influence on mortality in the Japan Collaborative Cohort. While overall risk of death, as well as ischemic heart disease, were reduced with moderate consumption, increase was noted with heavy intake, even after cessation. With heavy consumption, overall cancers were also increased. In males, risk of oesophageal cancer was particularly elevated and risk of liver and renal cancer was found to be increased in ex-drinkers. Heavy consumption appears to be also a risk factor for rectal and gallbladder cancer. Furthermore, cerebrovascular disease was increased with dose-dependence.

Custo social e de saúde do consumo do álcool / The social and health burden of alcohol abuse

Baseando-se numa revisão, apresentada pela Organizacão Mundial da Saúde (OMS), de recentes estudos sobre avaliacão do custo social e de saúde decorrentes do uso do álcool, este artigo tem o objetivo de expor as evidências que permitem avaliar o consumo do álcool para além da esfera médica assistencial, pessoal e familiar, como questão prioritária do ponto de vista sócio-político e de saúde pública. São discutidos os dados mundiais e enfatizados os dados específicos do cenário brasileiro. O custo social é dimensionado com metodologia aplicada a diversos fatores, sendo unificados dados sobre violência, problemas familiares, abuso de menores, desordem pública, problemas profissionais, entre outros. O custo dos problemas de saúde é evidenciado pelo método epidemiológico, por meio de uma categorizacão elementar de dados de morbi-mortalidade geral de cada região e sub-região continental e triangulando-se dados de volume médio de consumo e padrões de consumo. Os resultados finais são obtidos através de análise comparativa de risco, utilizando-se basicamente um indicador representativo do número de anos de vida útil perdidos por adoecimento ou mortalidade precoce atribuíveis ao consumo do álcool, na língua inglesa designado "DALYs" (Disability Adjusted Life Years). O valor global do "DALYs", no ano de 2000, para o álcool, foi de 4 por cento da morbi-mortalidade mundial, revelando tendência de ascensão. Os gradientes encontrados entre as diversas regiões do planeta são analisados à luz de uma crítica de seus potenciais determinantes.