Do automotive window films affect drivers' safety by decreasing vision sensitivity? A Cross-sectional study / Películas automotivas e perda de acuidade visual? Estudo transversal

ABSTRACT Objective: To measure visual acuity in high contrast and low contrast sensitivities in different grades of visible light transmission films in three different positions (front, lateral and rear windows). Methods: Forty-four healthy volunteers between 30-75 y-o, with BCVA better than 0,5, were tested in the 5 following vehicles with different grades of visible light transmission films. Vehicle 1: 75% in the front and 70% in the lateral and rear windows; Vehicle 2: 70% in the front and lateral windows and 28% in the rear; Vehicle 3: 70% in the front, 28% in the lateral and 15% rear; Vehicle 4: 35% in all 3 windows; Vehicle 5: 50% in the front, 20% in the lateral and 15% in the rear. Descriptive statistics were used and the average of the 3 measurements of VA was considered. Wilcoxon Test was applied to compare the average visual acuity in each vehicle and position. P value<0.05 was considered statistically significant. Results: According to the Brazilian Traffic Regulations for driving in categories C/D/E, when low contrast was tested in the front window, all visible light transmissions were borderline, in the lateral window they were all outside the limit, while in the rear window for both low and high contrast, all visible light transmissions tested were outside the limit and also borderline for driving in categories A/B, with the exception of the vehicle with visible light transmission of 35%. Conclusion: Visual acuity is affected, especially in the rear window, by the use of automotive films. The study is an alert that window films is a possible cause of accidents and may contribute to the revision of traffic regulations worldwide.

RESUMO Objetivo: Medir a acuidade visual em alto e baixo contraste nas diversas graduações de transparência de filmes em três janelas de veículos: frontal, lateral e traseira. Métodos: Foram avaliados 44 voluntários saudáveis entre 30 e 75 anos, com acuidade visual melhor corrigida acima de 0,5, em cinco veículos, sendo: veículo 1, com 75% de transparência frontal e 70% na lateral e traseira; veículo 2, com 70% na frontal e na lateral e 28% na traseira; veículo 3, com 70% na frontal, 28% na lateral e 15% na traseira; veículo 4, com 35% nas três janelas; e veículo 5, com 50% na frontal, 20% na lateral e 15% na traseira. Foi realizada estatística descritiva utilizando a média de três medidas consecutivas, com teste de Wilcoxon para comparar a média de acuidade visual em cada janela, e foi considerado estatisticamente significativo quando valor de p<0,05. Resultados: Todas as transparências testadas nos vidros reduziram a acuidade visual em situação de baixo contraste para níveis limítrofes na janela frontal e níveis ilegais na lateral para conduzir veículos nas categorias C/D/E. Na janela traseira, tanto em alto quanto em baixo contraste, todas as transparências mostraram redução da acuidade visual para níveis ilegais para categorias C/D/E e limítrofes para as categorias A/B, exceto na transparência de 35%. Conclusão: A acuidade visual é reduzida pelo uso dos filmes automotivos, especialmente na janela traseira. Condutores de veículos com filmes devem ser alertados pelo risco aumentado de acidentes. Esse dado científico propõe revisões nas regulações de tráfego mundiais.

The patient with epilepsy and medicolegal aspects: a view for the neurologist / O paciente com epilepsia e aspectos legais em saúde: uma visão para o Neurologista

ABSTRACT Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient's permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver's license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient's independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help.

RESUMO O paciente com epilepsia enfrenta inúmeros impasses na vida diária, relacionados à autorização para dirigir e relações interpessoais, os quais requerem orientação médica. Este artigo apresenta revisão bibliográfica baseada em artigos científicos e nas legislações cível e de trânsito brasileiras, como forma de solucionar dúvidas que envolvam obrigações médicas na permissão do paciente para dirigir e trabalhar. A admissão do trabalhador exige que o contratante garanta condições de segurança, além da necessidade do paciente, no exame de admissão, informar ao médico as condições médicas prévias, inclusive a epilepsia. Mais de 90% dos pacientes com epilepsia omitem essas informações na avaliação de aptidão, podendo consequentemente, estarem sujeitos à imputação de crime de falsidade ideológica (artigo 299 do Código Penal brasileiro). A violação do sigilo médico pode ocorrer apenas em situações específicas. No Brasil, a autorização e a renovação da carteira de habilitação são regidas pelo Código de Trânsito (Lei Federal n° 9503/1997). Para avaliação dos pacientes, dois grupos são considerados: aqueles em uso de medicação antiepiléptica e aqueles em retirada de medicação. É também necessária a opinião favorável do médico assistente, em ambas as categorias. As convulsões que ocorrem exclusivamente durante o sono, eventos focais perceptivos ou com aura prolongada não são diferenciadas de outros tipos de crises no Código de Trânsito Brasileiro. É responsabilidade do médico assistente analisar cada caso para resolver conflitos entre segurança pública e independência do paciente. Um relacionamento médico-paciente franco e honesto é essencial para que o paciente entenda as consequências individuais e coletivas das crises epilépticas e se sinta à vontade para procurar ajuda médica.

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.

Teste do bafômetro: resultados e recusas de motoristas interceptados pela Operação Lei Seca no Rio de Janeiro / Breathalyzer test: results and refusals to take the test of drivers intercepted under the DUI Spot-Check Campaign in Rio de Janeiro

Resumo Estudo transversal que avaliou os resultados e as recusas ao teste do bafômetro entre motoristas interceptados pela Operação Lei Seca na capital do Rio de Janeiro e Baixada Fluminense. Realizado com base em dados cedidos pelo Governo do Estado que foram coletados durante atendimento de motoristas interceptados entre dezembro de 2013 e janeiro de 2014. Procederam-se análises descritivas da amostra e de associação entre as variáveis sexo, faixa etária e local de abordagem com as recusas e os resultados do teste do bafômetro através de um modelo de regressão logística. Dos 4756 (100%) condutores interceptados, 59 (1,2%) apresentaram resultado positivo no teste do bafômetro e 229 (4,8%) recusaram-no. Apenas a variável local de abordagem apresentou significância estatística com maiores chances de resultados positivos (OR = 4,01) e recusas ao teste (OR = 5,14) entre os condutores interceptados na Baixada Fluminense. As ações sistemáticas de fiscalização efetuadas pela Operação Lei Seca que ocorrem há mais tempo na capital parecem influenciar positivamente o comportamento de beber e dirigir dos motoristas.

Abstract Abstract This paper involved a cross-sectional study that evaluated the results and refusals to take the breathalyzer test among drivers intercepted by the Driving Under the Influence (DUI) Spot-Check Campaign (Operação Lei Seca) in the capital of Rio de Janeiro and Baixada Fluminense. It was conducted using data provided by the State Government which were collected from drivers intercepted in the months of December 2013 and January 2014. Descriptive analysis was conducted of the sample and of the association between gender, age and location variables with the result of the breathalyzer test and refusal to take the test using a logistic regression model. Of the 4756 (100%) drivers intercepted, 59 (1.2%) failed the breathalyzer test and 229 (4.8%) refused to take it. Only the location of interception variable was statistically significant with greater chances of failing (OR = 4.01) and refusal to take the test (OR = 5.14) among drivers intercepted in the Baixada Fluminense. Systematic monitoring actions taken by the DUI Spot-Check Campaign that have occurred for longer in the capital appear to have a positive impact on the drinking and driving behavior of drivers.

La década de acción en seguridad vial en Medellín, Colombia, a 2015 / The decade of action for road safety in Medellin, Colombia, to 2015

La seguridad vial-SV es dimensión clave del estudio e intervención de la movilidad humana. Es hace décadas prioridad en salud pública internacional y determinante del desarrollo de comunidades y naciones. La declaratoria de una crisis global de SV en los años 90 del siglo XX por las Naciones Unidas impulsó los procesos sociales, políticos y técnicos para proponer la Década de Acción en Seguridad Vial-DASV 2010-2020. La DASV tiene un plan de acción global estructurado en cinco pilares, el primero referido a la gestión institucional de la SV. Este artículo describe antecedentes, marcos, evidencias y los pobres efectos de la gestión del primer quinquenio de la DASV en Medellín, Colombia, al año 2015.

Road safety (RS) is key in the study and intervention of human mobility. It is a determining priority in international public health and in the development of communities and nations. The declaration of a global RS crisis in the 1990s by the United Nations urged the social, political and technical processes to propose the Decade of Action for Road Safety 2010-2020 (DARS). The DARS has a global action plan structured around five pillars; the first refers to institutional management. The article describes the background, framework, evidence, and effects of poor management during first half of the DARS in Medellin, Colombia up to 2015.

Intervenções de segurança viária e seus efeitos nas lesões causadas pelo trânsito: uma revisão sistemática / Road safety measures and their effects on traffic injuries: a systematic review

OBJETIVO: Identificar e sintetizar os achados de estudos que descrevem intervenções cuja proposição principal é a redução de lesões causadas pelo trânsito. MÉTODOS: Trata-se de uma revisão sistemática integrativa, sem metanálise. Os critérios de qualidade Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) foram utilizados para sintetizar os achados dos artigos revisados. Foi realizada uma busca eletrônica de artigos no período de 2006 a 2011 nas bases de dados PubMed, Web of Science, SciELO e LILACS, utilizando os descritores "acidentes de trânsito", "avaliação" e "políticas públicas" na sua forma isolada ou combinados pela expressão booleana "And". RESULTADOS: Foram incluídos 22 estudos, dos quais dois descreveram estratégias de engenharia, dois descreveram outras políticas de segurança viária, três descreveram estratégias de educação e 15 descreveram iniciativas de fiscalização. A fiscalização foi a estratégia que apresentou resultados imediatos aparentemente mais efetivos. A engenharia se mostrou importante no sentido de promover um ambiente seguro. Por fim, a educação teve um caráter mais informativo e de apoio às outras estratégias e não apresentou evidência significativa para uma mudança cultural de segurança viária. CONCLUSÕES: A fiscalização parece ser a estratégia mais efetiva para mudar o comportamento do condutor, principalmente em relação ao excesso de velocidade e ao consumo de álcool associado com direção.

OBJECTIVE: To identify and summarize the findings of studies describing interventions aimed at reducing road traffic injuries. METHODS: An integrative systematic review without meta-analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to synthesize the findings of the articles reviewed. The keywords "traffic accidents", "review" and "public policy" were used in isolation or combined with boolean operator "And" to search PubMed, Web of Science, SciELO, and LILACS for the period between 2006 and 2011 RESULTS: Twenty-two studies were included in the systematic review. Of these, two described engineering strategies, two described other road safety policies, three described education strategies, and 15 described law enforcement policies. Law enforcement had the most effective immediate results. Engineering strategies proved important to promote a safe environment. Finally, education strategies had an informative role and served to support other strategies, but did not seem sufficient to promote cultural changes regarding road safety. CONCLUSIONS: Law enforcement seems to be the most effective strategy to change the behavior of drivers, especially regarding speed limits and drinking and driving.

Impacto de la reforma en la legislación sobre consumo de alcohol y conducción en Guadalajara y Zapopan, Jalisco, México: una mirada en el corto plazo / Short-term impact of changes in drinking-and-driving legislation in Guadalajara and Zapopan, Jalisco, Mexico / Impacto da reforma da legislação sobre consumo de álcool e direção em Guadalajara e Zapopan, Jalisco, México: um olhar de curto prazo

Los municipios de Guadalajara y Zapopan, Jalisco, México, han participado en los esfuerzos para reducir la incidencia de las lesiones causadas por el tránsito a lo largo de los años. Así, han sido partícipes de la Iniciativa Mexicana de Seguridad Vial desde 2008, y en septiembre de 2010 entró en vigor la reducción del límite legal de alcoholemia para conducir vehículos de motor. Con el fin de evaluar el impacto en el corto plazo de estas dos acciones en la ocurrencia de colisiones y lesiones, relacionadas con el consumo de alcohol, así como la gravedad de las mismas, se realizó un análisis secundario de las bases de datos oficiales de mortalidad, morbilidad y eventos viales. Se realizó un análisis de series de tiempo, con el objetivo de analizar la tendencia. Se observaron cambios significativos en el porcentaje mensual de muertes asociadas con alcohol y en la tasa de choques a partir de la aplicación de estas intervenciones. Se realizan diversas recomendaciones para mejorar la aplicación y resultados de esta reforma.

The municipalities of Guadalajara and Zapopan, Jalisco State, Mexico, have participated in efforts to reduce road traffic injuries. They have participated actively in the Mexican Road Safety Initiative since 2008. As a result, in September 2010 they passed laws to reduce the legal alcohol levels for driving motor vehicles. To assess the short-term impact of these measures on rates and severity of alcohol-related collisions and injuries, we conducted a secondary analysis of official databases on mortality, morbidity, and collisions. We performed a time-series analysis to assess the trend. Significant changes were observed in the monthly proportion of alcohol-related deaths and collision rates following these interventions. The article concludes with recommendations to improve the reform’s enforcement and results.

Os municípios de Guadalajara e Zapapan, Jalisco, México, têm particidado dos esforços para reduzir a incidência de lesões causadas pelo trânsito ao longo dos anos. Assim, têm participado da Iniciativa Mexicana de Seguridad Vial desde 2008, e em setembro de 2010 entrou em vigor a redução do limite legal de alcoolemia para condução de veículos automotores. Com o objetivo de avaliar o impacto de curto prazo dessas ações na ocorrência de acidentes e lesões relacionados ao consumo de álcool, assim como a gravidade das mesmas, realizou-se análise de séries temporais, com dados secundários das bases de dados oficiais de mortalidade, morbidade e acidentes de trânsito, de modo a analisar a tendência destes. Observou-se alterações significativas no porcentual mensal de mortes associadas ao álcool e na taxa de acidentes a partir da implementação dessas intervenções. São apresentadas diversas recomendações para melhorar a aplicação e os resultados dessa reforma.

Have drivers at alcohol outlets changed their behavior after the new traffic law?

Objective: In an attempt to reduce high levels of traffic crashes, a new legislation was approved in Brazil in 2008. This study aimed to assess behavioral change among drivers who had drunk at alcohol outlets (AO) after implementation of the law. Method: A three-stage probability sampling survey was conducted in Porto Alegre, state of Rio Grande do Sul, Brazil. Individuals seen leaving AOs after drinking were approached (n=3,018). Selected drivers (n=683) answered a structured interview, were breathalyzed, and had saliva specimens collected for drug screening. Results: Overall, 60.3% (SE 4.5) of drivers reported they did not change their behavior. Among those who reported behavioral changes, most reported drinking less as their main strategy toward safer driving behavior. Variables independently associated with behavior change included having drunk at a high outlet density area (odds ratio [OR] 1.7 [1.1-2.8]) and having a favorable opinion about the law (OR 4.3 [2.1-8.9]). Conclusions: Our findings suggest that awareness of the law has not been enough to promote behavioral change. As most drivers had a favorable opinion of the law and this variable was found to be the strongest predictor of behavior change, efforts to better integrate education and enforcement seem to be pivotal and might be well received by the population. .

A continuidade do uso de anfetaminas por motoristas de caminhão no Estado de São Paulo, Brasil, a despeito da proibição de sua produção, prescrição e uso / Persistent amphetamine consumption by truck drivers in São Paulo State, Brazil, despite the ban on production, prescription, and use / El uso continuado de anfetaminas por parte de los conductores de camión en el estado de São Paulo, Brasil, a pesar de la prohibición de su producción, prescripción y uso

O uso de anfetaminas por motoristas de caminhão com fins ocupacionais é amplamente reconhecido, entretanto, no mês de outubro de 2011, sua produção e uso foram proibidos através de uma resolução da Agência Nacional de Vigilância Sanitária (ANVISA). O objetivo deste estudo foi identificar o uso de anfetaminas entre motoristas de caminhão após a implementação da referida resolução. Uma amostra de conveniência de 427 motoristas de caminhão foi abordada em rodovias do Estado de São Paulo, Brasil, durante o ano de 2012. Os participantes foram solicitados a responder um instrumento de pesquisa estruturado, assim como fornecer uma amostra de urina para avaliar o uso recente de anfetaminas através de análise toxicológica. Entre os motoristas avaliados, 7% fizeram uso recente de alguma substância ilícita, dos quais 2,7% usaram anfetaminas. Aparte a periculosidade associada ao uso de anfetaminas, assim como a despeito da resolução que o regulamenta, esse uso continua entre os motoristas de caminhão. Assim, sugere-se que as autoridades competentes fiscalizem a posse, assim como o uso de anfetaminas no contexto do trânsito.

Amphetamine use by truck drivers for occupational purposes is widely known. The production and consumption of amphetamines was banned by the Brazilian National Health Surveillance Agency (ANVISA) in October 2011. This study analyzes persistent amphetamine use by truck drivers since the ban was implemented. A convenience sample of 427 truck drivers was taken along highways in São Paulo State in 2012. Participants were asked to answer a structured questionnaire and provide a urine sample to screen for recent amphetamine consumption through toxicological analysis. Among the interviewed drivers, 7% had used some illicit drug recently and 2.7% had used amphetamines. Amphetamines are still consumed by truck drivers despite the risks and the recent ban. The authorities should thus monitor the possession and use of amphetamines by drivers in order to effectively enforce the ban.

El uso de anfetaminas con fines profesionales entre los conductores de camiones es ampliamente reconocido, sin embargo, en octubre de 2011, su producción y uso fueron prohibidos por una resolución de la Agencia Nacional de Vigilancia Sanitaria (ANVISA). El objetivo de este estudio fue identificar el uso de anfetaminas entre conductores de camión después de la implementación de esa resolución. Una muestra de conveniencia compuesta por 427 conductores de camiones fue abordada en las carreteras del estado de São Paulo, Brasil, en el año 2012. A los participantes se les pidió rellenar una encuesta estructurada, así como dar una muestra de orina para determinar el consumo reciente de anfetaminas, a través de análisis toxicológico. Entre los conductores evaluados, el 7% consumió recientemente algún estupefaciente, de los cuales un 2,7% había consumido anfetaminas. Aparte de los peligros asociados al uso de anfetaminas, y de la resolución que lo regula, ese uso sigue vigente entre los conductores de camión. Por lo tanto, se sugiere que las autoridades competentes supervisen la posesión, así como el consumo de anfetaminas, en el tráfico rodado.

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.

Predictors of positive Blood Alcohol Concentration (BAC) in a sample of Brazilian drivers / Preditores de alcoolemia positiva em uma amostra de motoristas brasileiros

OBJECTIVE: To verify the frequency of positive Blood Alcohol Concentration (BAC) among drivers and to examine associated factors in a cross-sectional study of Brazilian state capitals. METHODS: 3,398 drivers were approached on highways crossing all 27 Brazilian capitals from 12 p.m. to 12 a.m. (Fridays and Saturdays). They were breathalyzed and data on their driving characteristics and alcohol consumption were collected. Multivariate logistic regression following a hierarchical conceptual framework was used to evaluate associated factors. RESULTS: The overall weighted prevalence of positive BAC (> 0.1 mg/L) was 4.2%. The multivariate analysis showed that education up to 8 years (OR = 2.0; 95% CI: 1.4-3.0), age > 30 years (OR = 2.6; 95% CI: 1.8-3.8), type of vehicle (cars: OR = 3.0; 95% CI: 1.7-5.1; motorcycles: OR = 3.7; 95% CI: 2.1-6.4), binge drinking (OR = 1.7; 95% CI: 1.3-2.4), having been breathalyzed before (OR = 2.6; 95% CI: 1.8-3.7), and purpose of the trip (coming from a party: OR = 1.9; 95% CI: 1.3-3.0; leisure trip: OR = 1.7; 95% CI: 1.32.4; driving after 8 p.m.: OR = 1.7; 95% CI: 1.3-2.3) were independently associated with DUI. CONCLUSION: Study findings suggest that selected external environmental factors, such as socioeconomic and demographic characteristics as well as personal characteristics like alcohol consumption and the relationship between drinking and driving were associated with positive BAC among Brazilian drivers. Results can help to inform drinking and driving policy and preventive approaches.

OBJETIVO: Verificar a frequência de alcoolemia positiva entre os motoristas e examinar fatores associados em um estudo transversal nas capitais brasileiras. MÉTODOS: 3.398 motoristas foram abordados em rodovias que atravessam todas as 27 capitais brasileiras nos horários entre 12:00 e 00:00 (sextas e sábados). Eles realizaram o teste do etilômetro e foram coletados dados sobre suas características de condução e consumo de álcool. Para avaliar os fatores associados, foi realizada uma regressão logística multivariável seguindo um quadro conceitual hierárquico. RESULTADOS: A prevalência de alcoolemia positiva (> 0,1 mg/L) foi de 4,2%. A regressão logística múltipla mostrou que educação (até 8 anos de estudo: OR = 2,0; IC 95%: 1,4-3,0), idade (> 30 anos: OR = 2,6; IC 95%: 1,8-3,8), tipo de veículo (dirigir um carro: OR = 3,0; IC 95%: 1,7-5,1; conduzir uma motocicleta: OR = 3,7; IC 95%: 2,1-6,4), consumo excessivo de álcool (OR = 1,7; IC 95%: 1,3-2,4), ter realizado o teste do etilômetro anteriormente (OR = 2,6; IC 95%: 1,8-3,7), e a finalidade da viagem (retorno de uma festa: OR = 1,9; IC 95%:1,3-3,0; viagem de lazer: OR = 1,7; IC 95%: 1,3-2,4; e estar dirigindo após as 20 horas: OR = 1,7; IC 95%: 1,3-2,3) foram independentemente associados com o dirigir sob influência de álcool. CONCLUSÃO: Os resultados sugerem que fatores ambientais externos selecionados, tais como características socioeconômicas e demográficas, bem como características pessoais, como o consumo de álcool e comportamento em relação a beber e dirigir, foram associados com alcoolemia positiva entre os motoristas brasileiros. Os resultados podem ajudar a orientar políticas em relação a beber e dirigir e abordagens preventivas.

Ley chilena de tolerancia cero al alcohol: fortalezas, falencias y carencias que no deben ser obviadas / Alcohol zero tolerance law in Chile: strengths, flaws and shortcomings that should not be overlooked

Background: Chile has recently entered into force Act No. 20.580, which modifies the legal limits of blood alcohol concentration in drivers and increases the penalties for driving under the influence of alcohol, narcotics or psychotropic substances. The aim of this review was to give an account of the strengths of this new law but, at the same time, to alert the scientific and legal community about its flaws. We also present some shortcomings of Chilean regulatory framework that remain uncorrected, those that should be considered in the design of public policies for improving road safety and the criteria that judges should ponder during judgment, to determine either conviction or acquittal.

Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

O impacto da "Lei Seca" sobre o beber e dirigir em Belo Horizonte/MG / The Impact of Prohibition on drinking and driving in Belo Horizonte in the State of Minas Gerais

O objetivo do presente trabalho é apresentar dados, de estudo comparativo, sobre a conduta de beber e dirigir na cidade de Belo Horizonte, no período de 2005 a 2009, avaliando o impacto da Lei 11.705, a "Lei Seca", de 20 de junho de 2008. Para tanto, dados de prevalência desta conduta, coletados em postos de fiscalização da sobriedade (Sobriety Checkpoints) - metodologia internacionalmente utilizada -, foram analisados a partir de amostras representativas de motoristas abordados em vias públicas de tráfego intenso dessa capital, permitindo a avaliação do impacto da nova Lei. Os resultados da análise destes dados apontaram para uma redução de cerca de 50% na prevalência de condutores dirigindo com algum nível de álcool no sangue, em 2008, quando comparados a 2007, o que coincide com a mudança na legislação. O estudo permitiu determinar que o impacto da Lei 11.705/2008 foi bastante expressivo, no sentido de modificar a conduta estudada. Entretanto, outras medidas de controle devem somar-se à mudança na legislação, para que seja buscada uma contínua redução na incidência do "beber e dirigir", favorecendo, assim, uma cultura de sobriedade no trânsito.

The scope of this paper is to present comparative data on drinking and driving behavior among drivers in Belo Horizonte in the State of Minas Gerais, in the period from 2005 to 2009, evaluating the impact of Law No. 11.705 (Prohibition), dated June 6, 2008. Data regarding prevalence of this behavior, collected at Sobriety Checkpoints (internationally used methodology) were analyzed using representative samples obtained from drivers on different public roads with intensive traffic in Belo Horizonte (2005-2009), thus permitting analysis of the impact of the new law. In 2008, the data showed a reduction of approximately 50% in the prevalence of individuals driving with any level of alcohol in the blood, when compared to 2007, after the change in legislation. This study showed that the impact caused by Law No.11.705 was marked in the sense of modifying the behavior under scrutiny. However, other control measures need to be added to the current legislation, in order to obtain a continuous reduction of drinking and driving behavior, thereby fostering a culture of sobriety on the road.

A road traffic injury surveillance system using combined data sources in Peru / Sistema de vigilancia de traumatismos por accidentes de tránsito con fuentes de datos combinadas en el Perú

A national hospital-based nonfatal road traffic injury surveillance system was established at sentinel units across Peru in 2007 under the leadership of the Ministry of Health. Surveillance data are drawn from three different sources (hospital records, police reports, and vehicle insurance reports) and include nonfatal road traffic injuries initially attended at emergency rooms. A single data collection form is used to record information about the injured, event characteristics related to the driver of the vehicle(s), and the vehicle(s). Data are analyzed periodically and disseminated to all surveillance system participants. Results indicated young adult males (15-29 years old) were most affected by nonfatal road traffic injuries and were most often the drivers of the vehicles involved in the collision. Four-wheeled vehicle occupants comprised one-half of cases in most regions of the country, and pedestrians injured in the event accounted for almost another half. The system established in Peru could serve as a model for the use of multiple data sources in national nonfatal road traffic injury surveillance. Based on this study, the challenges of this type of system include sustaining and increasing participation among sentinel units nationwide and identifying appropriate prevention interventions at the local level based on the resulting data.

Con el liderazgo del Ministerio de Salud, en el 2007 se estableció un sistema hospitalario nacional de vigilancia de traumatismos no mortales por accidentes de tránsito en unidades centinela de todo el Perú. Los datos de vigilancia se extraen de tres fuentes diferentes (registros hospitalarios, informes policiales e informes del seguro del vehículo) e incluyen los traumatismos no mortales por accidentes de tránsito atendidos inicialmente en las salas de urgencia. Se usa un único formulario de recopilación de datos para registrar la información sobre los heridos, las características del hecho relacionadas con el conductor o los conductores de los vehículos y del vehículo o los vehículos involucrados. Los datos se analizan periódicamente y se comunican a todos los participantes del sistema de vigilancia. Los resultados indicaron que los hombres adultos jóvenes (de 15 a 29 años) fueron los más afectados por traumatismos no mortales por accidentes de tránsito y con mayor frecuencia eran los conductores de los vehículos que participaron en la colisión. Los ocupantes de vehículos de cuatro ruedas representaron la mitad de los casos en la mayoría de las zonas del país y los peatones lesionados en el hecho representaron prácticamente la otra mitad. El sistema establecido en el Perú podría servir de modelo del uso de múltiples fuentes de datos para la vigilancia a nivel nacional de traumatismos no mortales por accidentes de tránsito. Según los resultados de este estudio, los retos de un sistema de este tipo consisten en mantener y aumentar la participación de las unidades de vigilancia de todo el país y determinar las intervenciones de prevención adecuadas en el nivel local según los datos obtenidos.

Medidas de prevención primaria para controlar lesiones y muertes en peatones y fomentar la seguridad vial / Primary prevention measures for controlling pedestrian injuries and deaths and improving road safety

Dentro de las lesiones causadas por el tránsito (LCT) los atropellamientos representan a nivel mundial al menos la tercera parte de éstas; son eventos que habitualmente generan lesiones corporales incapacitantes e incluso pueden provocar la muerte. En Latino-América las personas afectadas, en general, son hombres entre 20 y 45 años, en edad productiva, jefes de hogar, personas que sostienen sus familias, su ausencia genera gran impacto en la economía de sus hogares. Se realizó una revisión sistemática sobre la carga que representan las LCT, en especial los atropellamientos y sobre las medidas de prevención primaria diseñadas e implementadas para el control de lesiones fatales y no fatales en peatones a través del mejoramiento de procesos de seguridad vial. En Latino- América los atropellamientos han sido poco estudiados; el grueso de intervenciones para reducir las LCT se han orientado hacia el conductor y ocupantes de vehículos y poco hacia los demás actores del tránsito, incrementando la desigualdad y vulnerabilidad de peatones; existe consenso mundial entre expertos, que es necesario investigaciones rigurosas, en especial en países de bajos y medianos ingresos orientados a evaluar la efectividad de intervenciones focalizadas hacia otros actores del tránsito; en la presente revisión se expone una variedad de estrategias de prevención primaria diferentes a puentes peatonales que según la evidencia disponible debe empezar a implementarse. Varias de éstas incluyen modificaciones al medio ambiente físico, educación, control de la velocidad, cumplimiento de la legislación y respeto por el peatón, valorando sus limitantes y vulnerabilidad.

At least 30 percent of traffic-related injuries involve pedestrians. These events typically result in incapacitating physical injury and may even cause death. Productive-agedmen, aged 20 to 45, represent the people generally affected in Latin-America. They tend to be heads of household supporting their families and whose absence greatly affects the home's financial situation. A systematic review was conducted of the burden represented by traffic-related injuries, especially those involving pedestrians, and of the primary preventative measures designed and implemented for controlling fatal and non-fatal injuries to pedestrians by improving road safety. There have been few studies in Latin-America regarding these types of accidents and most interventions aimed at reducing traffic-related injuries have been directed towards vehicle drivers and passengers, little attention being focused on other traffic-related actors. This increases pedestrian inequality and vulnerability. There is a consensus among experts worldwide that rigorous investigation is needed (especially in low- and middle-income countries) to evaluate the effectiveness of interventions focused on other traffic-related actors. This review presents a variety of primary prevention strategies, other than pedestrian bridges, which (according to the available evidence) should start to be implemented. These would include modifying the physical environment, education, speed controls, enforcing legislation and imposing respect for pedestrians, valuing their limitations and vulnerability.

¿Puedo conducir un automóvil, doctor?: Evaluación para el manejo de automóviles en personas con discapacidad y su importancia en la rehabilitación / Can I drive a car, doctor?: Car driving evaluation for people with disability and the importance in rehabilitation

One of the main objectives in the rehabilitation of people with disability is to give them the possibility of mobilizing independently and a car is a modern and effective tool for achieving this objective. It is essential to make a specific assessment that includes at least the visual, cognitive and motor area before deter-mining whether the individual can drive a car, or also what kind of adaptations may be required. It is also essential to properly know the Traffic Law in force in our country to be able to guide the steps that the patient has to follow to obtain a driver's license. The objective of this review is to study deeply this interesting subject and all the edges that have been mentioned above.

[ role of pupil liaisons' on traffic penalties and road traffic injuries]

To determine the role of pupil liaisons' education on social discipline promotion and road traffic injury prevention. This was a before-after interventional study on 2800 pupils randomly selected from 6 different districts of Tehran, Iran. The pupils were taught about common driving offences and were asked to note and prevent offences if their parents performed offences. Data were collected by a questionnaire for childern's performances and other demographic information. Subjects were pupils 8-15 years. The mean age of participants was 11 years. Overall, 47.7 percent of pupils were boys. Non use of seat belt [39.1%], speaking with mobile while driving [31.8%] and speeding [29.8%] were major offences as noted by pupils' liaisons. Recorded offences by traffic police before the intervention for thease families was 2789 cases. A significant differences with 17.9 percent reduction in offences were observed after intervention [2290 cases, P<0.001]. The most offences reduction were eating and drinking during driving [92.7%]. Pupil liaisons' program was effective on reduction of driving offences. The most reduction was eating or drinking during driving. All 9 common offences which were monitored by pupil liaisons' were effective on reduction of offences except for mobile speaking while driving