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.

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.

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.

Estatuto de Defesa do Torcedor: um diálogo com o futebol pelotense / Estatuto de Defensa del Hincha: un diálogo conel fútbol Pelotense / Spectator's Statute of Defense: a Dialogue with the Pelotense Soccer

Este estudo objetiva analisar a situação dos estádiosde futebol profissional de Pelotas, tendo como referênciao Estatuto de Defesa do Torcedor (EDT), com atençãoespecial para as condições de higiene, segurança, ingressose transporte. Como metodologia, além da análisedocumental do EDT realizamos visitas aos estádios em trêsmomentos com registros fotográficos e entrevistamos umdirigente de cada clube: Grêmio Esportivo Brasil, EsporteClube Pelotas e Grêmio Atlético Farroupilha. Constatamosque a atenção dedicada pela mídia e pelos órgãosfiscalizadores à implementação do EDT está sendo menordo que ocorreu no momento da sua publicação.

This study has as objective analyses thesituation of the stadiums of professional soccer ofPelotas, using as reference the Spectator’s Statuteof Defense (SSD), with special attention to theconditions of hygiene, safety, entrances andtransport. As methodology, besides documentalanalysis of the SSD we realized visits to thestadiums in three moments where we tookphotographic registrations, as well as interviewswith one manager of each club: Grêmio EsportivoBrasil, Esporte Clube Pelotas e Grêmio AtléticoFarroupilha. We verified that the attention dedicatedfor press communication and controllers organs toimplementation of SSD is being less than occurs atthe moment of your publication.

Este estudo objetiva analisar lasituación de los estadios de fútbol de la ciudad dePelotas, tomando como referencia el Estatuto deDefensa del Hincha (EDH), con atención especialpara las condiciones de higiene, seguridad, ingresoy transporte. Como metodología, además delanalisis documental del EDH realisamos visitas alos estadios en tres momentos con registrosfotográticos y entrevistamos un dirigente de cadaclub: Gremio Desportivo Brasil, Esporte ClubPelotas y Gremio Atlético Farroupilha. Constatamosque la atención dedicada en la media y por losorganos fiscalizadores a la implementación delEDH es menor de la que ocurrió en el momento dela publicación.

Making road safety a public health concern for policy-makers in India.

BACKGROUND: Road traffic injuries contribute substantially to the disease burden in India. This paper describes the road safety issues discussed by members of the Indian Parliament, and highlights the gaps that need to be addressed to make road safety visible as a public health problem to policy-makers in India. METHODS: All questions asked to and information provided by the Ministry of Road Transport and Highways, and questions relating to accident asked to the Ministry of Health and Family Welfare of the Government of India were reviewed for the two Houses of the Indian Parliament for the years 2002 to 2004. RESULTS: Of the 1529 questions asked to the Ministry of Road Transport and Highways, only 140 (9.1%) were related to road safety, whereas 1076 (70.5%), 181 (11.8%), 51 (3.3%) and 81 (5.3%) were related to other aspects of the national highways, state roads, vehicles and other issues, respectively. Data on the magnitude of road crashes dealt only with the number of crashes and fatalities and not with the age, sex and type of road users affected by road traffic injuries. The parliamentarians were informed that human error was the main cause of road crashes in India; however, the robustness of this information is questionable. Strategies to prevent road crashes focused mainly on training of drivers with little attention to other factors that cause road crashes. The discussion on legislations also focused on drivers, ignoring other road users. Ten of the 4741 questions (0.2%) asked to Ministry of Health and Family Welfare were related to accident, the majority of which were about the setting up of trauma care services. CONCLUSION: An appropriate policy and intervention response by policy-makers is not possible with data that are presented in a manner that do not highlight the true nature of the problem, and are neither comprehensive nor robust. Majority of the proposed road safety interventions by the Ministry of Road Transport and Highways are based on the traditional view of human error as a major cause of road crashes highlighting the lack of a scientific public health approach towards prevention of road crashes. It would be useful to build the technical capacity of the Ministry of Road Transport and Highways in road safety to use the available data more effectively, and to facilitate generation of further relevant data about the magnitude, underlying causes and impact of road traffic injuries, for policy-makers to better understand the critical issues for planning effective road safety policies and interventions to reduce the high burden of mortality and morbidity due to road crashes in India.

Atención al paciente VIH/SIDA: legislacion y bioseguridad odontológica en Colombia / Care for HIV/AIDS patients: norms and biosecurity for oral health in Colombia

Este artículo describe normas universales de bioseguridad en la atención odontológica, particularmente las referidas a la atención de personas infectadas con VIH/SIDA, al tiempo que pasa revista a leyes y decretos relativos al tema vigentes en Colombia. Establecer la rutina de evaluar, controlar y prevenir accidentes de trabajo e infecciones asociadas a la práctica odontológica garantiza una mejor atención y calidad de vida, tanto para los pacientes como para el personal de salud.

The present article describes biosecurity universal norms for dental care, specifically those referred to care of persons with HIV/AIDS, and also it reviews laws and norms at Colombia with respect to the topic. It establishes the routine of evaluating, controlling and preventing accidents at work and infections associated with dental health practices, guaranteeing a better care and quality of life both for patients and for health personnel.

Este artigo decreve normas universais de biossegurança na atenção odontológica, particularmente no que se refere aos cuidados de pessoas infectadas com o VIH/AIDS. Faz também uma revisão das leis e decretos relacionados com o tema vigentes na Colombia. Estabelecer uma rotina de avaliação, controle e prevenção de acidentes de trabalho e infecções associadas à prática odontológica garante uma atenção melhor e qualidade de vida, tanto para os paceintes como para os profissionais da saúde.