The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting.

Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country.

OBJECTIVE: This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN: This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS: A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION: During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS: · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..

Clusters of cause specific neonatal mortality and its association with per capita gross domestic product: A structured spatial analytical approach.

BACKGROUND: Infant mortality rate is a measure of population health and neonatal mortality account for great proportion of these deaths. Underdevelopment might be associated to higher neonatal mortality risk due to assistant related factors. Spatial and temporal distribution of mortality help identifying and developing strategies for interventions. OBJECTIVE: To investigate the cluster areas of asphyxia-associated neonatal mortality and to explore its association with per capita gross domestic product (GDP) in São Paulo State (SP), Brazil. METHODS: Ecological study including live births residents in SP from 2004-2013. Neonatal deaths (0-27 days) with perinatal asphyxia were defined as intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome written in any line of the Death Certificate. Geoprocessing analytical approach included detection of first order effects through quintiles and spatial moving average maps, followed by second order effects by global and local spatial autocorrelation (Moran and LISA, respectively) before and after smoothing with local Bayesian estimates. Finally, Spearman correlation was applied between asphyxia-associated neonatal mortality and mean per capita GDP rates for the municipalities with significant LISA. RESULTS: There were 6,713 asphyxia-associated neonatal deaths among 5,949,267 live births (rate: 1.13/1000) in SP. Spatial moving average maps showed a non-random distribution among municipalities, with presence of clusters (I = 0.048; p = 0.023). LISA map identified clusters of asphyxia-associated neonatal mortality in the south, southeast and northwest. After applying local Bayes estimates, clusters were more pronounced (I = 0.589; p = 0.001). There was a partial overlap of the areas of higher asphyxia-associated neonatal mortality and lower mean per capita GDP. CONCLUSIONS: Spatial analysis identified cluster areas of high asphyxia-associated neonatal mortality and low per capita GDP rates, with a significant negative correlation. This optimized, structured, and hierarchical approach to identify high-risk areas of cause-specific neonatal mortality may be helpful for guiding public health efforts to decrease neonatal mortality.

Trends in Melanoma Mortality in Brazil: A Registry-Based Study.

PURPOSE: A substantial increase in melanoma incidence has been consistently observed worldwide over the past decades. However, melanoma mortality rates have remained stable or declined over the past years in most regions. Given the paucity of melanoma mortality data for different Brazilian regions, we sought to describe melanoma mortality trends in southeastern Brazil and their relationship with demographic variables. MATERIALS AND METHODS: A cross-sectional registry-based analysis was conducted to describe melanoma mortality trends in the state of São Paulo, Brazil, from 1996 to 2016. Demographic information from melanoma-related death records, including sex and age, was collected from the Fundação Sistema Estadual de Análise de Dados database. The annual percentage change (APC) was calculated to identify mortality trends over the period. RESULTS: An increasing melanoma mortality trend was detected among males, regardless of age (APC, 1.72%; P < .001), and was more pronounced for men ≥ 60 years old (APC, 2.63%; P < .001). Melanoma mortality rates have also increased for patients ≥ 60 years old, regardless of sex (APC, 1.11%; P < .001). A non-statistically significant increase in the overall melanoma mortality rate was observed over the 20-year period analyzed (APC, 0.36%; P = .4). CONCLUSION: Our data suggest a stable melanoma mortality over the past two decades for the overall population studied; however, a significant increase in melanoma mortality rates has been demonstrated among males and in the population ≥ 60 years old, emphasizing the need to implement prevention strategies and expand access to effective therapies for this population.

Worse survival of invasive melanoma patients in men and de novo lesions

Abstract Background: The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better. Objective: To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables. Methods: Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor. Results: The worst survival rates were significantly associated with thicker tumors (p < 0.001), male sex (p = 0.014), high phototype (p = 0.047), nodular melanoma (p = 0.024) and "de novo" lesions (p = 0.005). When all variables were adjusted for melanoma thickness, male patients (p = 0.011) and "de novo" melanomas (p = 0.025) remained associated with worse survival. Study limitations: Retrospective study of a single tertiary hospital. Conclusions: Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for "de novo" melanomas even after adjustment of tumor thickness.

Worse survival of invasive melanoma patients in men and "de novo" lesions.

BACKGROUND: The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better. OBJECTIVE: To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables. METHODS: Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor. RESULTS: The worst survival rates were significantly associated with thicker tumors (p<0.001), male sex (p=0.014), high phototype (p=0.047), nodular melanoma (p=0.024) and "de novo" lesions (p=0.005). When all variables were adjusted for melanoma thickness, male patients (p=0.011) and "de novo" melanomas (p=0.025) remained associated with worse survival. STUDY LIMITATIONS: Retrospective study of a single tertiary hospital. CONCLUSIONS: Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for "de novo" melanomas even after adjustment of tumor thickness.

Trajetória da mortalidade por doenças infecciosas em menores de cinco anos no estado de São Paulo 1980 - 2016 / Trajectory of mortality from infectious diseases in children under five in the state of São Paulo 1980 - 2016

Introdução: A análise da mortalidade na infância tem relevância para a definição de ações preventivas mais efetivas. Entre os Objetivos do Desenvolvimento Sustentável temos a eliminação das mortes evitáveis na infância. Objetivos: 1) Analisar a mortalidade por causas infecciosas para <5 anos, no estado de São Paulo (ESP), em 1980, 1990, 2000, 2010 e 2016; 2) Analisar a mortalidade por causas infecciosas no universo da coorte de nascidos vivos, em 2010, e seguida até 59 meses e 29 dias de idade, segundo características das crianças e das mães; 3) Descrever espacialmente os óbitos por causas infecciosas, segundo características do local de residência; 4) Investigar fatores associados à sobrevida na coorte de nascidos. Método: Tratase de dois estudos, um deles de corte transversal descritivo, relativo aos anos de 1980, 1990, 2000, 2010 e 2016, e um estudo longitudinal do universo da coorte de nascidos vivos de 2010, no ESP, totalizando 601.604 crianças, acompanhadas até os 59 meses e 29 dias de idade. As fontes de informação são as bases de óbitos e nascidos vivos do Registro Civil da Fundação SEADE. O estudo de corte transversal analisou as causas básicas de óbito, segundo a nona e décima versão da Classificação Internacional de Doenças (OMS, CID-9, CID-10). As causas de morte referentes à CID-9 foram compatibilizadas com às da CID-10. Para o estudo longitudinal da coorte de nascidos, a base de dados foi criada aplicando-se a metodologia de vinculação determinística, entre a base de nascidos vivos de 2010 e as bases de óbitos de 2010 a 2015. As variáveis de interesse foram as características relativas à mãe, ao parto e à criança. Para análise do tempo até o óbito por causa infecciosa utilizou-se o estimador produto limite de Kaplan-Meier e o modelo de riscos proporcionais de Cox. Para investigar os fatores associados à sobrevida, tomamos o óbito por causa infecciosa como desfecho e as exposições de interesse como variáveis independentes. As estimativas das razões de riscos (HR), com respectivos intervalos de confiança de 95% (IC=95%), foram obtidas em modelo de riscos proporcionais de Cox. Resultados: As taxas de mortalidade de < 5 anos declinaram de 56,9 para 12,6 óbitos/1.000 NV (77,8%) entre 1980 e 2016, enquanto que, para causas infecciosas de 27,0 para 2,6 (90,4%). No início do período, a proporção de causas infecciosas situava-se em 47,0% dos óbitos, enquanto que, no final 20,6%; as diarreias, as pneumonias/broncopneumonias, as septicemias e as doenças imunopreveníveis apresentaram maior declínio, respectivamente, 99,1%, 95,4%, 84,7% e 98,9%. Na coorte de nascidos identificaram-se as seguintes exposições como independentemente associadas à sobrevida entre as crianças da coorte: mãe com < 7 anos de estudo (HRajustados=1,6); mãe com 4 ou + filhos (HRajustados=1,4); gestação de 32 a 36 semanas (HRajustados=1,8); gestação de < de 27 semanas (HRajustados=14,2); < 7 consultas de pré-natal (HRajustados=1,2); residir em município com elevada vulnerabilidade (HRajustados=1,4); peso ao nascer < de 1.500 gramas (HRajustados=13,9); malformação congênita (HRajustados=5,2); nascer no domicílio (HRajustados=3,2); apgar menor de 7 no primeiro minuto (HRajustados=2,3). Conclusões: O ESP apresentou expressivo declínio na mortalidade na infância, nas últimas décadas, especialmente, por causas infecciosas, no entanto, causas infecciosas e não infecciosas relacionadas à qualidade da assistência materno infantil persistem. Os estudos apresentam resultados que podem subsidiar estratégias com foco na diminuição da mortalidade na infância no ESP.

Introduction: The analysis of childhood mortality is relevant to the definition of more effective preventive actions. Among Sustainable Development Goals there is elimnination of preventable childhood deaths. Objectives: 1) Analyze mortality from infectious causes for<5 years old, in the state of São Paulo(ESP), in 1980, 1990, 2000, 2010 and 2016; 2) Analyze the mortaliy due to infectious causes in a cohort of 2010 newborns followed up to 59 months of age, according to the children and mothers'characteristics; 3) Describe deaths from infectius causes, according to the characteristics of the place of residence; 4) Investigate fator associated with survival in the birth cohort. Methods: There are two studies, one of which regarding a descriptive crosssection, relating to the years 1980, 1990, 2000, 2010 and 2016, and a longitudinal study of the universe of the 2010 born alive cohort, in the state of São Paulo, totalizing 601,604 children, followed up to 59 months of age. The sources of information to this study are the databases of deaths and born alive children of the Civil Record of the SEADE Foundation. The crosssectional study analyzed basic death causes, in agreement to the ninth and tenth versions of the International Classification of Diseases (WHO, ICD-10, ICD-9). The death causes referring to ICD-9 have been compatible with ICD-10. For the longitudinal study of the cohort of born alive, the database was created using the deterministic linkage methodology, between the born alive database from 2010 and the death databases from 2010 to 2015. The variables of interest were relative to mother, childbirth and child characteristics. To analyze the time until death due to infectious cause, the Kaplan-Meier product-limit estimator and Cox´s proportional hazards model were used. To investigate the factors associated with survival, we took death from infectious cause as an outcome and the exposures of interest as independent variables. The hazard ratio (HR) estimative, with 95% respective confidence intervals (CI - 95%), were obtained using the Cox proportional hazards model. Results: Mortality rates of <5 years old declines from 56.9 to 12.6 deaths / 1,000 born alive (77.8%) between 1980 and 2016, while for infectious causes declined from 27.0 to 2.6 (90.4%). In the beginning of the period the proportion of infectious causes stood at 47.0% of deaths, while at the end of the period dropped to 20.6% diarrhea, pneumonia/bronchopneumonia, septicemia an immunopreventable diseases presented an accented decline, respectively, 99.1%, 95.4%, 84.7% and 98.9%. In the born alive cohort, the following exposures were identifield as independently associated with survival among children in the cohort: mother with <7 years of study (HRadjusted = 1.6); mother wirg 4 or + children (HRadjusted= 1.4); gestation from 32 to 32 weeks (HRadjusted= 1.8); gestation <27 weeks (HRadjusted= 14.2); <7 prenatal consultations (HRadjusted= 1.2); live in a muncipality with high vulnerability (HRadjusted= 1.4); birth weight <1,500 grams (HRadjusted= 13.9); congenital malformation (HRadjusted= 5.2); being born at home (HRadjusted= 3.2); apgar score <7 in the first minute (HRadjusted= 2.3): Conclusions: The São Paulo State has shown a significant decline in the childhood mortality in recente decades, especially in infectious causes, even though, infectious and non-infectious causes related to the quality of maternal and childcare persist. The longitudinal study shows results that can support strategies focused on reducing childhood mortality in São Paulo State.

Melhora na qualidade e completitude da base de dados do Registro de Câncer de Base Populacional do município de São Paulo: uso das técnicas de linkage / Quality and completeness improvement of the Population-based Cancer Registry of São Paulo: linkage technique use

RESUMO: A disponibilidade de grandes bases de dados informatizadas em saúde tornou a técnica de linkage uma alternativa para diferentes tipos de estudos, proporcionando a geração de uma base de dados mais completa e de baixo custo operacional. Objetivo: Melhorar a qualidade e a completitude dos casos incidentes de câncer por meio dos linkages probabilístico e determinístico entre o Registro de Câncer de Base Populacional de São Paulo (RCBP-SP), o banco de dados de óbitos e de Autorização e Procedimentos de Alta Complexidade. Método: Foi utilizado o banco de dados do RCBP-SP, composto de 343.306 casos de câncer incidentes no município de São Paulo entre 1997 e 2005, com idades entre 1 e 106 anos, de ambos os sexos. Para o linkage foram utilizadas três bases de dados, a saber: do Programa de Aprimoramento de Mortalidade no Município de São Paulo (PRO-AIM), da Fundação SEADE e da Autorização e Procedimentos de Alta Complexidade/Custo do Sistema de Informação Ambulatorial do Sistema Único de Saúde (APAC-SIA/SUS). Foram analisadas os coeficientes brutos de incidência (CBI) e mortalidade (CBM) e a sobrevida global pela técnica de Kaplan-Meier. Resultados: Após o linkage, verificou-se um ganho de 4,3% para a CBI e 25,8% para a CBM. Na análise de sobrevida global antes do linkage havia uma subestimação da probabilidade de estar vivo para todas as variáveis analisadas (p < 0,001). Conclusão: As técnicas de linkage contribuíram para a melhora da qualidade da informação do RCBP-SP tanto na completitude das variáveis quanto na definição do status vital do paciente, refletindo a capacidade das bases de dados, quando trabalhadas de maneira conjunta, de fornecerem subsídios para diversos tipos de estudos e informações para o planejamento de ações políticas e estratégicas.

ABSTRACT: The availability of large computerized databases on health turned the record linkage technique into an alternative for different study designs. This technique provides the creation of more complete databases, at low operational costs. Objective: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. Methods: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. Results: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). Conclusion: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

Quality and completeness improvement of the Population-based Cancer Registry of São Paulo: linkage technique use. / Melhora na qualidade e completitude da base de dados do Registro de Câncer de Base Populacional do município de São Paulo: uso das técnicas de linkage.

OBJECTIVE:: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. METHODS:: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. RESULTS:: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). CONCLUSION:: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

A vida com a Aids no Estado de São Paulo: informação e desafios para a política pública de saúde* / Life with AIDS in São Paulo: information and challenges for public health policy

O estudo dimensiona a população com Aids no Estado de São Paulo e suas principais características demográficas e epidemiológicas. Este é o principal resultado da parceria entre a Fundação Seade e o Programa Estadual DST/ Aids, que uniram esforços para melhorar a qualidade e a completude das informações sobre a epidemia de Aids no Estado, construindo a Base Integrada Paulista de Aids – BIP-Aids. As informações reveladas nessa nova base de dados subsidiam a elaboração de ações da área da saúde paulista...

First- and fifth-minute Apgar scores of 0-3 and infant mortality: a population-based study in São Paulo State of Brazil.

AIMS: To determine the infant mortality of newborns with 1- and 5-min Apgar scores of 0-3. RESULTS: Population cohort study with neonates with birth weight ≥400 g, gestational age ≥22 weeks and 1- and 5-min Apgar scores of 0-3, without malformations, born in São Paulo State (Brazil) from January 2006 to December 2007. Apgar scores were confirmed in the original certificates of live births and/or medical records. During this period, among 1,027,132 live births, 1640 met the study criteria, with an incidence of 1.6 per 1000 live births. When the 5-min Apgar score was 0, 1, 2 and 3, the infant mortality rate was 97%, 94%, 64% and 47%, respectively. Risk factors associated with infant deaths were 5-min Apgar score of 0 or 1 [odds ratio (OR) 16.6, 95% confidence interval (CI) 11.1-24.8], birth weight <2500 g (OR 7.5, 95% CI 5.7-9.8), birth at hospitals outside the state capital (OR 1.7, 95% CI 1.3-2.3), in private or charitable hospitals (OR 1.6, 95% CI 1.2-2.0), and during the night shift (OR 1.3, 95% CI 1.0-1.7). CONCLUSIONS: For infants with 1- and 5-min Apgar scores of 0-3, the infant mortality is high. Besides the biological variables associated with the chance of dying, the organization of the perinatal care influences the outcome.

Acidentes e doenças do trabalho notificadas, de motoristas profissionais do Estado de São Paulo / Work injuries and occupational diseases of professional drivers of the State of Sao Paulo

São descritos os acidentes do trabalho para motoristas profissionais residentes no Estado de São Paulo. Os dados tiveram origem em base específica elaborada nas CATs e processos notificados na Previdência Social do Estado de São Paulo, entre 1997 e 1999. Apresentam-se as características dos motoristas acidentados e dos acidentes do trabalho. São analisadas taxas de incidência, mortalidade e letalidade dos motoristas para o Estado, Região Metropolitana de São Paulo e Município de São Paulo.

Acidentes e doenças do trabalho de profissionais do setor transporte: análise dos motoristas no Estado de São Paulo, 1997 a 1999 / Injuries and work related diseases among the professionals of the transport sector in State of São Paulo, Brazil, 1997 to 1999

Objetivo: Descrever e analisar os acidentes de trabalho (acidentes-tipo, acidentes de trajeto, e doenças do trabalho) em motorista residentes no Estado de São Paulo. Métodos: Base elaborada a partir do banco de dados da Fundação Seade/Fundacentro, composto dos dados coletados nas CAT’s notificadas na Previdência Social do Estado de São Paulo, entre 1997 e 1999. Os casos de 14.567 motoristas foram categorizados em seis grupos. Taxas de incidência, mortalidade e letalidade foram regionalizadas para o Interior, Região Metropolitana de São Paulo e Município de São Paulo. Resultados: Os acidentes ocorreram após, uma a três horas, e depois de sete horas de trabalho. O grupo motorista geral representou 33,9 por cento dos acidentes do trabalho, os de caminhão 32,4 por cento, os de ônibus 12,0 por cento, os motociclistas 11,0 por cento, os de caminhão pesado 7,3 por cento e outros 3,3 por cento. A taxa de incidência do Estado foi de 42,5 acidentes/1.000 trabalhadores do setor motoristas profissionais; para o Interior, 52,8; para a Região Metropolitana, 31,1 e para o Município 32,4. A mortalidade no Estado foi de 11,0 óbitos/10.000 motoristas profissionais; 17,0/10.000 para o Interior e 6,6/10.000 e 5,0/10.000 para a Região Metropolitana e Município. Neste grupo profissional, o estado de São Paulo apresentou uma taxa de letalidade de 26,0 óbitos/1.000 acidentes do trabalho, o Interior 32, 1, a Região Metropolitana 21,0 e o Município 15,4. No estudo da letalidade específica, segundo estes agrupamentos criados e citados acima, os motoristas em geral destacaram-se com 33,9 óbitos/1.000 acidentes para o Interior. Os motociclistas, para a Região Metropolitana e o Município, apresentam taxas próximas 11,9 e 12,2; respectivamente. Conclusões: O cálculo da taxas e a análise de grupos específicos de motoristas possibilitaram detectar especificidades na ocorrência de acidentes, na mortalidade e letalidade, Os acidentes-tipo e a incapacidade temporária representaram a maioria dos eventos. As causas de acidentes e doenças relacionadas com o trabalho que atingiram a maioria dos motoristas foram: os coques/colisões, o mal-súbito e a perda auditiva.

Acidentes do trabalho rural no interior paulista / Agricultural employment-related accidents in the São Paulo

No interior paulista, coabitam alta tecnologia e acidentes do trabalho estritamente manuais, ou seja, o alto índice de tecnologia utilizada na agropecuária não descartou a possibilidade de existirem acidentes com trabalhadores rurais, que exercem atividades com baixo padrão tecnológico, sobretudo as vinculadas ao plantio e corte de cana-de-açúcar. Onde eles, em sua maioria, sofrem acidentes no exercício diário de sua profissão.