Challenges to implement and operationalize the WEEE reverse logistics system at the micro level.

Waste electrical and electronic equipment (WEEE) possesses unique characteristics such as its growing production and the potential for resource extraction due to its composition. The implementation and operationalization of a reverse logistics system (RLS) for WEEE is a challenge, particularly concerning the micro level. The implementation of such systems often prioritizes urban centers and their higher population densities, generally overlooking the micro level. The latter refers to ward- or village-level divisions, which can be regarded as the smallest administrative divisions of both urban and rural areas. Furthermore, it encompasses any area facing logistical challenges regarding RLS operationalization due to factors such as geographical isolation, budgetary constraints, imbalances, social isolation, environmental aspects, and even geopolitical conflicts. This study is aimed at addressing this literature gap by discussing the challenges to implement and operationalize a WEEE RLS at the micro level. A systematic literature review was employed as our methodology. We found 13 challenges for developed and developing countries without distinction between macro and micro levels. An additional approach highlighted the significance of monitoring and controlling WEEE RLS. The challenge The population and LRS entities' lack or insufficient training and awareness received the most citations in the conducted search. These challenges were organized by operational phase and discussed from the perspective of the micro level to comprehend multifactorial local challenges involving all stakeholders in the reverse logistics of WEEE in emerging nations. This can assist local administrators and constitutes the primary contribution of this study.

Impact of COVID-19 Pandemic on Daily Mobility of the Elderly Living in Small Cities in Lodz Province.

The article presents a study into the impact that the COVID-19 pandemic had on the daily mobility of those over 60 residing in small towns in the Lodz Province. The study determines the impact on the trip destination, trip frequency, preferred means of transport, distance and duration of trips, and length of the target activity. To achieve these objectives, a survey was conducted using the CATI technique (Computer Assisted Telephone Interviewing), which comprised 500 residents of small towns in the Lodz Province aged 60+, who were divided into three classes of small towns (by population size). In order to determine the impact of the COVID-19 pandemic on the daily mobility of those over 60, the tools the authors decided to use descriptive statistics and hypothesis testing. Overall, the pandemic was found to have had only a minor impact on the changes in transport behavior of those over 60 in small towns. Only 9% of respondents declared any effect on their daily mobility. The impact mainly involved a reduction in travel time and frequency, primarily among the oldest residents. Since a low level of daily mobility leads to low social activity, especially for the elderly-with a consequent sense of loneliness or even depression-towns should take measures to improve the already poor situation, one that has been further exacerbated by the pandemic.

Weekend effect on air pollutant levels in southernmost cities of Brazil with different economic activities.

In view of the current premises of the need to investigate air pollution in small- and medium-sized cities, combined with concerns regarding the weekly behavior of air pollutants, this study aimed to investigate the weekly pattern of air pollution (O3, NO2, SO2, PM2.5) and the weekend effect in 4 Brazilian cities with different main economic activities. Our main findings include (1) positive weekend effect for all the assessed air pollutants in the four cities; therefore, in the southernmost region of Brazil, there was an increase in the concentration of air pollutants during weekends when compared to weekdays; (2) the highest levels of NO2 and SO2 were observed in the city characterized by the economic activity revolving around coal mining and generation of electricity through the burning of this mineraloid in a coal-fired power plant, while the highest levels of PM2.5 were in the city with economic activity linked to industries, due to its recognized industrial complex; and (3) the seasonal evaluation of the weekend effect showed different behaviors for the air pollutants in each location, which is related to the set of meteorological conditions, economic activities, and population mobility in each location. In conclusion, our results demonstrate the aspects of pollution between cities and highlight that the comprehensive understanding of the weekend effect and its intricacies allows the responsible personal and government authorities to gain deep insights into the true effectiveness of future control strategies and the development of possible action plans.

Identification of contributing factors and hotspots of pedestrian-vehicle collisions in urban areas: An alternative hybrid method for small cities.

OBJECTIVE: Traffic safety numbers in developing countries show a serious global problem that requires studies and actions to promote safety for the most vulnerable users, such as pedestrians, as a way of contributing to sustainable urban mobility. Therefore, this research proposes a hybrid method to identify contributing factors and critical points according to the profile of crashes involving pedestrians being run over by motor vehicles in small cities. METHODS: The proposed method uses multivariate data analysis, specifically Exploratory Factor Analysis (EFA) and Cluster Analysis (CA), combined with geospatial tools. The study scenario corresponds to pedestrian-vehicle collisions that occurred in the urban area of Cachoeira do Sul, a small city in Rio Grande do Sul, Brazil, recorded in police reports between 2015 and 2018. Additionally, Geographic Information Tools (GIS) were used to collect characteristics of the road environment. RESULTS: According to EFA, a set of attributes configured as contributing factors are discussed according to the components of the traffic system: user, road, vehicle, and environment. Subsequently, a CA was applied with the road-environmental factors, and three pedestrian-vehicle collision profiles were extracted, with clustering according to road segments with homogeneous characteristics. Moreover, a Kernel Density Estimate (KDE) was used to obtain heat maps of the pedestrian collisions profiles. The results allowed interventions to be proposed according to the contributing factors of each profile. CONCLUSIONS: The multivariate statistical analysis supported the discussion of the factors contributing to the occurrence of pedestrian-vehicle collisions in small cities in developing countries. The spatial visualization of the results showed urban corridors with a high risk for pedestrians and the identification of hotspots in the city. In addition, the study demonstrated that the hybrid method tested is an alternative for the government of cities with few resources to promote safety mobility.

Contextualizing the COVID-19 pandemic's impact on food security in two small cities in Bangladesh.

The COVID-19 pandemic is an evolving urban crisis. This research paper assesses impacts of the lockdown on food security and associated coping mechanisms in two small cities in Bangladesh (Mongla and Noapara) during March to May 2020. Due to restrictions during the prolonged lockdown, residents (in particular low-income groups) had limited access to livelihood opportunities and experienced significant or complete loss of income. This affected both the quantity and quality of food consumed. Coping strategies reported include curtailing consumption, relying on inexpensive starchy staples, increasing the share of total expenditure allocated to food, taking out loans and accessing relief. The pandemic has exacerbated the precariousness of existing food and nutrition security in these cities, although residents with guaranteed incomes and adequate savings did not suffer significantly during lockdown. While coping strategies and the importance of social capital are similar in small and large cities, food procurement and relationships with local governments show differences.

Políticas públicas e redes de apoio aos migrantes haitianos, em pequeno município do Rio Grande do Sul, Brasil / Public policies and support networks to haitian migrants, in a small municipality in Rio Grande do Sul, Brazil

Resumo: A migração de haitianos para o Brasil criou desafios públicos e privados para pequenos municípios. Avaliamos como as políticas públicas, empresas contratantes e as redes de apoio atenderam às necessidades dos migrantes, no município de Poço das Antas (RS). O método é de pesquisa multissituada, com questionários semiestruturados e busca de dados em empresas e órgãos públicos. Entre as interações, destaca-se o atendimento nas redes públicas de saúde, na área de educação infantil e na assistência social municipal.

Abstract: The migration of Haitians to Brazil has created public and private challenges for small municipalities. We assessed how public policies, hiring companies and support networks met the needs of migrants in the municipality of Poço das Antas (RS). The method is multi-situated research, with semi-structured questionnaires and search for data in companies and public agencies. Among the interactions, it is highlighted the public health networks, the area of early childhood education, and the municipal social assistance.

Short-Term Effects of Air Pollution on Cardiovascular Hospitalizations in the Pisan Longitudinal Study.

Air pollution effects on cardiovascular hospitalizations in small urban/suburban areas have been scantly investigated. Such effects were assessed among the participants in the analytical epidemiological survey carried out in Pisa and Cascina, Tuscany, Italy (2009-2011). Cardiovascular hospitalizations from 1585 subjects were followed up (2011-2015). Daily mean pollutant concentrations were estimated through random forests at 1 km (particulate matter: PM10, 2011-2015; PM2.5, 2013-2015) and 200 m (PM10, PM2.5, NO2, O3, 2013-2015) resolutions. Exposure effects were estimated using the case-crossover design and conditional logistic regression (odds ratio-OR-and 95% confidence interval-CI-for 10 µg/m3 increase; lag 0-6). During the period 2011-2015 (137 hospitalizations), a significant effect at lag 0 was observed for PM10 (OR = 1.137, CI: 1.023-1.264) at 1 km resolution. During the period 2013-2015 (69 hospitalizations), significant effects at lag 0 were observed for PM10 (OR = 1.268, CI: 1.085-1.483) and PM2.5 (OR = 1.273, CI: 1.053-1.540) at 1 km resolution, as well as for PM10 (OR = 1.365, CI: 1.103-1.690), PM2.5 (OR = 1.264, CI: 1.006-1.589) and NO2 (OR = 1.477, CI: 1.058-2.061) at 200 m resolution; significant effects were observed up to lag 2. Larger ORs were observed in males and in subjects reporting pre-existent cardiovascular/respiratory diseases. Combining analytical and routine epidemiological data with high-resolution pollutant estimates provides new insights on acute cardiovascular effects in the general population and in potentially susceptible subgroups living in small urban/suburban areas.

Modeling fatal traffic accident occurrences in small Indian cities, Patiala, and Rajpura.

This article investigates the effects of highway-related correlates such as geometric design features and traffic factors on fatal accident occurrences in small-sized Indian cities, Patiala and Rajpura, by estimating Negative Binomial regression models. Between 2013 and 2015, 61 and 188 fatal accidents were recorded in Rajpura and Patiala, respectively. The study reveals that the number of traffic lanes positively influences accident occurrences in Rajpura. On the other hand, in Patiala, the width of paved road surface, segment length and average daily traffic (ADT) are positively correlated with accident rates. Intercity highways passing through rural areas near the city boundary are more prone to fatal accidents than the highway segments within urban limits. Elasticity analysis suggests that an increase in paved road width and ADT by one percent would increase accident rates by 0.7% and 0.436% in Patiala and Rajpura, respectively. The findings of this research concur with the results of previous studies that infrastructural improvements such as increasing the number of lanes and paved road width are positively correlated with accident rates. It is expected that understanding the association between accident rates and non-behavioral factors would help transportation engineers identify the deficiencies in roadway designs in the study cities.

Retrato de uma região: impacto da indústria sucroalcooleira, indicadores de saúde e a percepção dos gestores / Pictures from a region: impact of the sugarcane industry, health indicators and managers' perception

Resumo Este artigo analisa indicadores de saúde dos municípios da região de São José do Rio Preto e a demanda da população segundo os gestores diante do processo de expansão da cana de açúcar. Dez municípios da região que possuem usinas de cana de açúcar e outros 10 municípios com o mesmo número de habitantes, mas sem usinas, foram selecionados. Os dados foram coletados por meio de entrevistas e em bancos de dados do Ministério da Saúde. Observou-se que, independentemente da presença de usinas sucroalcooleiras, houve melhora nos indicadores de saúde. Entretanto, para os gestores entrevistados, independentemente da presença ou ausência de usinas, a presença de migrantes para o corte da cana piorou os indicadores de saúde. Assim, constatou-se que a presença de usinas nos municípios não interferiu nos indicadores de saúde, mas os gestores consideram que a qualidade da saúde do município teve queda.

Abstract This article analyzes health indicators in the municipalities of the São José do Rio Preto region (state of São Paulo, Brazil) and the demand of the population according to the managers regarding the sugar cane expansion process. Ten municipalities in the region that have sugar cane mills and 10 other municipalities with the same number of inhabitants, but without the presence of plants, were selected. Data were collected through interviews and Ministry of Health databases. It was observed that, regardless of the presence of sugar and alcohol plants, there was an improvement in health indicators. However, to the interviewed managers, despite there being plants or not, the presence of migrants to cut sugarcane worsened health indicators. Therefore, it was observed that the presence of plants in the municipalities did not interfere in health indicators, but managers perceived a drop in health quality in the municipality.

Prevalência e fatores associados a dependência funcional em idosos longevos / Prevalence and factors associated with functional dependence in the oldest old

Objetivou-se avaliar a prevalência e os fatores associados a dependência funcional de idosos longevos residentes em municípios de pequeno porte. Trata-se de um estudo transversal de base populacional com idosos de 80 anos e mais, recorte dos estudos sobre as condições de saúde de idosos dos municípios de Coxilha-RS e Estação-RS. Os dados foram coletados por meio de questionário adaptado da pesquisa Saúde, Bem-Estar e Envelhecimento (SABE). Participaram 77 idosos longevos (63,3% mulheres). A prevalência de dependência funcional foi 26% (IC95% 16,8-36,4) e dentre as atividades básicas da vida diária (ABVD) deitar e levantar da cama (31,6%) e locomover-se (31,2%) representaram a maior frequência de dependência. Na análise de regressão multivariada mostraram-se associadas à dependência funcional a autopercepção de saúde negativa (RP= 1,20; IC95% 1,05-1,37), não praticar atividade física (RP= 1,20; IC95% 1,05-1,36) e possuir três ou mais doenças crônicas (RP= 1,24; IC95% 1,08-1,41). Nesse sentido, observamos que os idosos longevos com a condição de dependência possuem como razão de prevalência fatores passíveis de prevenção, e sobretudo que essa condição é evitável ou possível de ser postergada.

This study aimed to assess the prevalence and factors associated with functional dependence of the oldest elderly people living in small towns. This is a cross-sectional population-based study with aged, 80 and over, cut out studies on the health conditions of the elderly in the municipalities of Coxilha-RS and Estação-RS. Data were collected through adapted questionnaire Health, Well-Being and aging (SABE). Study participants were 77 oldest elderly (63,3% women). The prevalence of functional dependence was 26% (IC95% 16,8-36,4) and among the basic activities of daily living (ADL) bed and out of bed (31,6%) and getting yourself (31,2%) accounted for the frequency dependence. In multivariate regression analysis were associated with functional dependence negative self-rated health (RP= 1,20; IC95% 1,05-1,36), not physical activity (RP= 1,19; IC95% 1,05-1,36) and have three or more chronic diseases (RP= 1,24; IC95% 1,08-1,41). In this regard, we note that the oldest old with the condition of dependency have as prevalence ratio preventable factors, and above all that this condition is preventable or can be postponed.

'The big ole gay express': sexual minority stigma, mobility and health in the small city.

Recent research has examined how gay and bisexual men experience and navigate the variations in sexual minority stigma that exist across geographic contexts, with implications for their health. We extend this literature on stigma, mobility, and health by considering the unique and understudied setting of the small city. Drawing on semi-structured interviews (n = 29) conducted in two small US cities (New Haven and Hartford), we find that these small cities serve as both destinations and points of departure for gay and bisexual men in the context of stigma. New Haven and Hartford attracted gay and bisexual men from surrounding suburbs where sexual minority stigma was more prevalent and where there were fewer spaces and opportunities for gay life. Conversely, participants noted that these small cities did not contain the same identity affirming communities as urban gay enclaves, thus motivating movement from small cities to larger ones. Our data suggest these forms of mobility may mitigate stigma, but may also produce sexual health risks, thus drawing attention to small cities as uniquely important sites for HIV prevention. Furthermore, our analysis contributes to an understanding of how place, stigma and mobility can intersect to generate spatially distinct experiences of stigmatised identities and related health consequences.

Participação dos municípios de pequeno porte no Projeto Mais Médicos para o Brasil na macrorregião norte do Paraná / Participation of small municipalities in the Mais Médicos para o Brasil (More Doctors to Brazil) Program in the macro-region of Northern Paraná

Resumo Resumo Em municípios de pequeno porte, que em geral são situados em áreas geográficas mais isoladas, combinado com situações de maior vulnerabilidade social e econômica, a escassez de médicos é um problema constante. O objetivo deste estudo foi identificar a participação e as características dos municípios de pequeno porte da macrorregião norte do estado do Paraná que aderiram ao Projeto Mais Médico para o Brasil (PMMB). Trata-se de um estudo quantitativo realizado em 82 municípios que utilizou dados primários e secundários. Os resultados revelaram que eram poucos os municípios que possuíam algum critério de adesão (6,1%), mas isso não representou um impedimento para que os demais aderissem ao projeto (75,6%). Os municípios que possuíam menores índices de desenvolvimento humano, que tinham população de mais de cinco mil habitantes, algum critério de adesão e que eram mais afastados, seja da sede da região, seja do município de médio/grande porte mais próximo foram os que mais aderiram ao PMMB. Não se pode negar que o PMMB reduziu de forma significativa a distribuição desigual de médicos no Brasil e na região de estudo. Contudo, a sustentabilidade dessa política precisa estar atrelada ao enfrentamento de outros desafios que ainda persistem no SUS.

Abstract Doctor shortage is a constant problem in smaller cities and towns, which tend to be more vulnerable from a social and economic point of view, and located in geographically isolated areas. The goal of this study was to establish the share and characteristics of the small cities and towns in the macro-region of northern Paraná that subscribed to the Mais Médicos para o Brasil (PMMB) program. This is a quantitative study of 82 cities and towns using primary and secondary data. Results show that only a few of them (6.1%) had any adherence criteria, which was not an impediment for other cities and towns (75%) to adhere to the project. Cities and towns with over five thousand inhabitants, lower municipal HDI (Human Development Index), some adherence criteria and more geographically isolated, either from the main city in the region or the closest large or mid-sized city, tended to adhere to the PMMB. It is undeniable that the PMMB significantly reduced the uneven distribution of doctors in Brazil and the study region. However, the sustainability of this policy is linked to addressing other remaining challenges in the SUS system.

Aspectos da regulação em saúde na visão de equipes de saúde da família de um município de pequeno porte / Aspects of healthcare regulations according to family health teams in a small city / Aspectos de la regulación de la salud en la visión de los equipos de salud de la familia de una ciudad pequena

Objetivos: Identificar a visão de equipes da Estratégia Saúde da Família acerca do processo de regulação em saúde e caracterizar seus instrumentos quanto ao conteúdo informacional e sua utilização pela equipe. Métodos: Estudo de caráter descritivo, quantitativo e apoiado em fontes primária e secundária de dados, realizado em um município de pequeno porte. Foi aplicado um questionário aos profissionais de equipes de saúde da família, em 2012, com conteúdo referente ao processo de regulação em saúde e analisadas características de completude e legibilidade de informações registradas nas guias de referência às especialidades médicas. Resultados: Os profissionais da saúde da família relataram incertezas sobre a proposta conceitual e operativa do sistema de regulação em saúde. Apenas 50% dos participantes conheciam todos os serviços especializados de referência da rede de saúde. Cerca de 70% informaram a existência de protocolos na rede e/ou nas unidades de saúde. Houve prejuízo na completude e na legibilidade de informações das guias de referência. Conclusão: Os achados da pesquisa ratificaram a estreita relação entre o processo regulatório assistencial e a gestão da informação, bem como a importância da participação do profissional da saúde da família no mecanismo de regulação em saúde.

Objectives: To identify the opinion of Family Health Strategy teams about the healthcare regulation process and describe their instruments concerning the informational content and its use by the team. Methods: A descriptive, quantitative study, supported by primary and secondary data sources and held in a small city. A questionnaire was administered to professionals of family health teams in 2012, with content referring to the regulation process in healthcare and completeness characteristics and readability of the information recorded in charts to medical specialties were analyzed. Results: The family health professionals reported uncertainty about the conceptual and operational proposal of the healthcare regulation system. Only 50% of the subjects knew about all the reference specialized services in the healthcare system. About 70% reported the existence of protocols in the network and/or in healthcare facilities. There were problems in the completeness and readability of information in medical charts. Conclusion: The research findings have ratified the close relationship between the healthcare regulatory process and information management, as well as the importance of the participation of family health professionals in the regulation mechanism in healthcare.

Objetivos: Identificar la visión de equipos de la Estrategia de Salud Familiar acerca del proceso de regulación en salud y caracterizar sus instrumentos con respecto al contenido informativo y su uso por parte del equipo. Métodos: Estudio descriptivo, cuantitativo, basado en fuentes de datos primarios y secundarios, realizado en una ciudad pequeña. Se aplicó un cuestionario a los profesionales de los equipos de la estrategia de salud familiar en el 2012, con contenidos relacionados con el proceso de regulación en la salud y se analizó la integridad de las características y la legibilidad de la información registrada en las guías de referencia a las especialidades médicas. Resultados: Los profesionales de la Estrategia de Salud Familiar informaron incertidumbres acerca de la propuesta conceptual y del procedimiento funcional del sistema de regulación en salud. Sólo el 50% de los participantes conocía todos los servicios especializados de la red de salud. Aproximadamente el 70% informó la existencia de protocolos en la red y/o en los centros de salud. Hubo daños en la plenitud y legibilidad de la información de las guías de referencia. Conclusión: Los hallazgos de la investigación han ratificado la estrecha relación entre el proceso de la regulación asistencial y la gestión de la información, y la importancia de la participación del profesional de la estrategia de salud familiar en el mecanismo de regulación en salud.

Cost recovery of municipal solid waste management in small cities of inland China.

Financial performance of waste management, the key for efficiency and sustainability, has rarely been studied in China, especially for small cities. Through questionnaires and interviews, we conducted such a case study in several cities aiming to fill the gap and improve waste service. We found that labour accounts for more than half to three-quarters of the operation cost, followed by fuel and vehicle maintenance. The waste service heavily relies on budget transfer of the municipality. User fees collected recover less than half of total operation cost at best, even if the collection rate is relatively high. The low cost recovery is mainly due to low fee rates, unchanged for years owing to public pressure. Public complaint seems to be justified by the finding that the service only accounts for 5-10% of municipal revenue annually and even lower in government spending. Contrary to general perception, per capita waste generation in small cities is not less than big ones. Waste composition is dominated by kitchen wastes, with fractions of recyclables and combustibles much lower than big cities. These findings have implications on the waste management strategy: commercial incineration or recycling may not be economically viable for small cities. The article concludes that user fees might better serve, and be designed for, behaviour change than for cost recovery. Municipalities need to first improve cost efficiency and transparency of waste services to gain public trust and support in order to tackle the biggest challenge facing developing countries, cost recovery.

Body image dissatisfaction, nutritional status, and eating attitudes in adolescents / Insatisfação corporal, estado nutricional e atitudes alimentares em adolescentes

The study investigated the relationship between body image dissatisfaction, nutritional status, and eating attitudes in adolescents from a small town of the interior of São Paulo State. A total of 278 adolescents (106 boys and 172 girls) aged between 15 and 18 years had completed measures of body image dissatisfaction through the Figure Rating Scale and eating attitudes by the Eating Attitudes Test (EAT- 26) and had their weight and height measured. Girls related more dissatisfaction and abnormal eating behavior than boys and, in both genders the abnormal eating attitudes tend to increase with increasing dissatisfaction. Moreover, dissatisfaction was higher between those individuals classified as overweight and obesity. These results demonstrated that body image dissatisfaction and inappropriate eating behaviors afflict boys and girls even from small cities in developing countries, highlighting the need to undertake epidemiological studies to early recognition of populations at risk of developing eating disorders.

O estudo investigou a relação entre insatisfação com a imagem corporal, estado nutricional e atitudes alimentares em adolescentes de uma pequena cidade do interior do Estado de São Paulo. Um total de 278 adolescentes (106 meninos e 172 meninas) entre 15 e 18 anos tiveram respondidas medidas de insatisfação com a imagem corporal, por meio de uma Escala de Figuras de Silhuetas, e de atitudes alimentares, pelo Eating Attitudes Test (EAT-26), além de terem seu peso e altura aferidos. Meninas relataram maiores índices de insatisfação e atitudes alimentares inadequadas quando comparadas aos meninos e, em ambos os sexos, os comportamentos alimentares inadequados tendem a aumentar conforme aumenta a insatisfação com a imagem. Além disso, a insatisfação foi maior entre os adolescentes com sobrepeso e obesidade. Estes resultados demonstram que a insatisfação com a imagem corporal e os comportamentos alimentares inadequados afetam adolescentes até mesmo de pequenas cidades de países em desenvolvimento, demonstrando a necessidade de mais estudos epidemiológicos para o reconhecimento precoce de populações em risco de desenvolver transtornos alimentares.

Análise do impacto do programa ATLS (R) (advanced trauma life support (R)) no atendimento do traumatizado em cidade de pequeno porte no Brasil / Analysis of the impact of the ATLS (advanced trauma life support) program on trauma care in a small size city in Brasil

Introdução: o Programa ATLS foi desenvolvido nos EUA na década de 70, visando estabelecer um método padronizado para avaliação e tratamento iniciais dos pacientes vítimas de trauma pelos médicos que trabalham nas unidades de emergência. Hoje, apesar do sucesso e de sua ampla disseminação internacional, os benefícios do Programa em relação à modificação dos índices de mortalidade das vítimas de trauma ainda não foram largamente comprovados. Objetivos: o objetivo deste estudo é avaliar a efetividade do Programa ATLS no atendimento do traumatizado em cidade de pequeno porte do Brasil, analisando seu impacto sobre os índices de mortalidade, sobre o tempo de internação e sobre a realização de determinados procedimentos diagnósticos e terapêuticos. Métodos: no período compreendido entre 01 de Janeiro de 2003 e 31 de Dezembro de 2005, foram analisados 240 pacientes, vítimas de trauma, atendidos em hospital universitário de cidade de pequeno porte no Brasil, com RTS "Revised Trauma Score" - Escore Revisado de Trauma <6,62, subdivididos em duas amostras: grupo pré-ATLS (120 pacientes) - quando não havia protocolo específico para atendimento ao trauma, e grupo pós-ATLS (120 pacientes) - após a implantação do programa. Resultados: Houve diferença estatisticamente significativa na mortalidade, com redução média de 17% no grupo pós-ATLS. Também foi constatado, no grupo pós-ATLS, aumento estatisticamente significativo da mortalidade após 24 horas da chegada do paciente ao hospital. Quanto ao tempo de internação, não houve diferença estatisticamente significativa entre os grupos. Conclusão: a implantação do programa ATLS reduziu o índice de mortalidade global atestando efetividade no atendimento ao trauma.

Introduction: the ATLS Program was developed in U.S.A. in the decade of 70, aiming to provide a standardized method for initial evaluation and management of the trauma patient for the doctors that work at the emergency room. Today, despite the success and of its ample international dissemination, the impact of the benefits of the Program on trauma care has not been wide scientifically proven. Objectives: the objective of this study is to analyze the effectiveness of the ATLS Program in the management of trauma patients in a small size city of Brasil, studying the real impact on the mortality index, the time of hospital stay and the accomplishment of determined diagnostic and therapeutic procedures. Methods: starting on January 01, 2003 and ending on December 31, 2005, 240 trauma victims were studied at the university hospital of a small size city of Brasil, with RTS (Revised Trauma Score) < 6.62, subdivided in two samples: group pre-ATLS (120 patients) - when there was no specific protocol for trauma care, and group post-ATLS (120 patients) - after the implementation of the program. Results: It had statistical significant difference in mortality, with average reduction of 17% in the group post-ATLS. Also it was evidenced, in the group after-ATLS, statistical significant increase of mortality after 24 hours of the arrival of the patient to the hospital. Concerning the length of hospital stay, there was no statistical significant difference between the groups. Conclusion: the implementation of the ATLS program reduced the index of global mortality certifying effectiveness in the management of the trauma patient.