Coletiva de imprensa: anúncios do Governo SP - 21/09/2020

O Estado de São Paulo registra neste segunda-feira (21) 33.984 óbitos e 937.332 casos confirmados do novo coronavírus. Entre o total de casos diagnosticados de COVID-19, 803.994 pessoas estão recuperadas, sendo que 103.141 foram internadas e tiveram alta hospitalar. As taxas de ocupação dos leitos de UTI são de 47% na Grande São Paulo e 47,7% no Estado. O número de pacientes internados é de 9.072, sendo 5.127 em enfermaria e 3.945 em unidades de terapia intensiva, conforme dados das 10h desta segunda. Hoje, os 645 municípios têm pelo menos uma pessoa infectada, sendo 562 com um ou mais óbitos. A relação de casos e óbitos confirmados por cidade pode ser consultada em: www.saopaulo.sp.gov.br/coronavirus. Entre as vítimas fatais estão 19.650 homens e 14.334 mulheres. Os óbitos continuam concentrados em pacientes com 60 anos ou mais, totalizando 76,2% das mortes. Observando faixas etárias, nota-se que a mortalidade é maior entre 70 e 79 anos (8.699), seguida pelas faixas de 60 a 69 anos (7.988) e 80 e 89 anos (6.920). Entre as demais faixas estão os: menores de 10 anos (40), 10 a 19 anos (63), 20 a 29 anos (281), 30 a 39 anos (966), 40 a 49 anos (2.245), 50 a 59 anos (4.493) e maiores de 90 anos (2.289). Os principais fatores de risco associados à mortalidade são cardiopatia (59,5% dos óbitos), diabetes mellitus (43,1%), doenças neurológicas (10,8%) e renal (9,6%), pneumopatia (8,3%). Outros fatores identificados são obesidade (7,7%), imunodepressão (5,6%), asma (3%), doenças hepáticas (2,1%) e hematológica (1,8%), Síndrome de Down (0,5%), puerpério (0,1%) e gestação (0,1%). Esses fatores de risco foram identificados em 27.284 pessoas que faleceram por COVID-19 (80,3%). Entre as pessoas que já tiveram confirmação para o novo coronavírus estão 437.225 homens e 494.016 mulheres. Não consta informação de sexo para 6.091 casos. A faixa etária que mais concentra casos é a de 30 a 39 anos (221.647), seguida pela faixa de 40 a 49 (194.841). As demais faixas são: menores de 10 anos (22.570), 10 a 19 (43.575), 20 a 29 (157.301), 50 a 59 (141.337), 60 a 69 (85.338), 70 a 79 (43.414), 80 a 89 (20.760) e maiores de 90 (6.053). Não consta faixa etária para outros 496 casos.

A comparative analysis of MAIDS and ISO13232 databases for the identification of the most representative impact scenarios for powered 2-wheelers in Europe.

OBJECTIVE: The ISO13232 standard provides guidelines and methodologies for research on the effectiveness of protective devices fitted to motorcycles. The accident database used to develop the standard was composed of 2 data sets from Hannover and Los Angeles, dating from 1996. This study aims to apply the methodology outlined in the standard to a more recent European accident database to determine whether the set of the 7 most relevant impact configurations identified in the ISO13232 are representative of the European context. METHODS: The ISO13232 database was rebuilt from the data tables attached to the standard and processed according to the procedure described in ISO13232-Part 2, to ensure reproducibility of the results. The comparison data set was extracted from the Motorcycle Accidents In-Depth Study (MAIDS) database. Data were then coded, processed, and analyzed using the ISO13232 methodology. To eliminate any subjectivity in the selection process of the configurations, a new ranking criterion (configuration risk index, CRI) was implemented. The CRI combined the evaluation of an accident configuration's frequency of occurrence and its harmfulness. RESULTS: Comparison of the frequency ranking of the impact configurations from the 2 databases revealed some notable differences. Five of the 10 most important configurations were common to both databases, although ranking order differed. CRI-based selection led to differences in ranking orders. The CRI allowed better identification of the most important configurations and it was employed to define the proposed new set of configurations. CONCLUSION: A new set of 7 accident configurations was defined by applying the ISO13232 procedure to the MAIDS data and ranking the results with a newly proposed method. The final set had only one configuration in common with those defined in the ISO13232, testifying to the importance of defining an updated and more representative set of configurations for the European context.

A Comprehensive Approach to Motorcycle-Related Head Injury Prevention: Experiences from the Field in Vietnam, Cambodia, and Uganda.

Motorcyclists account for 23% of global road traffic deaths and over half of fatalities in countries where motorcycles are the dominant means of transport. Wearing a helmet can reduce the risk of head injury by as much as 69% and death by 42%; however, both child and adult helmet use are low in many countries where motorcycles are a primary mode of transportation. In response to the need to increase helmet use by all drivers and their passengers, the Global Helmet Vaccine Initiative (GHVI) was established to increase helmet use in three countries where a substantial portion of road users are motorcyclists and where helmet use is low. The GHVI approach includes five strategies to increase helmet use: targeted programs, helmet access, public awareness, institutional policies, and monitoring and evaluation. The application of GHVI to Vietnam, Cambodia, and Uganda resulted in four key lessons learned. First, motorcyclists are more likely to wear helmets when helmet use is mandated and enforced. Second, programs targeted to at-risk motorcyclists, such as child passengers, combined with improved awareness among the broader population, can result in greater public support needed to encourage action by decision-makers. Third, for broad population-level change, using multiple strategies in tandem can be more effective than using a single strategy alone. Lastly, the successful expansion of GHVI into Cambodia and Uganda has been hindered by the lack of helmet accessibility and affordability, a core component contributing to its success in Vietnam. This paper will review the development of the GHVI five-pillar approach in Vietnam, subsequent efforts to implement the model in Cambodia and Uganda, and lessons learned from these applications to protect motorcycle drivers and their adult and child passengers from injury.

Development of a Seating Comfort Questionnaire for Motorcycles.

Objective The aim of this study is to develop a reliable and valid Motorcycle Seating Comfort Questionnaire (MSCQ). Background Motorcycle seat development is an iterative process based on subjective evaluations; however, there are no established subjective tools for evaluation of seating comfort. Research also suggests that seating comfort in motorcycles is poor and needs improvement. The development of a MSCQ therefore is an important step that can enable further research and aid in improving the design of motorcycle seats. Method The MSCQ is developed following guidelines available in literature and referring to established questionnaires for seating comfort in passenger cars. The MSCQ is further refined based on pilot studies and interviews with experts. The final version of the MSCQ is then statistically evaluated for reliability and validity. The reliability is evaluated using a test-retest protocol with 31 volunteers. The validity is evaluated by comparing the ratings of the MSCQ with that of the Category Partitioning Scale (CP50 scale). The validity test is carried out with 15 volunteers evaluating five motorcycles using both scales. Results The results show that the MSCQ is reliable with a significant test-retest reliability coefficient ( r = 0.72, p < .01, n = 31) and internal consistency (Cronbach's α = 0.81, n = 31). The results also show that ratings of the MSCQ have a significant correlation ( r = -0.765, p < .05, n = 15) with that of CP50, establishing its validity. Conclusions A Motorcycle Seating Comfort Questionnaire is developed in this study with statistically established reliability and validity. Applications The MSCQ can be used as a tool for evaluation of seating comfort in motorcycles. The MSCQ can also form a basis for further research on motorcycle seating to develop prediction models and guidelines for the design of motorcycle seats.

Effectiveness of interventions to prevent motorcycle injuries: systematic review of the literature.

Globally, 49% of deaths from traffic crashes occur among vulnerable road users, including pedestrians, bicyclists, and motorcyclists. Approximately, a quarter of those killed are motorcyclists. The authors carried out a systematic review of the literature to evaluate the effectiveness of interventions to prevent motorcycle crashes and the associated morbidity and mortality. The studies included in this review provide evidence for the effectiveness of helmet use, protective clothing, training, and penalties for alcohol consumption and speeding in preventing injury and death to motorcyclists. The use of helmets is effective, especially if it is universally required by law for drivers and passengers. Training to obtain a license also has positive effects but not when it is totally voluntary. There is limited but consistent evidence that strengthening laws for penalties related to alcohol consumption or speeding has an impact on risk. Traffic calming interventions could help reduce crashes in urban areas. In jurisdictions where there is limited regulation or adherence to effective measures, such as the use of helmets, efforts should be directed primarily at expanding such practices. In other areas, efforts can focus on approaches based on alternative effective measures or on more innovative interventions adapted to local conditions.

Exhaust emissions of volatile organic compounds of powered two-wheelers: effect of cold start and vehicle speed. Contribution to greenhouse effect and tropospheric ozone formation.

Powered two-wheeler (PTW) vehicles complying with recent European type approval standards (stages Euro 2 and Euro 3) were tested on chassis dynamometer in order to measure exhaust emissions of about 25 volatile organic compounds (VOCs) in the range C1-C7, including carcinogenic compounds as benzene and 1,3-butadiene. The fleet consists of a moped (engine capacity ≤ 50 cm(3)) and three fuel injection motorcycles of different engine capacities (150, 300 and 400 cm(3)). Different driving conditions were tested (US FPT cycle, constant speed). Due to the poor control of the combustion and catalyst efficiency, moped is the highest pollutant emitter. In fact, fuel injection strategy and three way catalyst with lambda sensor are able to reduce VOC motorcycles' emission of about one order of magnitude with respect to moped. Cold start effect, that is crucial for the assessment of actual emission of PTWs in urban areas, was significant: 30-51% of extra emission for methane. In the investigated speed range, moped showed a significant maximum of VOC emission factor at minimum speed (10 km/h) and a slightly decreasing trend from 20 to 60 km/h; motorcycles showed on the average a less significant peak at 10 km/h, a minimum at 30-40 km/h and then an increasing trend with a maximum emission factor at 90 km/h. Carcinogenic VOCs show the same pattern of total VOCs. Ozone Formation Potential (OFP) was estimated by using Maximum Incremental Reactivity scale. The greatest contribution to tropospheric ozone formation comes from alkenes group which account for 50-80% to the total OFP. VOC contribution effect on greenhouse effect is negligible with respect to CO2 emitted.

Evaluation of motorcycle safety strategies using the severity of injuries.

The growth of motorcycle fatalities in California has been especially prominent, specifically with regard to the 24 and under age group and those aged 45-54. This research quantitatively examined factors associated with motorcyclist fatalities and assessed strategies that could improve motorcyclist safety, specifically focusing on the two age groups mentioned above. Severity of injury was estimated separately for both age groups with multinomial logit models and pseudo-elasticity using motorcycle-related collision data that was collected between 2005 and 2009. The results were compared with motorcyclists aged 35-44, a group that shows a consistent trend of fatalities. This research found that lack or improper use of helmets, victim ejection, alcohol/drug effects, collisions (head-on, broadside, hit-object), and truck involvement were more likely to result in fatal injuries regardless of age group. Weekend and non-peak hour activity was found to have a strong effect in both the younger and older age groups. Two factors, movement of running off the road preceding a collision and multi-vehicle involvement, were found to be statistically significant factors in increasing older motorcyclist fatalities. Use of street lights in the dark was found to decrease the probability of severe injury for older motorcyclists. Driver type of victim, at-fault driver, local road, and speed violation were significant factors in increasing the fatalities of younger motorcyclists. Road conditions and collision location factors were not found to be statistically significant to motorcyclist fatalities. Based on the statistically significant factors identified in this research, the following safety strategies appear to be effective methods of reducing motorcyclist fatalities: public education of alcohol use, promoting helmet use, enforcing heavy vehicle and speed violations, improving roadway facilities, clearer roadway guidance and street lighting systems, and motorcyclist training.

Risks of high-powered motorcycles among younger adults.

OBJECTIVES: We assessed whether policies designed to safeguard young motorcyclists would be effective given shifts in ownership toward high-powered motorcycles. METHODS: We investigated population-wide motor vehicle driver and motorcyclist casualties (excluding passengers) recorded in Britain between 2002 and 2009. To adjust for exposure and measure individual risk, we used the estimated number of trips of motorcyclists and drivers, which had been collected as part of a national travel survey. RESULTS: Motorcyclists were 76 times more likely to be killed than were drivers for every trip. Older motorcyclist age-strongly linked to experience, skill set, and riding behavior-did not abate the risks of high-powered motorcycles. Older motorcyclists made more trips on high-powered motorcycles. CONCLUSIONS: Tighter engine size restrictions would help reduce the use of high-powered motorcycles. Policymakers should introduce health warnings on the risks of high-powered motorcycles and the benefits of safety equipment.

An examination of some safety issues among commercial motorcyclists in Nigeria: a case study.

The reduction of road crashes and injuries among motorcyclists in Nigeria requires a system inquiry into some safety issues at pre-crash, crash and post-crash stages to guide action plans. This paper examines safety issues such as age restriction, motorcycle engine capacity, highway code awareness, licence holding, helmet usage, crash involvement, rescue and payment for treatment among commercial motorcyclists. The primary data derived from a structured questionnaire administered to 334 commercial motorcyclists in Samaru, Zaria were analysed using descriptive statistics and logistic regression technique. There was total compliance with age restriction and motorcycle engine capacity. About 41.8% of the operators were not aware of the existence of the highway code. The odds of licence holding increased with highway code awareness, education with above senior secondary as the reference category and earnings. The odds of crash involvement decreased with highway code awareness, earnings and mode of operation. About 84% of the motorcyclists did not use crash helmet, in spite of being aware of the benefit, and 65.4% of motorcycle crashes was found to be with other road users. The promotion of safety among motorcyclists therefore requires strict traffic law enforcement and modification of road design to segregate traffic and protect pedestrians.

Using baseline and formative evaluation data to inform the Uganda Helmet Vaccine Initiative.

Motorcycles are an important form of transportation in Uganda, and are involved in more road traffic injuries than any other vehicle. The majority of motorcycles in Uganda are used as motorcycle taxis, better known locally as boda bodas. Research shows that a motorcycle helmet is effective at reducing a rider's risk of death and head injury. As part of the Uganda Helmet Vaccine Initiative (UHVI), researchers collected baseline and formative evaluation data on boda boda operators' helmet attitudes, beliefs, and behaviors to inform UHVI activities. Researchers collected data on motorcycle helmet-related attitudes and beliefs through focus group discussions and structured roadside interviews, and researchers conducted roadside observations to collect data on helmet-wearing behaviors. Of the 12,189 motorcycle operators and passengers observed during roadside observations, 30.8% of drivers and <1% of passengers were wearing helmets. The most commonly reported helmet-wearing barriers from the focus group discussions and structured roadside interviews were: (1) 'Helmet is uncomfortable', (2) 'Helmet is too hot', (3) 'Helmet is too expensive', and (4) 'Helmet is of low quality'. Researchers incorporated findings from the formative research into the UHVI campaign to increase motorcycle helmet use. Radio messages addressing helmet comfort and cost were widely aired throughout Kampala, Uganda. In addition, campaign staff held nine boda boda operator workshops, covering approximately 900 operators, in which the facilitator addressed barriers and facilitators to helmet use. Each workshop participant received a high-quality tropical motorcycle helmet. UHVI will continue to use a data-driven approach to future campaign activities.

The effectiveness of antilock brake systems on motorcycles in reducing real-life crashes and injuries.

This study set out to evaluate the effectiveness of antilock brake system (ABS) technology on motorcycles in reducing real-life injury crashes and to mitigate injury severity. The study comprised an analysis of in-depth fatal crash data in Sweden during 2005-2008 to investigate the potential of ABS as well an estimate of the effectiveness of ABS in crash reduction in Sweden between 2003 and 2008 using induced exposure methods. Findings show that head-on collisions were the least ABS-affected crash types and collisions at intersections the most influenced. Induced exposure analysis showed that the overall effectiveness of ABS was 38 percent on all crashes with injuries and 48 percent on all severe and fatal crashes, with a minimum effectiveness of 11 and 17 percent, respectively. The study recommends the fitment of ABS on all new motorcycles as soon as possible and that customers only purchase motorcycles with ABS.

The impact of time, legislation, and geography on the epidemiology of traumatic brain injury.

In 1991, a population-based epidemiologic traumatic brain injury (TBI) study was done in urban and rural areas of Taiwan; this was 5 years before the helmet use law was passed and 8 years before the drink driving law was passed. In order to evaluate the impact of three major determinants (time, geography, and legislation) on the epidemiology of TBI, we conducted a prospective study in 2001 and used the 1991 data to examine the differences in TBI distribution in urban and rural Taiwan a decade after these laws were passed. In 2001, 5754 TBI cases were collected from the urban area of Taipei City, and 1474 TBI cases were collected from the rural area of Hualien County. The TBI incidence rate in Taipei City in 2001 was estimated to be 218/100,000 population (285/100,000 for males and 152/100,000 for females). When compared to the 1991 data, the incidence rate in 2001 had increased by 20%. The TBI incidence rate in Hualien County in 2001 was estimated to be 417/100,000 population (516/100,000 for males and 306/100,000 for females); this was a 37% increase over the 1991 data. Our study found that the distribution of causes and age distribution had shifted significantly over the 10-year period. In 2001, the age group with the highest incidence was 20-29 years, while in 1991 it had been the over 70 years age group. While traffic-related TBI had decreased, falls and assaults had increased in 2001. We also found that legislation, such as the helmet law, affects TBI distribution by decreasing the traffic-related TBI rate, decreasing the admission severity of TBI, and reducing TBI-related mortality. Finally, geography plays a crucial role in the outcome of TBI; over the 10 year period, Taipei had an increase in moderately severe outcomes, while Hualien had an increase in more severe outcomes. Comparative studies of TBI in urban and rural areas have shown that time, legislation, and geography are crucial determinants of TBI epidemiology. Although time and legal interventions seem to have more of an impact, geography does affect TBI outcomes.

Risky behavior of drivers of motorized two wheeled vehicles in India.

INTRODUCTION: Motorized two-wheeled vehicles (MTV) account for a large proportion of road traffic in India and the riders of these vehicles have a high risk of road traffic injuries. We report on the availability of drivers licenses, use of a helmet, driver behavior, and condition of vehicles for MTV drivers in Hyderabad, a city in India METHODS: Drivers of a MTV aged >16 years were interviewed at petrol filling stations RESULTS: There were 4,183 MTV drivers who participated in the study. Four hundred sixty one (11%; 95% CI 9.7-12.3%) drivers had not obtained a drivers license and 798 (21.4%) had obtained a license without taking the mandatory driving test. Two thousand nine hundred twenty (69.8%; 95% CI 67.9-71.7%) drivers reported no/very occasional use of a helmet, the significant predictors of which included that those driving borrowed a MTV (odds ratio 7.90; 95% CI 3.40-18.40) or driving moped/scooterette/scooter as compared with motorcycle (3.32; 2.76-3.98), lower education (3.10; 2.66-3.61), age >45 years (2.41; 1.63-3.57), and males (1.57; 1.16-2.13). Two thousand five hundred and eight (59.9%) drivers reported committing a traffic law violation at least once within the last 3 months. Overall, 1,222 (29.2%) drivers reported ever being caught by traffic police for a traffic law violation with data on violations available for 1,205 of these drivers, of whom 680 (56.4%) paid a fine, 310 (25.7%) paid by bribe, and 215 (17.8%) made no payment. The proportion of those who did not make payment for committed violation was significantly higher among females (46.8%) than males (16.3%). Two thousand fifty two (49%) of all MTVs had no rearview mirror CONCLUSIONS: These data suggest the need to enact and enforce policy interventions for improving the drivers license system, mandatory use of a helmet, effective traffic law enforcement, and ensuring good vehicle condition to reduce the risk factors that potentially contribute to mortality and morbidity in road traffic crashes in MTV drivers in Indian cities.

Motorcycle helmet effect on a per-crash basis in Thailand and the United States.

OBJECTIVE: To compare the effectiveness of motorcycle helmets seen in prospective on-the-street motorcycle accident investigations. The data are drawn from two detailed, in-depth studies of motorcycle accidents, in which trained investigators collected extensive accident evidence on-scene immediately after the crash. This article compares helmeted and unhelmeted motorcycle riders on a per-accident basis for fatality rates, the rate of serious (AIS > 2) brain injuries among survivors, or an outcome that involved either of the two. METHODS: Nine hundred motorcycle crashes in Los Angeles and 969 crashes in Thailand were investigated in detail at the accident scenes, including photos of vehicles, skids, damage, and sometimes the rider. Helmets were collected and injury information was obtained from riders and care providers. This evidence was then used to reconstruct collision events to identify speeds, precrash motions, collision contacts, injury causation, and helmet performance. RESULTS: In both studies, approximately 6% of riders were killed and 20-25% were hospitalized. Overall, unhelmeted riders were two to three times as likely to be killed, and three times as likely to suffer either death or survival with AIS > 2 brain injury. Unhelmeted survivors had three to four times as many AIS > 2 brain injuries as helmeted riders on a per-crash basis. Nearly 100% of riders with AIS > 4 somatic injuries died. Such injuries were 30% of Thailand fatalities and 57% of L.A. fatalities, but only about 2-3% of the overall accident population. Among the 97-98% of riders with AIS < 5 somatic injuries, helmet use could prevent about three-fourths of fatalities and brain injuries. CONCLUSIONS: Helmets were extremely effective in preventing brain injury and death in 97% of the accident population in less-than-extreme crashes. Helmet use cannot prevent all fatalities because many of those killed succumb to below-the-neck injuries that a helmet cannot prevent.

Prevención del accidente infantil / Prevention of childhood accident

En Chile, los accidentes representan la tercera causa de muerte en la población general, después de la ocasionadas por enfermedades cardiovasculares y las de origen oncológico. En la edad infantil, sin embargo, se constituyen como la primera causa de muerte entre los niños de 1 a 14 años, con una tasa registrada de 28,6 por 100.000 habitantes