Cosme Marcelo Furtado Passos da Silva

Violence and injuries in Brazil: the effect, progress made, and challenges ahead

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100,000 people and traffic-related mortality was 23·5 per 100,000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

Iniciativa STROBE: subsídios para a comunicação de estudos observacionais

Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative.El objetivo del articulo fue estimar la prevalencia de extremos antropometricos indicativos del estado nutricional de ninos. Se realizo estudio transversal con muestra probabilistica de 1.386 ninos menores de cinco anos del estado de Alagoas. Las prevalencias de deficit (z< -2; patron de la Organizacion Mundial de Salud - 2006) para los indices peso-para-edad (bajo peso), peso-para-altura (flacura) y altura-para-edad (deficit estatural) fueron, respectivamente, 2,9% (n=40), 1,2% (n=17) y 10,3% (n=144). El exceso de peso-para-altura (sobrepeso) acometio 135 ninos (9,7%). Se concluyo que las prevalencias de bajo peso y flacura son epidemiologicamente irrelevantes y que el deficit estatural y el sobrepeso prevalecen con identica magnitud.

Caracterização dos casos de violência doméstica contra a mulher atendidos em dois hospitais públicos do Rio de Janeiro

This paper aims at: (a) to analyze the distribution of the cases of domestic violence against women (adolescent and adult) in relation to emergency care due to external causes; (b) to characterize the victims and the rendered care; (c) to analyze the circumstances in which events happened. In methodological terms, it tries to articulate the quantitative and qualitative approaches. The study was developed in two public hospitals of reference placed in the city of Rio de Janeiro. Of the 72 assisted women, most referred to the husband, the partner or the boyfriend as the aggressor (69,4%) and were beaten (70.4%), especially on the face and on the head. The study cames to the conclusion that the health services should provide a good clinical care and promote preventions actions.

Emergency care costs for victims of violence treated at two hospitals in Rio de Janeiro

The following is a cost analysis of one month of emergency room treatment provided for different types of injuries at two public hospitals in Rio de Janeiro. The study focused on the following: 1) costs at each hospital for treatment of different injuries (annual and monthly estimates); 2) mean cost of each injury; 3) detailed itemized costs of care (materials and drugs, surgery, standard procedures, tests, professional fees, and meals). The items were investigated at the respective hospitals and included services, materials, and resources employed in treating the 1,053 patients included in the sample (498 in the Miguel Couto Municipal Hospital - MCMH - and 555 in the Salgado Filho Municipal Hospital - SFMH). Traffic accidents (run-over pedestrians, motor vehicle collisions, and transportation accidents) accounted for 74.3% of costs at MCMH and 48.4% at SFMH. Injuries due to aggression were also considered relevant in the cost profile, mainly at SFMH (49% of costs due to violence) as compared to 24.9% of the total care costs at MCMH. Mean treatment costs for pedestrians run over by motor vehicles varied from R

Teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil

77.76 (SFMH) to R

Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men

237.77 (MCMH). Mean treatment costs for victims of aggression varied from R

Relations between children's invented spelling and the development of phonological awareness

107.35 (SFMH) to R

Avaliação dos Centros de Orientação e Apoio Sorológico/CTA/Coas da Região Nordeste do Brasil

84.19 (MCMH). The study suggests public health measures to deal with and prevent violence.

Violência no Município do Rio de Janeiro: áreas de risco e tendências da mortalidade entre adolescentes de 10 a 19 anos

This article analyzes teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil. The study included a sample of births in Rio de Janeiro, and exposure variables were organized hierarchically. For fetal death, the results showed the protective effect of adequate prenatal care, while maternal morbidity increased the risk. For neonatal death, adequate prenatal care and female gender in the newborn were protective factors, while black or brown maternal skin color, history of stillbirth, maternal morbidity, and physical aggression during the index pregnancy increased the risk. Low birth weight and prematurity were corroborated as determinants of fetal and neonatal death. Risk of post-neonatal death was highest with increased parity, intra-gestational morbidity, and low birth weight. Teenage pregnancy itself was an independent factor for post-neonatal death. The findings reaffirm the relevance of social and health policies targeting adolescents, as well as improvements in prenatal care.

Testagem sorológica para o HIV e a importância dos Centros de Testagem e Aconselhamento (CTA): resultados de uma pesquisa no município do Rio de Janeiro

Objective:Brazil accounts for ∼70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM). Design:Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000-2006. Methods:Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. Results:Among 28,426 patients, 6777 died during 87,792 person-years of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM. Conclusions:Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities.