Darli Antonio Soares

Perfil do trabalho e acidentes de trânsito entre motociclistas de entregas em dois municípios de médio porte do Estado do Paraná, Brasil

This cross-sectional study focused on motorcycle couriers (work profile, work conditions, and traffic accidents) in Londrina and Maringá, Paraná State, Brazil. Data were collected from self-completed questionnaires in 2005-2006. In Londrina and Maringá, respectively, 377 and 500 motorcycle couriers completed the questionnaire, with mean ages of 28 and 29 years. Londrina showed a higher proportion of couriers that earned per delivery, worked both day and night or on night shifts only, and who worked more than 10 hours a day (p < 0.05). Despite greater exposure to hazardous work and traffic conditions in Londrina, there was no significant difference in the accident rates during the 12 months prior to the survey in Londrina and Maringá (2.89 and 2.80 per 100 person-months, respectively). The study detected precarious work conditions, high exposure to hazardous traffic conditions, and high accident rates among motorcycle couriers.

Risky behavior for traffic accidents: a survey among medical students in Southern Brazil

BACKGROUND Traffic accidents are one of the most frequent cause of mortality among Brazilian youths. Therefore, this study aimed at detecting the prevalence of risk factors for such accidents in a young population. METHODS Questionnaires containing questions about risky behavior for traffic accidents were answered by students from the first to the fourth year of the Medical course of the State University of Londrina, Paraná State, Brazil, during October and November, 2000. The chi-square test was used to detect differences between the sexes, with a 5% significance level. RESULTS Compared to women, male students reported a statistically significant higher frequency of transportation as a car driver, owning a driver license, to have learnt to drive a car under the age of 16 and to have drunk alcoholic beverages before driving a vehicle during the last 30 days. Among regular drivers, a lower proportion of desirable behavior was also noted among male students. Lack of attention (59.3%), disregarding traffic signals (33.5%) and speeding (22.5%) were the main factors cited as determinants for the occurrence of the last accident, with no gender difference. CONCLUSIONS These results point out for the need to implement measures in order to reduce factors that favors the occurrence of traffic accidents among these youths, especially among males.

Fatores de risco para nascimentos pré-termo em Londrina, Paraná, Brasil

The objective of this study was to identify risk factors associated with pre-term birth among live births in a hospital in Londrina, Parana State, Brazil. Cases consisted of 328 pre-term births, and controls were 369 births with gestational age greater than 37 weeks. A multiple hierarchical logistic regression analysis was carried out. There was a significant correlation (p 30 kg/m2; history of prematurity; history of assisted reproduction; mothers in a relationship for less than two years; maternal stress; weekly maternal alcohol consumption; insufficient prenatal care; gestational complications such as bleeding, genital tract infection, altered amniotic fluid volume, high blood pressure, and hospital admission; and twin pregnancy. Regular walks during pregnancy were a protective factor. Improved quality of prenatal care and the identification of the above factors during pregnancy may help reduce premature birth.

Qualidade da informação sobre causas externas no Sistema de Informações Hospitalares

OBJECTIVE To analyze the coverage and quality of the data on hospitalizations due to external causes in the Hospital Information System of the Brazilian National Health System. METHODS Hospitalizations recorded in the Hospital Information System of 11 hospitals in two municipalities (Londrina and Maringá, Southern Brazil), in 2004, were compared with hospitalizations identified as consequences of external causes through investigating medical records, complemented with mortality and pre-hospital data. The crude agreement rate, sensitivity and positive predictive value were calculated. The profile of groups of hospitalization causes recorded in the System was compared with that obtained from investigations. RESULTS In Londrina, 3,002 hospitalizations due to external causes were recorded in the System and, in Maringá, 1,403. The investigations found 4,018 and 2,370, respectively. The System presented high positive predictive values for hospitalizations due to external causes in both municipalities: 97.7% in Londrina and 98.6% in Maringá. However, the sensitivity was low: 57.3% in Maringá and 73% in Londrina, thus denoting underrecording of these causes. Comparison between the profiles of the types of causes revealed that there was underestimation of some causes in the System, especially regarding accidents due to exposure to inanimate mechanical forces, assaults and intentional self-harm. CONCLUSIONS Underrecording of hospitalizations due to external causes and some distortions regarding the types of causes occurred in the Hospital Information System in both municipalities. Detection of these deficiencies may contribute towards the process of improving the quality of the information in this System.OBJETIVO: Analisar a cobertura e a qualidade das informacoes sobre internacoes por causas externas no Sistema de Informacoes Hospitalares do Sistema Unico de Saude. METODOS: As internacoes ocorridas no Sistema de Informacoes Hospitalares de 11 hospitais, em 2004, em dois municipios (Londrina e Maringa, PR), foram comparadas com aquelas identificadas como consequencias de causas externas por pesquisa em laudos medicos, complementadas por dados de mortalidade e de servico pre-hospitalar. Foram calculados indicadores de concordância bruta, sensibilidade e valor preditivo positivo. Comparou-se o perfil de agrupamentos de causas das internacoes registradas no Sistema com o obtido na pesquisa. RESULTADOS: Foram registradas no Sistema 3.002 internacoes por causas externas em Londrina e 1.403 em Maringa, enquanto a pesquisa detectou 4.018 e 2.370, respectivamente. O Sistema apresentou alto valor preditivo positivo para internacoes por causas externas em ambos os municipios (97,7% em Londrina e 98,6% em Maringa). Porem, a sensibilidade foi baixa: 57,3% em Maringa e 73% em Londrina, denotando sub-registro dessas causas. A comparacao dos perfis de tipos de causas externas revelou que ha subestimacao de algumas causas no Sistema, especialmente por acidentes por exposicao a forcas mecânicas inanimadas, agressoes e lesoes autoprovocadas. CONCLUSOES: Ha sub-registro de internacoes por causas externas e algumas distorcoes em relacao aos tipos de causas no Sistema de Informacoes Hospitalares nos dois municipios estudados. A deteccao dessas deficiencias pode contribuir para o processo de qualificacao da informacao desse Sistema.

Uso de capacete por vítimas de acidentes de motocicleta em Londrina, sul do Brasil

OBJECTIVE To describe helmet use among motorcyclists injured in traffic accidents in Londrina, a medium-sized city in Paraná, a state in southern Brazil, and to identify factors associated with not wearing a helmet at the time of the accident. METHODS We analyzed data concerning motorcycle users (drivers and passengers) who received care in 1998 from the only pre-hospitalization trauma and emergency care ambulance service in Londrina. The following variables were assessed: helmet use at the time of the accident; age; sex; seating position (driver or passenger); smell of alcohol on the breath; time of the day, day of the week, and month when the accident happened; and location of the accident (in the downtown area or outside of it). RESULTS The average rate of helmet use was 63.2%. Factors independently associated with not using a helmet were (according to strength of association): being younger than 18 years of age (odds ratio (OR) = 6.61), having alcohol on the breath (OR = 3.93), accident occurring at night (OR = 2.51), accident happening outside the citys downtown area (OR = 2.27), and accident taking placing during the weekend (OR = 2.25). CONCLUSIONS It is imperative to implement public policies aimed at promoting safety for motorcyclists, ongoing education in defensive driving, and the use of helmets and other safety equipment. Interventions should take into account that driving behaviors depend not just on individuals but also on the overall social and historical context.

Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001

This objective of this paper was to verify the relations between the living and infrastructure conditions of municipalities in the State of Paraná, Brazil, and infant mortality rate and its components. An ecological study was carried out having the 399 municipalities of the State being classified into five clusters of living conditions. Infant, neonatal and postneonatal rates were calculated for the period 1997/2001. The mean infant, neonatal and postneonatal mortality rates in the State were, respectively, 19.3, 12.0 and 7.3 per 1,000 live births. Postneonatal mortality rates ranged from 8.7 (cluster of worst living conditions) to 6.3 per 1,000 live births (in the cluster classified as having the best living conditions). Regarding the neonatal component, clusters classified as holding the best and the worst living conditions presented the lowest values: 11.8 and 11.4 per 1,000 live births, respectively. We conclude that the postneonatal component still adequately discriminate living conditions in the State of Paraná. However, there is a need of complementary studies that aim to clarify the causes of similar neonatal mortality rates observed in the richest and in the poorest cluster of municipalities.

Condições de trabalho e riscos no trânsito urbano na ótica de trabalhadores motociclistas

Uma das profissoes que mais se expandem no Brasil e a dos motociclistas profissionais, o que pode aumentar os acidentes de trânsito envolvendo esta categoria. Este estudo tem como objetivo identificar e analisar qualitativamente a percepcao de motoboys acerca de aspectos relacionados ao seu trabalho, aos riscos no trânsito e a ocorrencia de acidentes. Os dados foram coletados por meio de grupo focal, realizado em fevereiro de 2005, com 11 motoboys atuantes em Londrina (PR). Este artigo focaliza os principais motivos que levaram os motoboys a insercao na profissao, suas condicoes de trabalho, os riscos a que estao expostos e seu envolvimento em acidentes de trânsito. Os principais motivos para a insercao na profissao foram o desemprego e a baixa escolaridade. A pressao exercida pelas empresas e clientes por entregas rapidas e fator determinante para a adocao de comportamento de risco no trânsito, tendo o ganho por produtividade menor peso na tomada de decisoes. Todos os participantes do estudo relataram envolvimento em acidentes de trânsito. Melhorar suas condicoes de trabalho e o grande desafio colocado no momento, tanto para os proprios motoboys, por meio da uniao da categoria e luta por seus direitos, como para a sociedade em geral, cabendo ao Estado fiscalizar as empresas que oferecem servicos de entrega e estabelecer normas que aumentem a seguranca desses motociclistas no desempenho do seu trabalho.

Cobertura e fatores associados com a realização do exame Papanicolaou em município do Sul do Brasil

Purpose: to verify the coverage and factors associated with Papanicolaou (Pap) testing in Londrina (PR), Brazil. Methods: this is a cross-sectional study, carried out in 2004, in microareas of five Basic Health Units (BHU) of Londrina. One or two microareas from each BHU were selected and a list of all women aged 20-59 years resident in these places, was made through search in the Basic Attention Information System, the women being then visited and interviewed. Those with a Pap test in the last three years were considered as having an updated examination, and the remaining as delayed. The association of some factors with the examination situation was investigated. Data analysis was performed using Epi-Info 6.04d. Results: Pap smear coverage among the 513 participants of the study was 80.7%, ranging from 71.5% to 88.4%. Delay in taking the test was higher (p<0.05) among women who worked only at home (22.4% as compared with 14.3% among those who worked outside), and among those who belonged to D/E social classes (24.9%) as compared to C (17.5%) and A/B (8.3%) classes. The proportion who ignored the next test date was higher (p<0.01) among those who had the last Papanicolaou testing at a BHU (14.7%), as compared to those who had been attended privately or by a health insurance company (5.8%). Conclusion: the coverage of Pap smear in the studied areas can be considered satisfactory, although there is a need of improving compliance with Pap test, mainly among women who are the poorest and who work only at home.

Consumo de medicamentos entre adultos na área de abrangência de uma Unidade de Saúde da Família

There are few studies about the consumption of medication by adults in Brazil. Therefore, the purpose of this research was to identify the profile of medication consumption and associated factors among adults aged 29 to 59 years old. This is a cross-sectional study. The sample included 374 individuals from the area of a family health unit in the city of Ponta Grossa, State of Paraná. The interviews were conducted from December 2006 to January 2007, with a 7-day recall. The medications were classified according to the Anatomical Therapeutic Chemical Classification. Qui-square test and logistic regression were used for statistical analysis. The prevalence of medication consumption was 67.1%. The use varied from 1 to 17 drugs. Analgesics were the therapeutic class most consumed. After multivariate analysis, the variables which remained significantly associated to use were: gender, self-perception of health, presence of chronic diseases, and access to a health plan. Commercial pharmacy was the main place for obtaining medicines (63.6%). The prevalence of medication consumption was similar to that found in national and international studies. The findings in this research may be a guide for the actions of family health teams.

Toxoplasmose na gestação: diagnóstico, tratamento e importância de protocolo clínico

OBJECTIVES: to compare therapeutic and laboratory aspects of toxoplasmosis in pregnant women as well as its cost in a real situation and in a hypothetical situation employing a clinical protocol.METHODS: a time-series cohort study was carried out with pregnant women taking part between January and November 2004 in the prenatal program at the Primary Health Units in Londrina, Parana, Brazil, whose prenatal routine laboratory tests included serology for acute toxoplasmosis. Data were obtained at the citys Department of Health and the University Hospital. Additional tests, treatment and corresponding expenses were compared with data from a hypothetical situation employing a clinical protocol. RESULTS: in the real situation, there was no definitive diagnosis for 75% of the pregnant women with reactive IgM for toxoplasmosis, and among those who underwent an additional test, the median time period between the two tests was 23 weeks; 28.5% of the women were treated without confirmation and a single confirmed case was not treated. Compared with the hypothetical situation, if an additional test had been carried out with the same blood sample it would have been possible to arrive at a definitive diagnosis of all cases. Lower expenditure on medicines would compensate for extra expenses related to additional tests. CONCLUSIONS: the results show the importance of an appropriate clinical protocol both for health protection and cost reduction.