Márcio Dênis Medeiros Mascarenhas

Alcohol-related injuries in emergency departments in Brazil, 2006 and 2007

Alcohol-related injuries are an important public health issue worldwide. The objective of this study was to describe the epidemiology of alcohol intake perceived by interviewers among injury victims seen at emergency departments in selected Brazilian cities. Cross-sectional data were collected from the injury surveillance system based on sentinel health services recently implemented in the country through intentional sampling in 2006 and 2007 and analyzed in Epi Info 3.5.1. Alcohol intake perception was higher in violence-related injuries than in unintentional injuries (37.9% versus 8%). For violence-related injuries, highest proportions of alcohol intake perception were observed among males (43.7%), 20 to 39 years old (45.3%), blacks (40.5%), and low schooling level victims (40.3%). Settings where these injuries occurred with the highest concerned proportions were taverns (78.2%) and public places (39.5%). Higher alcohol intake perception was observed in assaults (39.1%), suicide attempts (25.4%), transport-related injuries (16.8%), and falls victims (5.9%).

Vivência de violência entre escolares brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE)

This article presents the main results of the National Adolescent School-based Health Survey (PeNSE). A questionnaire was applied to a sample of 60,973 students of the 9th year of Junior high school in public and private schools of the Brazilian state capitals and the Federal District, between March and June 2009. The prevalence and confidence interval of 95% (CI 95%) of the violence situations involving adolescents were analyzed. The following situations were identified: lack of safety on the way home-school (6.4%; CI95%: 6.1%-6.8%) and at school (5.5%; CI95%: 5.2%-5.8%); involving fights with physical aggression (12.9%; CI95%: 12.4%-13.4%), with knife (6.1%; CI95%: 5.7%-6.4%) or fire arm (4.0%; CI95%: 3.7%-4.3%); physical aggression by family member (9.5%; CI95%: 9.1%-9.9%). Violence situations were more prevalent among male students. There were great variations among the cities studied. Adolescents are exposed to different violence manifestations in the institutions that supposedly must assure their protection and healthy development: school and the home. These results aim to support health promotion measures and prevention of these risk factors.

A proposta da rede de serviços sentinela como estratégia da vigilância de violências e acidentes

No Brasil, as bases de dados oficiais permitem o monitoramento da mortalidade e internacoes no SUS, decorrentes dos acidentes e violencias. E preciso conhecer a magnitude e o perfil dessas causas que demandam os servicos de emergencia, bem como identificar alguns problemas ocultos tais como as violencias domestica e sexual. O proposito deste artigo e apresentar a proposta do Ministerio da Saude de implantacao da Rede de Servicos Sentinela de Vigilância de Violencias e Acidentes - Rede VIVA, iniciada em 2006, que visa complementar o sistema de informacoes existente para a vigilância dessas causas. Para obter um quadro mais completo do problema e atender a legislacao vigente no Pais, foram estabelecidos dois componentes: 1) Vigilância de acidentes e violencias em emergencias hospitalares selecionadas: coleta em um mes a cada ano, atraves de uma amostra; 2) Vigilância das violencias sexual, domestica e/ou outras violencias interpessoais em servicos de referencia: coleta universal e continua. O estabelecimento da Rede VIVA foi realizado pelo Ministerio da Saude em parceria com as Secretarias Estaduais e Municipais de Saude a partir de criterios previamente estabelecidos. A adesao ao projeto foi acima das expectativas, todas as regioes do Brasil foram representadas.

Unintentional injuries at the Emergency Department Injury Surveillance System: Brazil, 2006

In 2006, the Brazilian Ministry of Health established the Injury Surveillance System Network in Sentinel Services (Rede VIVA) to describe data on injuries victims treated at emergency departments (ED), especially minor injuries which do not cause deaths and hospitalization. This study describes the characteristics of unintentional injuries victims treated in these EDs by means of a transversal descriptive study with data coming from EDs located in 35 municipalities with the highest injury rates. The data were collected during 30 consecutive days in an alternated 12-hour shift. There were a total of 41,677 patients with unintentional injuries, mainly among males (64.8%), people aged 20 to 29 years (23.0%) and low level of education (45.8%). Falls were the main cause (40.1% overall), followed by transport related injuries (26.6% overall). The more frequent place of occurrence were public streets (36.3% overall) and residences (33.6% overall). The body parts most affected were upper members (42.7%), lower members (42.0%) and head/face (29.2%). The injury surveillance in sentinel services allows collecting timeless data about minor cases which is essential for planning and implementing preventive measures.

Perfil epidemiológico da tuberculose entre casos notificados no Município de Piripiri, Estado do Piauí, Brasil

ResumoEmbora conhecida desde a Antiguidade, a tuberculose continua preocupando as autoridades sanitarias ate os dias de hoje. O presente estudo descreve o perfil clinico e epidemiologico da doenca entre casos notificados a Secretaria Municipal de Saude de Piripiri, Estado do Piaui, no periodo de junho de 1997 a outubro de 2000. Os dados foram coletados a partir das Fichas de Investigacao Individual da doenca e do Livro de Registro e Controle de Tratamento dos Casos de Tuberculose e, a seguir, processados pelo software Epi Info 6.04b. Verificou-se predominio da doenca em pessoas do sexo masculino (61,4%), adultos jovens (40,2%) e analfabetos (68,4%). A incidencia foi de 82,4 e 80,2 casos por 100.000 habitantes, respectivamente, nos anos de 1998 e 1999. Com relacao aos aspectos clinicos, 93,1% dos doentes apresentaram tuberculose pulmonar. De todos os casos, a baciloscopia foi realizada em 93,1%; destes, 75,5% apresentaram resultado positivo. A radiologia toracica foi empregada em 34,5% dos enfermos. Quanto a evolucao dos casos, 91,7% foram curados, ocorreram dez casos de obito (6,9%) e apenas um caso de abandono (0,7%) do Programa de Controle de Tuberculose (PCT) do Municipio. A investigacao possibilitou conhecer caracteristicas da tuberculose na populacao estudada, alem de avaliar, indiretamente, o servico de saude dirigido ao controle da doenca em Piripiri-PI.Palavras-chave: tuberculose; epidemiologia; estudos de avaliacao.SummaryAlthough known since ancient times, tuberculosis continues to preoccupy medical authorities nowadays. This work describes the clinical and epidemiological profile of tuberculosis cases notified to the health department in the Muni-cipality of Piripiri, Piaui State, from June 1997 to October 2000. Data from individual Tuberculosis Investigation Files and Tuberculosis Case Registry were compiled. Data were processed using Epi Info 6.04b software. Disease occurred predominantly in males (64.4%), young adults (40.2%), and illiterate persons (68.4%). The incidence was 82.4 and 80.2 per 100,000 inhabitants in 1998 and 1999, respectively. In regard to the clinical presentation, 93.1% of patients had pulmonary tuberculosis. Bacilluscopy was done in 93.1% of the patients, of which 75.5% had a positive result. Chest x-rays were performed in 34.5% of patients. Among cases treated by the Municipal Tuberculosis Control Program (PCT), 91.7% were cured, 6.9% died and 0.7% (1 case) abandoned treatment. This investigation permits an improved understanding of the characteristics of tuberculosis in the study population and enables an indirect evaluation of health service treatment of this disease in Piripiri, Piaui.Key words: tuberculosis; epidemiology; evaluation studies

Violence against children: revealing the characteristics of emergency treatment, Brazil, 2006 and 2007

The aim of this article was to describe the profile of emergency care for injuries resulting from violence against children (< 10 years of age) treated Surveillance System for Violence and Accidents (VIVA) of the Ministry of Health, for 30 consecutive days in 2006 and 2007 in selected cities of Brazil. The 518 children in the sample were predominantly male (60.6%), aged 5-9 years (52.1%), and black (71.2%). The majority (55%) of the cases occurred in the home, 34.2% involved sharp objects, and 68.7% evolved to discharge. The most frequent form of violence was physical aggression (67.4%), involving beating, sharp objects, and firearms. The other types of violence included neglect (32%), psychological abuse (9.5%), and sexual assault (3.5%). The aggressors were largely male (48.1%) and family members of the victim (36.3%). The study shows childrens vulnerability to situations of violence. It is necessary to develop specific strategies for inter-sector care and social mobilization to intervene in this problem.

Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros

O objetivo deste estudo foi identificar a associacao entre o consumo de alcool e outras drogas e o bullying com o envolvimento em situacoes de violencia fisica entre adolescentes de 13 a 15 anos, em escolas publicas e privadas das capitais brasileiras e do Distrito Federal. Foram analisados os dados da Pesquisa Nacional de Saude do Escolar (PeNSE) de 2009. Para analise dos dados foi utilizada a regressao logistica. A prevalencia de envolvimento em situacoes de violencia fisica foi 12,9% maior no sexo masculino. Em ambos os sexos, foram observadas associacoes entre violencia fisica e ser vitima de bullying com o uso de drogas ilicitas e efeito potencializado do consumo de alcool e drogas. Para o sexo masculino, o uso de alcool mostrou associacao significante com violencia fisica. Morar o pai ou ambos os genitores na residencia apresentou associacao inversa para violencia fisica no sexo feminino. O conhecimento de fatores associados a violencia fisica entre adolescentes e importante para auxiliar estrategias de promocao da saude e da cultura de paz, rompendo com a ideia de que a violencia entre adolescentes e algo banal e esperado.This study aimed to identify the association between alcohol and drug consumption and bullying on the one hand and involvement in situations of physical violence among adolescents 13 to 15 years in public and private schools in State capitals and the Federal District of Brazil. The study analyzed data from the National School Health Survey (PeNSE) for the year 2009. Data analysis used logistic regression. Prevalence of involvement in physical violence was 12.9% more common in boys than girls. Both genders showed associations between physical violence or being a victim of bullying and use of illegal drugs, plus the heightened effect of the combined consumption of alcohol and other drugs. In boys, alcohol consumption showed a significant association with physical violence. Having the father or both parents living at home was inversely associated with physical violence in girls. Knowledge of factors associated with physical violence among adolescents is important for supporting health promotion strategies and a culture of peace, thereby counteracting the idea of taking teenage violence for granted.

Exposição ao álcool entre escolares e fatores associados

OBJECTIVE : To describe the prevalence of alcohol consumption among adolescent school students and identify its individual and contextual associated factors. METHODS : The present research used data from the 2009 National School Health Survey (PeNSE), which included a sample of 59,699 9th grade students in Brazilian capitals and the Federal District. The association between regular alcohol consumption and independent explanatory variables was measured by means of the Pearson’s Chi-square test, with a 0.05 significance level. The explanatory variables were divided into four groups based on affinity (sociodemographic; school and family context; risk factors; and protection factors). A multivariate analysis was carried out for each group, always adjusting for age and sex. Variables with p < 0.10 were used in the final multivariate analysis model. RESULTS : The highest alcohol consumption in the preceding 30 days was independently associated with pupils aged 15 years (OR = 1.46) and over, female (OR = 1.72), white, children of mothers with higher education, studying in private school, students who had tried smoking (OR = 1.72) and drug use (OR = 1.81), with regular tobacco consumption (OR = 2.16) and those who have had sexual intercourse (OR = 2.37). The factors related to family were skipping school without parental knowledge (OR = 1.49), parents not knowing what children do in their free time (OR = 1.34), having fewer meals with their parents (OR = 1.22), reporting that parents do not care (OR = 3.05), or care little (OR = 3.39) if they go home drunk, and having suffered domestic violence (OR = 1.36). CONCLUSIONS : The results reinforce the importance of viewing alcohol consumption among adolescents as a complex, multifactorial and socially determined phenomenon.OBJECTIVE To describe the prevalence of alcohol consumption among adolescent school students and identify its individual and contextual associated factors. METHODS The present research used data from the 2009 National School Health Survey (PeNSE), which included a sample of 59,699 9th grade students in Brazilian capitals and the Federal District. The association between regular alcohol consumption and independent explanatory variables was measured by means of the Pearson’s Chi-square test, with a 0.05 significance level. The explanatory variables were divided into four groups based on affinity (sociodemographic; school and family context; risk factors; and protection factors). A multivariate analysis was carried out for each group, always adjusting for age and sex. Variables with p < 0.10 were used in the final multivariate analysis model. RESULTS The highest alcohol consumption in the preceding 30 days was independently associated with pupils aged 15 years (OR = 1.46) and over, female (OR = 1.72), white, children of mothers with higher education, studying in private school, students who had tried smoking (OR = 1.72) and drug use (OR = 1.81), with regular tobacco consumption (OR = 2.16) and those who have had sexual intercourse (OR = 2.37). The factors related to family were skipping school without parental knowledge (OR = 1.49), parents not knowing what children do in their free time (OR = 1.34), having fewer meals with their parents (OR = 1.22), reporting that parents do not care (OR = 3.05), or care little (OR = 3.39) if they go home drunk, and having suffered domestic violence (OR = 1.36). CONCLUSIONS The results reinforce the importance of viewing alcohol consumption among adolescents as a complex, multifactorial and socially determined phenomenon.

Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009

Adolescents are seeking new references and experiences, which may involve attitudes of risk and exposure to accidents and violence from external causes. These events constitute a serious Public Health problem. The scope of this study was to analyze the occurrence of accidents by external causes in adolescents from 10 to 19 years of age attended at sentinel urgency and emergency services in Brazil. Data from the 2009 Surveillance System for Violence and Accidents (VIVA 2009) was analyzed in 74 emergency units in 23 state capitals and the Federal District. The findings revealed that 6,434 adolescents (89.8%) were victims of accidents and 730 (10.2 %) were victims of violence. The main causes of the accidents were falls and traffic accidents, and assaults were predominant in violence. For both accidents and violence, non-white male adolescents were predominant and the events occurred most frequently on the public highways. A marked increase was detected, with hospitalization of victims of violence between 15 and 19 years of age. Understanding the epidemiological reality of external causes among adolescents represents an important tool for health prevention and promotion policies and the culture of peace seeking to reduce morbidity and mortality.

Violence-related injury in emergency departments in Brazil

OBJECTIVE This article describes the characteristics of violence-related injury (VRI) cases presenting at emergency departments (EDs) in Brazil and compares circumstances for assault-related and self-inflicted cases. METHODS The study is cross-sectional. The data describe cases seen in September 2006 in 62 EDs, representing all 26 states and the Federal District. A total of 4 835 case records were analyzed. Basic statistical tabulations were complemented by logistic regression analysis to assess potential associations between type of violence (assault or self-harm) and multiple factors. RESULTS Males comprised 72.8% of cases while those aged 20 to 29 comprised 35.4%. Alcohol use was reported or suspected in 42.7% of cases, more commonly among males. Assault victims comprised 91.4% of cases versus self-inflicted injuries, which accounted for 8.6%. Three-fourths of the assault victims were male, while over half of the self-inflicted injury victims were female. The leading mechanism for assaults was physical force/blunt objects (46.2%), whereas poisoning was the predominant mechanism for self-inflicted injuries (71.4%). Younger females were significantly more likely to have been victims of self-inflicted injuries than younger males, while younger males were more likely to have been victims of assault; this finding is more pronounced in cases where alcohol use was reported. Self-inflicted injuries were significantly more likely to occur in residences, while assaults were more likely to occur away from home. CONCLUSION These results can improve understanding of the scope and characteristics of VRIs in Brazil (and thus contribute to national injury prevention efforts), and help identify areas for future research.