Tanara Rosângela Vieira Sousa

Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths

Objective: According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million people annually; over 90 percent occur in low- and middle-income countries. Brazils road traffic mortality rate of ∼20 per 100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on road traffic fatalities among vulnerable road users (VRUs) in Brazil. Methods: Road traffic fatality data from 2000 to 2008 were extracted from Brazils Mortality Information System (SIM). Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01–V89) and then subcategorized by VRU categories. Information was then disaggregated by gender, age, and region. Results: In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of 20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade, motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per 100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76 per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher proportions of VRU deaths compared with other regions. Conclusions: Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil. Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths.

Factors associated with alcohol and drug use among traffic crash victims in southern Brazil

OBJECTIVE To investigate the prevalence of and factors associated with alcohol- or drug-related traffic crashes (TC) in a sample of TC victims who were admitted to the two emergency rooms of Porto Alegre in southern Brazil. METHODS A cross-sectional study with consecutive samples was used. Victims of non-fatal TCs (as drivers, passengers or pedestrians) who had presented at emergency rooms during the 45 days of data collection were selected. Subjects participated in a structured interview, were breathalyzed and underwent salivary drug testing. A multinomial logistic regression model was used to verify factors associated with alcohol or drug use. RESULTS Of the 609 victims who participated in the interview, 72% were male, and the median age was 29 years (interquartile range 23.0-40.0 years). The drivers were mostly men (p<0.001), with a higher binge drinking rate (p=0.003) and marijuana use (p=0.005) than seen in pedestrian and passengers. The prevalence of a positive blood alcohol concentration (BAC) ranged from 7.8% among the drivers to 9.2% among the pedestrians (p=0.861), and the cannabis prevalence was 13.3% among the drivers. The variables associated with an alcohol-related accident were binge drinking in the prior 12 months (OR 2.4; CI 95% 1.1-5.1) and coming from a party/bar (OR 8.7; CI 95% 2.8-26.7). Alcohol abuse or dependence increased by 5.2-fold the chance of another substance-related TC. CONCLUSION The large number of individuals found in TC-related emergency room visits in a short time frame is evidence of the Brazilian epidemic of TC. The data showed that alcohol abuse or dependence also increases the risk of intoxication by other drugs, and they point to alcohol and drug use as a major problem requiring specific TC-related public policies and law enforcement.

Análise por dados em painel do status de saúde no Nordeste Brasileiro

OBJETIVO: Analisar fatores determinantes do status de saude em cada estado da Regiao Nordeste do Brasil. METODOS: Estudo utilizando a metodologia de dados em painel, com informacoes agregadas para municipios. Os dados compreendem os anos de 1991 e 2000, e foram obtidos no Atlas do Desenvolvimento Humano do Programa das Nacoes Unidas para o Desenvolvimento, e Secretaria do Tesouro Nacional. Utilizou-se como indicador do status de saude, a taxa de mortalidade infantil, e como determinantes as variaveis: gastos com saude e saneamento per capita, numeros de medicos por mil habitantes, acesso a agua tratada, taxa de fecundidade e de analfabetismo, percentual de maes adolescentes, renda per capita e indice de Gini. RESULTADOS: As taxas de mortalidade infantil na regiao Nordeste reduziram-se em 31,8% no periodo analisado, desempenho pouco superior ao apresentado para a media nacional. No entanto, em alguns estados, como Rio Grande do Norte, Bahia, Ceara e Alagoas, a reducao foi mais significativa. Isso pode ser atribuido a melhora de alguns indicadores que sao os principais determinantes da reducao da taxa de mortalidade infantil: maior acesso a educacao, reducao da taxa de fecundidade, aumento da renda, e do acesso a agua. CONCLUSOES: Os estados que apresentaram maiores ganhos no acesso a agua tratada, educacao, renda e reducao da taxa de fecundidade, foram tambem os que obtiveram maiores ganhos na reducao da mortalidade de menores de um ano de idade.OBJECTIVE To assess health status determinants in Brazils Northeast states. METHODS Study carried out based on panel data analysis of aggregated information for municipalities. Data was obtained from the United Nations Development Program Atlas of Human Development and Brazilian National Treasury Department for the years 1991 and 2000. Health status indicator was infant mortality rate and health determinants were the following variables: per capita health and sanitation expenditure; number of physicians per inhabitant; access to drinking water; fertility rate; illiteracy rate; percentage of adolescent mothers; per capita income; and Gini coefficient. RESULTS Infant mortality rates in Northeast Brazil were reduced by 31.8%, during the period studied, slightly above the national average. However, in some states, such as Rio Grande do Norte, Bahia, Ceará and Alagoas, the reduction was more significant. This can be attributed to improvement in some indicators that are main determinants of infant mortality rate reduction: greater access to education, reduction of fertility rates, increased income, and access to drinking water. CONCLUSIONS Brazilian states that showed greater gains in access to drinking water, education, income and reduction of fertility rates were also the ones that achieved major reductions in mortality of children under a year of age.

A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway

BACKGROUND A large proportion of road traffic crashes are related to driving under the influence (DUI) of alcohol or drugs. The aim of this study was to compare the use of alcohol, illegal drugs and psychoactive medicinal drugs among random drivers in Brazil and Norway, two countries with the same legal limit for drunk driving, but with marked differences in legislation history, enforcement and penalties for DUI, and to discuss any differences found. METHODS Roadside surveys were conducted on Fridays and Saturdays between noon and midnight. Samples of oral fluid were collected for analysis of drugs, whereas alcohol was determined by breath testing or by analysis of oral fluid. RESULTS High participation rates of 94-97% were obtained in both countries. The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations (BAC) above 0.2g/L was 2.7% (95% CI 2.2-3.3) in Brazil and 0.2% (95% CI 0.0-0.5) in Norway. Stimulants (amphetamines or cocaine) were found in samples from 1.0% (95% CI 0.7-1.4) of drivers in Brazil and 0.3% (95% CI 0.1-0.7) in Norway. The prevalence of amphetamines was highest among Brazilian truck drivers (3.6%; 95% CI 2.0-6.4). Tetrahydrocannabinol was found in samples from 0.5% (95% CI 0.3-0.8) of drivers in Brazil and 1.0% (95% CI 0.6-1.5) in Norway, whereas benzodiazepines or zopiclone were found in 1.0% (95% CI 0.7-1.4) and 1.7% (95% CI 1.2-2.4) of the samples from Brazil and Norway, respectively. CONCLUSIONS The difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936, whereas Brazil has attempted to do the same for only a few years. Differences for drugs may be related to different patterns in the use of stimulants, cannabis and medicines.

Efeitos das condições macroeconômicas sobre a saúde no Brasil

OBJETIVO: Analisar a relacao entre condicoes macroeconomicas e saude no Brasil. METODOS: Para analisar o impacto do emprego e a renda sobre a mortalidade, utilizou-se um painel de dados para o Brasil em nivel estadual para o periodo de 1981-2002. Como proxy para saude, foram utilizadas as informacoes sobre a taxa de mortalidade obtidas do Sistema de Informacoes sobre Mortalidade (SIM). Para as condicoes macroeconomicas, foram empregadas as variaveis emprego e renda media e para os aspectos socioeconomicos, considerou-se a taxa de analfabetismo. Os efeitos das variaveis foram estimados por modelos estatico e dinâmico a fim de analisar duas hipoteses: 1) a hipotese de Ruhm, que sugere que elevadas taxas de emprego e de renda estao associadas com maior taxa de mortalidade e 2) a hipotese de Brenner, que indica que elevadas taxas de emprego e de renda estao relacionadas a menores taxas de mortalidade. RESULTADOS: A relacao entre a taxa de mortalidade (proxy utilizada para a saude) com as condicoes macroeconomicas (mensurada por meio da taxa de emprego) se mostrou negativa. As estimativas indicaram que a taxa de mortalidade total foi maior nos periodos de recessao economica, sugerindo que a medida que as condicoes macroeconomicas melhoram, aumentando o nivel de emprego na economia, ocorreu uma queda na taxa de mortalidade. A estimativa para a relacao entre a taxa de analfabetismo (proxy utilizada para o nivel educacional) e a taxa de mortalidade mostrou o papel que maiores niveis de escolaridade tem na melhora da saude. CONCLUSOES: Os resultados encontrados a partir do modelo estatico e dinâmico para a relacao entre a taxa de mortalidade e as condicoes macroeconomicas favorecem a aceitacao da hipotese de Brenner, em que elevadas taxas de emprego estao relacionadas a menores taxas de mortalidade.OBJECTIVE To analyze the relationship between macroeconomic conditions and health in Brazil. METHODS The analysis of the impact of employment and income on mortality in Brazil was based on panel data from Brazilian states between 1981 and 2002. Mortality rates obtained from the national mortality database was used as a proxy for health status, whereas the variables employment, income, and illiteracy rates were used as proxies for macroeconomic and socioeconomic conditions. Static and dynamic models were applied for the analysis of two hypotheses: a) there is a positive relationship between mortality rates and income and employment, as suggested by Ruhm; b) there is a negative relationship between mortality rates and income and employment, as suggested by Brenner. RESULTS There was found a negative relationship between mortality rates (proxy for health) and macroeconomic conditions (measured by employment rate). The estimates indicated that the overall mortality rate was higher during economic recession, suggesting that as macroeconomic conditions improved, increasing employment rates, there was a decrease in the mortality rate. The estimate for the relationship between illiteracy (proxy for education level) and mortality rate showed that higher levels of education can improve health. CONCLUSIONS The results from the static and dynamic models support Brenners hypothesis that there is a negative relationship between mortality rates and macroeconomic conditions.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

OBJECTIVE To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. METHOD This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. RESULTS A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). CONCLUSIONS In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

Panel data analysis of health status in Northeast Brazil

OBJETIVO: Analisar fatores determinantes do status de saude em cada estado da Regiao Nordeste do Brasil. METODOS: Estudo utilizando a metodologia de dados em painel, com informacoes agregadas para municipios. Os dados compreendem os anos de 1991 e 2000, e foram obtidos no Atlas do Desenvolvimento Humano do Programa das Nacoes Unidas para o Desenvolvimento, e Secretaria do Tesouro Nacional. Utilizou-se como indicador do status de saude, a taxa de mortalidade infantil, e como determinantes as variaveis: gastos com saude e saneamento per capita, numeros de medicos por mil habitantes, acesso a agua tratada, taxa de fecundidade e de analfabetismo, percentual de maes adolescentes, renda per capita e indice de Gini. RESULTADOS: As taxas de mortalidade infantil na regiao Nordeste reduziram-se em 31,8% no periodo analisado, desempenho pouco superior ao apresentado para a media nacional. No entanto, em alguns estados, como Rio Grande do Norte, Bahia, Ceara e Alagoas, a reducao foi mais significativa. Isso pode ser atribuido a melhora de alguns indicadores que sao os principais determinantes da reducao da taxa de mortalidade infantil: maior acesso a educacao, reducao da taxa de fecundidade, aumento da renda, e do acesso a agua. CONCLUSOES: Os estados que apresentaram maiores ganhos no acesso a agua tratada, educacao, renda e reducao da taxa de fecundidade, foram tambem os que obtiveram maiores ganhos na reducao da mortalidade de menores de um ano de idade.OBJECTIVE To assess health status determinants in Brazils Northeast states. METHODS Study carried out based on panel data analysis of aggregated information for municipalities. Data was obtained from the United Nations Development Program Atlas of Human Development and Brazilian National Treasury Department for the years 1991 and 2000. Health status indicator was infant mortality rate and health determinants were the following variables: per capita health and sanitation expenditure; number of physicians per inhabitant; access to drinking water; fertility rate; illiteracy rate; percentage of adolescent mothers; per capita income; and Gini coefficient. RESULTS Infant mortality rates in Northeast Brazil were reduced by 31.8%, during the period studied, slightly above the national average. However, in some states, such as Rio Grande do Norte, Bahia, Ceará and Alagoas, the reduction was more significant. This can be attributed to improvement in some indicators that are main determinants of infant mortality rate reduction: greater access to education, reduction of fertility rates, increased income, and access to drinking water. CONCLUSIONS Brazilian states that showed greater gains in access to drinking water, education, income and reduction of fertility rates were also the ones that achieved major reductions in mortality of children under a year of age.

Effects of macroeconomic conditions on health in Brazil

OBJETIVO: Analisar a relacao entre condicoes macroeconomicas e saude no Brasil. METODOS: Para analisar o impacto do emprego e a renda sobre a mortalidade, utilizou-se um painel de dados para o Brasil em nivel estadual para o periodo de 1981-2002. Como proxy para saude, foram utilizadas as informacoes sobre a taxa de mortalidade obtidas do Sistema de Informacoes sobre Mortalidade (SIM). Para as condicoes macroeconomicas, foram empregadas as variaveis emprego e renda media e para os aspectos socioeconomicos, considerou-se a taxa de analfabetismo. Os efeitos das variaveis foram estimados por modelos estatico e dinâmico a fim de analisar duas hipoteses: 1) a hipotese de Ruhm, que sugere que elevadas taxas de emprego e de renda estao associadas com maior taxa de mortalidade e 2) a hipotese de Brenner, que indica que elevadas taxas de emprego e de renda estao relacionadas a menores taxas de mortalidade. RESULTADOS: A relacao entre a taxa de mortalidade (proxy utilizada para a saude) com as condicoes macroeconomicas (mensurada por meio da taxa de emprego) se mostrou negativa. As estimativas indicaram que a taxa de mortalidade total foi maior nos periodos de recessao economica, sugerindo que a medida que as condicoes macroeconomicas melhoram, aumentando o nivel de emprego na economia, ocorreu uma queda na taxa de mortalidade. A estimativa para a relacao entre a taxa de analfabetismo (proxy utilizada para o nivel educacional) e a taxa de mortalidade mostrou o papel que maiores niveis de escolaridade tem na melhora da saude. CONCLUSOES: Os resultados encontrados a partir do modelo estatico e dinâmico para a relacao entre a taxa de mortalidade e as condicoes macroeconomicas favorecem a aceitacao da hipotese de Brenner, em que elevadas taxas de emprego estao relacionadas a menores taxas de mortalidade.OBJECTIVE To analyze the relationship between macroeconomic conditions and health in Brazil. METHODS The analysis of the impact of employment and income on mortality in Brazil was based on panel data from Brazilian states between 1981 and 2002. Mortality rates obtained from the national mortality database was used as a proxy for health status, whereas the variables employment, income, and illiteracy rates were used as proxies for macroeconomic and socioeconomic conditions. Static and dynamic models were applied for the analysis of two hypotheses: a) there is a positive relationship between mortality rates and income and employment, as suggested by Ruhm; b) there is a negative relationship between mortality rates and income and employment, as suggested by Brenner. RESULTS There was found a negative relationship between mortality rates (proxy for health) and macroeconomic conditions (measured by employment rate). The estimates indicated that the overall mortality rate was higher during economic recession, suggesting that as macroeconomic conditions improved, increasing employment rates, there was a decrease in the mortality rate. The estimate for the relationship between illiteracy (proxy for education level) and mortality rate showed that higher levels of education can improve health. CONCLUSIONS The results from the static and dynamic models support Brenners hypothesis that there is a negative relationship between mortality rates and macroeconomic conditions.

Detection of ethanol in Brazilian gasoline station attendants

In Brazil, gasoline station attendants are regularly exposed to the ethanol contained in fuel, as well as the one used as the gasoline additive. This study aimed to assess the potential exposure of these workers to fuels, using breathalyzers and oral fluid (OF) analysis by headspace gas chromatography/mass spectrometry (HS-GC/MS). Attendants of 26 gasoline stations were invited to respond to a questionnaire covering the main features of the study population and the profile of drinking and driving behavior, followed by a breath test and OF collection with a Quantisal™ device. All OF samples were analyzed by HS-GC/MS. Ethanol was found in 100% of the OF samples whereas 72.83% had concentrations above the quantification limit of the method (0.00125 g dL−1). Regarding the breath tests, only one exhaled air sample (0.62%) showed a positive result (0.03 mg L−1). The positive results in OF samples and negative results in exhaled air may be explained by the higher sensitivity of OF analysis by HS-GC/MS, when compared to the breathalyzer.

Comparison of Cocaine/Crack Biomarkers Concentrations in Oral Fluid, Urine and Plasma Simultaneously Collected From Drug Users

The use of oral fluid (OF) as an alternative specimen for drug analysis has become very popular in forensic toxicology. Many clinical studies have evaluated the correlations between concentrations of cocaine and its metabolites in OF and other matrices, but results have shown high variability. In addition, there are no data available regarding the correlations between biomarkers of crack-cocaine use in different matrices. This study evaluated the relationship between concentrations of cocaine/crack-cocaine biomarkers in OF, urine and plasma samples collected from cocaine users. All samples were analyzed for the presence of cocaine (COC), benzoylecgonine (BZE) and anhydroecgonine (AEC) by a validated liquid chromatography-mass spectrometry method. Median COC, BZE and AEC concentrations ranged from 4.20 to 33.26 ng/mL, from 13.03 to 3,615.86 ng/mL and from 7.40 to 1,892.5 ng/mL across matrices, respectively. The relationship between drug concentrations in OF versus plasma (OF/P) and OF versus urine (OF/U) was evaluated by their coefficients of determination (R2). Least-squares regression analyses demonstrated significant correlations between OF/P and OF/U for cocaine and BE (P < 0.05), with R2 = 0.17, 0.07 for cocaine and R2 = 0.73, 0.45 for BE, respectively. The correlation coefficients (r) found for BZE, COC and AEC in OF/P and OF/U were 0.85 and 0.67 (P < 0.05); 0.41 and 0.26 (P < 0.05); and 0.30 and -0.37 (P > 0.05), respectively. Many factors contribute to the variability of drug correlation ratios in studies involving random samples, including uncertainty about the time of last administration and dosage. Overall, we found significant R2 values for COC and BZE in OF/P and OF/U, but not for AEC. Despite the good correlations found in some cases, especially for BZE, the large variation in drug concentrations seen in this work suggests that OF concentrations should not be used to estimate concentrations of COC, BZE or AEC in plasma and/or urine.