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Introducción: El trauma abdominal se considera un problema de salud significativo, debido a que su cinemática ocasiona lesiones tanto anatómicas como funcionales de los órganos del abdomen. Objetivo: Caracterizar el trauma abdominal en un grupo de pacientes lesionados del Hospital Universitario General Calixto García. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal en los pacientes con trauma abdominal atendidos en el Servicio de Cirugía General desde enero de 2017 hasta diciembre de 2019. La muestra fue de 879 pacientes. Resultados: Existió un mayor número de pacientes con trauma abdominal en el grupo etario de 19-29 años, con una prevalencia del sexo masculino. Predominaron los accidentes de tránsito como la principal causa de trauma abdominal con el 52 por ciento. Prevalecieron las lesiones sobre órganos macizos, con mayor frecuencia en el hígado con un 33 por ciento. El tratamiento que con mayor asiduidad se empleó fue el quirúrgico, lo que representa el 83 por ciento con respecto al manejo conservador. Conclusiones: Por su ubicación y funcionalidad, las lesiones asociadas a trauma abdominal se convierten en un factor que representa gran riesgo para la vida del paciente. Los accidentes de tránsito continúan estando dentro de las primeras causas de trauma abdominal. Aunque la conducta conservadora ha ganado adeptos, existe un predominio en el tratamiento quirúrgico apoyado fundamentalmente en la sintomatología de los pacientes y en los medios diagnósticos(AU)

Introduction: Abdominal trauma is considered a significant health problem due to the fact that its kinematics causes both anatomical and functional injuries to the abdominal organs. Objective: To characterize abdominal trauma in a group of injured patients from Hospital Universitario General Calixto García. Methods: An observational, descriptive, prospective and cross-sectional study was conducted in patients with abdominal trauma attended at the general surgery service from January 2017 to December 2019. The sample was 879 patients. Results: There was a higher number of patients with abdominal trauma within the age group 19-29 years, with a prevalence of the male sex. Road traffic accidents predominated as the main cause of abdominal trauma, accounting for 52 percent. Injuries to solid organs prevailed, most frequently to the liver, accounting for 33 percent. The most frequently used treatment was surgical, which represents 83 percent with reference to conservative management. Conclusions: Due to their location and functionality, injuries associated with abdominal trauma become a factor that represents a great risk for the patient's life. Road traffic accidents continue to be among the first causes of abdominal trauma. Although the conservative approach has gained followers, there is a predominance of surgical treatment supported mainly by the patients' symptomatology and diagnostic means(AU)

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Aim: At the University Medical School Hospital in Honduras, a paper-based injury surveillance system (InSS) registered all injury cases in the emergency department in 2013. This is the first study to identify the injury profiles of children in Honduras, using the InSS data. Materials and methods: A case-series study was carried out using the InSS. Children aged 0-14 years were identified in the data set, and the descriptive statistics and bivariate analyzes were completed using this data. Results: Of 17,971 study patients, 5,873 (32.7%) patients were 0-14 years old with an average age of 7.3 ± 4.1 years. Unintentional injuries, most commonly road traffic incidents, falls, and blunt force trauma, constituted 94.2% of the total injuries. In all, 1.9% (109) self-inflicted injuries and 3.9% (230) deliberate interpersonal injuries with 35.8% due to blunt force trauma and 22.6% due to gunshot wounds. The mortality rate was 0.2%, and 84% of children spent 3 or fewer days in the hospital. Firearm injuries were more severe and resulted in a longer hospital stay. Conclusion: Childhood injuries are highly prevalent and a public concern throughout Honduras. This study profiles these injuries of over an entire year and provides insight into the types of interventions that could be effective in preventing and managing the high burden of pediatric injuries in this region. Clinical significance: This study provides the groundwork to profiling the high burden of injuries in Honduran children. Targeted injury prevention strategies and interventions can begin to be developed and implemented using the profile.

Objetivo: En el Hospital Escuela de la Facultad de Medicina de la Universidad de Honduras, un sistema de vigilancia de lesiones en papel (InSS) registró todos los casos de lesiones en el Departamento de Emergencias en el año 2013. Utilizando los datos del InSS, este estudio es el primero en describir el perfil de las lesiones en niños en Honduras. Materiales y métodos: Se realizó un estudio de serie de casos utilizando el InSS. Se identificaron los pacientes de 0 a 14 años en el conjunto de datos, y se realizaron estadísticas descriptivas y análisis bivariados utilizando estos datos. Resultados: Hubo 5.873 pacientes de 0­14 años de un total de 17.971 pacientes (32,7%) con una edad promedio de 7,3 ± 4,1 años. Las lesiones no intencionales, más comunes fueron los eventos de tránsito, las caídas y los traumatismos contundentes; en total constituyeron el 94,2% del total de lesiones. Hubo 1.9% (109) lesiones autoinfligidas y 3.9% (230) lesiones interpersonales deliberadas con 35.8% debido a traumatismos contundentes y 22.6% debido a heridas por armas de fuego. La tasa de mortalidad fue del 0,2% y el 84% de los niños pasaron 3 días o menos en el hospital. Las lesiones por arma de fuego fueron más graves y resultaron en una estancia hospitalaria más prolongada. Conclusión: Las lesiones infantiles son altamente prevalentes y una preocupación en salud pública en Honduras. Este estudio describe estas lesiones y proporciona información sobre los tipos de intervenciones que podrían ser efectivas para prevenir y manejar la alta carga de lesiones pediátricas en esta región. Importancia clínica: El estudio proporciona la base para perfilar la alta carga de lesiones en los niños hondureños. Estrategias e intervenciones de prevención de lesiones pueden comenzar a desarrollarse e implementarse utilizando este perfil.

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Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.

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Os Acidentes de Transporte Terrestre (ATT) têm significativo impacto na sociedade. Suas consequências implicam em número elevado de internações hospitalares, gastos em saúde pública e perda da produtividade. Analisar a tendência temporal de internações por ATT em Santa Catarina, no período entre 2008 a 2016. Trata-se de um estudo ecológico de séries temporais, com dados de 61.412 mil internações por ATT, em população residente em Santa Catarina, segundo sexo e faixa etária. Foram analisados os registros referentes às internações por ATT segundo ano, sendo esta a variável independente (2008 a 2016) e as variáveis dependentes, a taxa geral, a taxa de internação segundo sexo e faixa etária. Para a análise da tendência temporal pelo método de regressão linear simples foram utilizadas as taxas de internação.A taxa geral de internação por ATT aumentou em 91,01%, passando de 65,99 (2008) para 126,03/100.000 habitantes (2016). O aumento foi mais elevado no sexo masculino (94,25%), com tendência linear crescente, passando de 50,59 (2008) para 98,26/100.000 habitantes (2016). Entre as mulheres o aumento no período foi de 80,44%. A maior incidência de internações ocorreu na faixa etária dos 20 aos 39 anos (89.54%), seguida da faixa entre 40 a 59 anos, com 128.41%. Pode-se concluir que a tendência das internações por ATT no Estado de Santa Catarina foi crescente entre 2008 e 2016, em maiores proporções no sexo masculino e na faixa etária 20-39 anos.

Road traffic accidents (RTA) have a significant impact on society. Its consequences imply high numbers of hospital admissions, public health expenditures, and lost productivity. To analyze the temporal tendency of hospitalizations by RTA in Santa Catarina, between 2008 and 2016. This is an ecological time-trend study, with data of 61,412 thousand hospitalizations per RTA in a resident population in Santa Catarina, according to gender and age group. The records referring to hospitalizations for RTA according to year were analyzed, being this the independent variable (2008 to 2016) and the dependent variables were the general rate, the hospitalization rate according to sex and age group. For the time trend analysis through simple linear regression method, hospitalization rates were used. The general rate RTA increased by 91.01%, from 65.99 (2008) to 126.03 / 100,000 (2016). The increase was higher in males (94.25%), with a linear trend increasing, from 50.59 (2008) to 98.26 / 100.000 inhabitants (2016). Among women, the increase in the period was 80.44%. The highest incidence of hospitalizations occurred in the age group 20 to 39 years (89.54%), followed by the age range of 40 to 59 years, with 128.41%. It can be concluded that the tendency of hospitalizations for RTA in the State of Santa Catarina was increasing between 2008 and 2016, in greater proportions in males and in the age group 20-39 years.

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INTRODUCCIÓN: En el Estado de México no existen investigaciones que proporcionen información para toma de decisiones y administración de recursos relacionados con la atención de las lesiones por causa externa (LCE). OBJETIVO: Describir las LCE en un servicio de urgencias durante un periodo de cinco años. MÉTODO: Se diseñó un estudio retrospectivo con pacientes que ingresaron al servicio de urgencias (2010-2015) por diagnóstico de LCE. Se realizó análisis descriptivo y de clúster. RESULTADOS: En el servicio de urgencias, 16.59 % de las atenciones derivaron de LCE. Se incluyeron 16 567 pacientes de 14 a 99 años (media o promedio = 37.7, DE = 17.28), 69.2 % fue del sexo masculino. Las LCE principalmente ocurrieron en la vía pública (26.3 %) y en el hogar (23.7 %). Las causas más frecuentes fueron agresiones fuera del hogar (32.7 %), en promedio a los 34 años; caídas (25 %) en promedio a los 45 años; accidentes ocasionados por vehículos de motor (9.7 %), en promedio a los 33 años. El análisis por clúster identificó cuatro grupos: agresiones fuera del hogar 32.7 % (5417), contactos traumáticos 26.30 % (4363), accidentes de tránsito 15.9 % (2,640) y caídas 25 % (4147). CONCLUSIÓN: Las LCE relacionadas con vehículos de motor mostraron consecuencias más severas. BACKGROUND: In the State of Mexico there are no investigations that provide information for decision-making and administration of resources related to the care of externally-caused injuries (ECI). OBJECTIVE: To describe ECIs seen in an emergency department over a 5-year period. METHOD: A retrospective study was designed with patients admitted to emergency department (2010-2015) with ECI diagnosis. Descriptive and cluster analyses were performed. RESULTS: At the emergency department, 16.59% of emergency care was related to ECI. A total of 16,567 patients of 14 to 99 years of age (average = 37.7; SD = 17.28) were included; 69.2% were males. ECIs occurred mainly in public places (26.3%) and at home (23.7%). The main causes were aggression outside the home (32.7%), on average at 34 years of age, falls (25%) on average at 45 years, and motor vehicle accidents (9.7%) on average at 33 years. The cluster analysis identified four groups: aggression outside the home 32.7% (5,417), traumatic contacts, 26.30% (4,363), road traffic accidents 15.9% (2,640) and falls 25% (4,147). CONCLUSIONS: Motor vehicle accident-related ECIs showed the most severe consequences.

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Introducción: Los siniestros de tránsito son considerados un problema de salud pública a nivel mundial que repercuten en la sociedad, e inciden en la economía y en el sistema de salud de un país. Se considera dentro de las principales causas de muerte en el mundo. Entre los siniestros de tránsito, los asociados con las motos han llamado la atención a investigadores, debido a su alta participación porcentual. Objetivo: Evaluar los siniestros de moto ocurridos en la ciudad de Medellín-Colombia entre los años 2008 al 2014. Materiales y métodos: Se tomó la información reportada mensualmente por la Secretaría de Tránsito de 107.125 casos relacionados con los siniestros de tránsito asociados con los conductores de moto. Se utilizó análisis probabilístico, descriptivo exploratorio de tipo unidimensional y análisis MANOVA. Resultados: Se encontró un incremento significativo en los siniestros asociados con la conducción de motos, en la ciudad de Medellín en los últimos años, detectando diferencia (p<0,01) entre sexos, entre rangos de edad y tipos de siniestro. Conclusión: Esta investigación permitió evidenciar una tendencia creciente en la cantidad de heridos y personas fenecidas asociadas a la participación de motociclistas o de acompañantes, anotando que la mayoría perten|r{ al sexo masculino, en edades que oscilan entre los 20 y 29 años.

Introduction: Road traffic injuries are considered a public health problem worldwide which have an impact on society, economy and the health system of a country. It is considered one of the main causes of death around the world. Among road traffic injuries, those associated with motorcycles have drawn attention to researchers due to its high percentage participation. Objective: To evaluate motorcycle accidents that occurred between 2008 and 2014 in Medellin, Colombia.Materials and methods: The information reported monthly by the Secretariat of Transportation of 107.125 cases related to traffic accidents associated with motorcycle riders was taken. Probabilistic analysis, descriptive and exploratory analysis of dimensional type, and MANOVA were used. Results: A significant increase in road traffic injuries associated with motorcycle riding was found in the city of Medellin during the last years as well as the difference (p <0,01) between sexes, age ranges and types of loss. Conclusion: This research allowed to highlight an increasing trend in the number of wounded and defunct people associated with the participation of motorcycle riders or passengers, noting that the majority of them were males between 20 and 29 years old.

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Resumo As lesões decorrentes dos acidentes com motociclistas constituem importante problema de saúde pública no Brasil. Objetivou-se descrever as características de motociclistas envolvidos em acidentes de transporte, atendidos em serviços públicos de urgência e emergência nas capitais de estado e no Distrito Federal. Estudo transversal com base nos dados do Inquérito sobre Violências e Acidentes em Serviços de Urgência e Emergência (VIVA Inquérito) de 2014. Os dados foram analisados segundo características sociodemográficas, do evento e do atendimento. Diferenças proporcionais entre os sexos foram analisadas pelo teste do qui-quadrado (Rao-Scott) com nível de significância de 5%. Do total de atendimentos de motociclistas, predominaram homens (n = 9.673), (razão de sexo = 3,2), jovens de 20 a 39 anos (65,7%), pretos/pardos (73,6%), com atividade remunerada (76,4%). Uso de capacete foi relatado por 79,1% das vítimas, 13,3% haviam consumido álcool nas seis horas anteriores ao acidente, 41,4% dos eventos estavam relacionados ao trabalho da vítima. Os acidentes foram mais frequentes nos finais de semana, durante a manhã e final da tarde. Estas características pode apoiar o desenvolvimento de políticas públicas de prevenção de acidentes e na promoção da saúde.

Abstract Injuries resulting from motorcycle road traffic accidents are an important public health issue in Brazil. This study aimed to describe the characteristics of motorcyclists involved in traffic accidents attended in public urgent and emergency services in the state capitals and the Federal District. This is a cross-sectional study based on data from the Violence and Accident Surveillance System (VIVA Survey) in 2014. Data were analyzed according to sociodemographic, event and attendance characteristics. Proportional differences between genders were analyzed by chi-square test (Rao-Scott) with 5% significance level. Motorcyclist-related attendances (n = 9,673) reported a prevalence of men (gender ratio = 3.2), young people aged 20–39 years (65.7%), black / brown (73.6%), paid work (76.4%). Helmet use was reported by 79.1% of the victims, 13.3% had consumed alcohol in the six hours prior to the accident, 41.4% of the events were related to the victim's work. Accidents were more frequent on weekends, in the morning and late afternoon. These characteristics can support the development of public accident prevention policies and health promotion.

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INTRODUCTION: More than 90% of traumatic morbidity and mortality occurs in low- and middle-income countries (LMIC). Haiti is the poorest country in the Western Hemisphere and lacks contemporary statistics on the epidemiology of traumatic injuries. This study aimed to characterize the burden of traumatic injuries among emergency department patients in the Northeast region of Haiti. METHODS: Data were collected from the emergency departments of all public hospitals in the Northeast region of Haiti, which included the Fort Liberté, Ouanaminthe, and Trou du Nord sites. All patients presenting for emergent care of traumatic injuries were included. Data were obtained via review of emergency department registries and patient records from October 1, 2013 through November 30, 2013. Data on demographics, mechanisms of trauma, and anatomical regions of injury were gathered using a standardized tool and analyzed using descriptive statistics. Temporal analysis of injury frequency was explored using regression modeling. RESULTS: Data from 383 patient encounters were accrued. Ouanaminthe Hospital treated the majority of emergent injuries (59.3%), followed by Fort Liberté (30.3%) and Trou du Nord (10.4%). The median age in years was 23 with 23.1% of patients being less than 15 years of age. Road traffic accidents (RTAs) and interpersonal violence accounted for 65.8% and 30.1% of all traumatic mechanisms, respectively. Extremity trauma was the most frequently observed anatomical region of injury (38.9%), followed by head and neck (30.3%) and facial (19.1%) injuries. Trauma due to RTA resulted in a single injury (83.8%) to either an extremity or the head and neck regions most frequently. A minority of patients had medical record documentation (37.9%). Blood pressure, respiratory rate, and mental status were documented in 19.3%, 4.1%, and 0.0% of records, respectively. There were 6.3 injuries/day during the data collection period with no correlation between the frequency of emergent trauma cases and day of the week (R(^2)=0.01). CONCLUSIONS: Traumatic injuries are a common emergent presentation in the Northeast region of Haiti with characteristics similar to other LMIC. Documentation and associated data to adequately characterize the burden of disease in this region are lacking. Road traffic accidents are the predominate mechanism of injury, suggesting that interventions addressing prevention and treatment of this common occurrence may provide public health benefits in this setting.

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INTRODUCCIÓN: En Argentina, los años de vida potencialmente perdidos (AVPP) atribuibles a lesiones por tránsito (LT)han mostrado un incremento del 68% en los últimos 10 años. Este trabajo plantea la importancia de construir la información sobre este tipo de lesiones a partir de múltiples fuentes de datos. OBJETIVO: Describir la epidemiología, la letalidad y los factores de riesgo presentes en los lesionados por tránsito (LT) en el Partido de General Pueyrredón (PGP), Provincia de Buenos Aires, entre junio de 2010 y mayo de 2011. MÉTODOS: Mediante un diseño transversal con análisis multivariado y espacial, se estudiaron las características epidemiológicas de LT en el PGP durante 12 meses a partir de cinco fuentes de datos. RESULTADOS: De 4.832 LT, el 66% fueron varones. Los motociclistas fueron el 51% y representaron el 36% de óbitos. En los mayores de 60 años, el 40% fueron peatones y se presentó la mayor letalidad. De cada 100 LT, 30 fueron internados y 1 falleció. Hubo mayor porcentaje de usuarios vulnerables (76%) que en otras publicaciones. Se hallaron cuatro tipologías: a) motociclistas varones jóvenes; b) ocupantes de vehículo a motor de cuatro ruedas; c) menores de 15 años; d) mujeres peatones y ciclistas. CONCLUSIONES: Los datos epidemiológicos y sobre factores de riesgo obtenidos a partir de múltiples fuentes contribuyen a diseñar estrategias eficaces de prevención. Es necesario promover el trabajo en red e intersectorial para alcanzar un abordaje complejo y multicausal.

INTRODUCTION: In Argentina, potential years of life lost due to premature death (PYLL) attributable to traffic injuries have increased over 68% the last 10 years. This paper discusses the importance of building information about this kind o injuries from multiple data sources. OBJECTIVE: To describe epidemiology, lethality and risk factors in people injured in road traffic accidents (PIRTA) at General Pueyrredón District (GPD), Province of Buenos Aires, from June 2010 to May 2011. METHODS: A cross-sectional design with multivariate and spatial analysis was used to study the epidemiological characteristics of PIRTA in GPD during 12 months. Five data sources were used. RESULTS: Out of 4832 PIRTA, 66% were males. Motorcyclists totaled 51%, with a death rate of 36%. The over 60s age group had 40% of pedestrians and showed the highest lethality. Out of 100 PIRTA, 30 were hospitalized and 1 died. The rate of vulnerable users (76%) was higher than in other publications. The analysis presented four typologies: a)young male motorcyclists; b) four-wheel motor vehicle occupants;c) people younger than 15 years old; d) women pedestrians and cyclists. CONCLUSIONS: Epidemiological and risk factor data obtained from multiple sources contribute to designing effective prevention strategies. It is necessary to promote networking and intersectoral work in order to have a complex, multicausal approach.

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Maxillofacial injuries can cause significant long-term functional, esthetic, and psychological complication. Besides, these injuries may pose a substantial economic consequence for the patients as the treatment may involve a complex procedure. The purpose of the current retrospective study was to investigate the pattern of maxillofacial fractures in Medellín, Colombia over a 13-year period (1998-2010). A retrospective study of 2680 subjects with 4893 maxillofacial fractures admitted at the Oral and Maxillofacial Surgery Department of the San Vicente de Paul University Hospital in Medellín, Colombia, is presented. The patients were evaluated by age, gender, etiology, type of injury, treatment modalities and hospitalization time. The Chi-Square test was used to compare the counts of categorical response between two independent variables. The study population consisted of 2193 males and 487 females with a mean age of 26.5 (SD: 13.5) years. The age group 21-30 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related followed by interpersonal violence. There were mainly mandibular, maxilla alveolar process and zygomatic bone fractures in both males and females, accounting for approximately 92 percent of all fractures. The main fracture site of the mandible was the mandibular condyle. The results of the present study reveal that road traffic accidents remain among the main reasons of maxillofacial fractures. Measures on prevention of road traffic crashes and policies that strengthen social investment should be strongly emphasized in order to reduce the occurrence of these injuries.

Las lesiones maxilofaciales pueden causar complicaciones funcionales, estéticas y psicológicas significativas a largo plazo. Además, pueden representar una consecuencia económica sustancial para los pacientes, y su tratamiento puede implicar un procedimiento complejo. El propósito de este estudio retrospectivo fue investigar el patrón de las fracturas maxilofaciales en Medellín, Colombia en un período de 13 años (1998-2010). Se estudiaron 2.680 pacientes con 4.893 fracturas maxilofaciales, quienes ingresaron al Departamento de Cirugía Oral y Maxilofacial del Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Los pacientes fueron evaluados clasificados según edad, sexo, etiología de la fractura, tipo de lesión, tratamiento y tiempo de hospitalización. Se utilizó la prueba de chi-cuadrado para comparar los conteos de respuestas categóricas entre dos variables independientes. La muestra se conformó por 2.193 hombres y 487 mujeres, con una edad promedio de 26,5 años (DE 13,5). El grupo entre 21-30 años fue el más numeroso. La causa más común de fracturas fue el accidente de tránsito, seguido por la violencia interpersonal. En ambos sexos se observaron, principalmente, fracturas de la mandibula, proceso alveolar maxilar y hueso cigomático; aproximadamente el 92 por ciento de todas las fracturas. En la mandíbula, el sitio principal de fractura fue el cóndilo mandibular. Los resultados revelan que los accidentes de tránsito aun son la principal causa de fractura maxilofacial. Se debe enfatizar en medidas de prevención de los accidentes de tránsito, junto a políticas que fortalezcan la inversión social con el fin de reducir la aparición de estas lesiones.

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Objetivo: comparar o risco de morte por ATT antes e depois na implantação da Lei 11.705 (Lei Seca), que restringe o consumo de bebida alcoólica no Brasil. Metodologia: foram avaliados os dados do Sistema de Informações sobre Mortalidade (SIM) de 2007 a 2009. Avaliaram-se as variações da taxa padronizada de mortalidade por ATT e respectivos intervalos de confiança de 95 por cento no período anterior (julho/2007 a junho/2008) e posterior (julho/2008 a junho/2009) à implantação da Lei Seca. Resultados: identificou-se redução proporcional significativa no risco de morte por ATT, variando de -7,4 por cento para o Brasil a -11,8 por cento nas capitais, principalmente entre os homens (-8,3 por cento e -12,6 por cento, respectivamente). Conclusões: recomenda-se a manutenção e ampliação da fiscalização e educação para o trânsito e ainda a continuidade de estudos analíticos para melhor avaliar o impacto da medida restritiva ao álcool e direção.

Objective: to compare the risk of death due to road traffic accidents (RTA) before and after the implementation of Law Number 11,705 (Dry Law) that restricts the consumption of alcoholic beverages in Brazil. Methodology: data from the Mortality Information System (SIM), from 2007 to 2009, were evaluated. The standardized RTA death rate variations and their respective confidence intervals of 95 per cent were evaluated in the period from July 2007 to June 2008 (before the Dry Law) and from July 2008 to June 2009 (after the implementation of the Dry Law). Results: a significant proportional reduction in RTA death rates was observed, ranging from 7.4 per cent for Brazil to 11.8 percent for state capitals, especially among men (-8.3 percent and -12.6 percent, respectively). Conclusions: the continuous maintenance and increase in surveillance and traffic education activities along with the development of analytical studies to better evaluate the impact of such restrictive measures are recommended.

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En los últimos años los accidentes de tránsito sufridos por los trabajadores mientras llevan a cabo su jornada laboral, han aumentado en número y severidad. En el presente trabajo se estudiaron los accidentes de tránsito que fueron valorados como riesgo laboral en la Sección de Medicina del Trabajo durante los años 2006-2007 (total de casos evaluados por esta causa 121). Obteniéndose del mismo una caracterización del trabajador afectado, siendo este, de sexo masculino, entre 30 y los 49 años, chofer o mensajero motorizado. Además se logró determinar que la mayoría de las lesiones presentadas por estos trabajadores correspondió con fracturas de los miembros inferiores (tibia y peroné) y con traumatismo craneoencefálicos, resultando como secuelas más destacadas el dolor residual y la limitación funcional, por lo que se les otorgó una incapacidad temporal y permanente acorde con la severidad de sus secuelas...

Assuntos

RESUMO

Resumen: En México los accidentes son un grave problema de salud pública. Estos eventos de tipo traumático tienen una probabilidad potencial de ocurrir de forma fortuita en cualquier momento de la vida de los individuos. Actualmente ocupan la tercera causa de mortalidad general y la primera en adultos jóvenes. Los accidentes producidos por vehículos de motor ocupan el primer puesto dentro del rango de los accidentes en general, esto de acuerdo a las tasas de mortalidad en adultos jóvenes que publican la OMS, la OPS y la SSA en México. Una de las consecuencias de los accidentes de tránsito por vehículo de motor es la secuela psicológica que dejan en los individuos en edad productiva. Estas secuelas se conocen como Trastorno por Estrés Postraumático (TEPT) y a pesar de que en nuestro país existen cifras alarmantes de ausentismo laboral y baja en la productividad como consecuencia de ello, no ha sido estudiado a profundidad. El Estrés Postraumático es un trastorno de ansiedad causante de disfunción psicosocial y aparece en condiciones de exposición a un estresor traumático. La etiología del TEPT es multifactorial y en ella intervienen factores genéticos, psicológicos, educativos y ambientales. El propósito del presente estudio fue determinar la frecuencia del TEPT en pacientes que hubiesen tenido lesiones físicas por accidentes de tránsito (accidentes automovilísticos producidos por vehículos de motor) y que fueron atendidos en el Servicio de Ortopedia y Trauma, del Hospital Regional "Lic. Adolfo López Mateos" del ISSSTE. Para ello se diseño un estudio transversal descriptivo con muestreo no probabilístico seleccionando una muestra mediante los criterios de inclusión siguientes: ser mayor de 18 años, haber sufrido accidente por vehículo de motor, haber sido atendido al menos por un mes en el Servicio de Trauma y Ortopedia de ese centro hospitalario, y encontrarse en condiciones físicas y mentales para contestar un cuestionario. El instrumento fue un formato autoaplicable conformado por la Escala de Mississippi para el TEPT para tamizaje, selección de casos y medición de la severidad de los síntomas. También se incluyó la Cédula de Evaluación Clínica en Neuropsiquiatría de la OMS (Schedules for Clinical Assessment in Neuropsychiatry-SCAN), un instrumento que establece el perfil de afecto (PANAS), y por último una cédula de identificación para datos sociodemográficos. En el estudio participaron 37 sujetos que cumplieron con los criterios de inclusión. De éstos, 57% fueron hombres y 43% mujeres, con un promedio de edad de 35 años (DE=12.44); 40.5% eran solteros, 51.4% casados; 43.2% de los sujetos tenía nivel de educación básica y 56.8% media superior y superior. Para la calificación de TEPT, se determinó como casos a los sujetos que puntuaron por arriba de 5 en la Escala de Mississippi y posteriormente eran confirmados con la cédula SCAN. La mayoría de los sujetos que sufrieron accidentes fueron hombres (57%), los eventos ocurrieron en día sábado, cuando éstos se dirigían a su casa, en su automóvil y sin compañía. La mayoría de los sujetos estuvieron involucrados en choques vehiculares. De todos los casos, 62.2% cumplieron con los criterios para ser corroborados con TEPT, lo cual representa un porcentaje mayor al reportado en población mexicana. Se encontraron diferencias estadísticamente significativas en la proporción de sujetos que reportaron TEPT y el tipo de vehículo en que se encontraban al ocurrir el accidente (X2=9.868, p=.007), así como en el tiempo que había trascurrido desde el momento del mismo (X2=8.651, p=.013). De las pruebas de asociación con el perfil de afecto, el afecto negativo durante la última semana anterior al estudio tuvo una correlación positiva y significativa con el TEPT, es decir que a mayor afecto negativo hay más síntomas de estrés.

Summary: We have carried out this research because accidents are a serious public health problem in Mexico. They are the third overall mortality cause and the first among young adults. In addition, in our country, the study of posttraumatic stress disorder (PTSD) has not been focused sufficiently on accidents, not to speak of motor vehicles accidents. Among the different types of accidents, traffic accidents are placed at the top of the list. Aside from causing injuries and the loss of man hours at work, these accidents bring about emotional distress to affected individuals. Stress is a factor that triggers short-and medium-term consequences which are in turn reflected in the quality of life of the patient and his/her family. PTSD is an anxiety disorder that causes psychosocial disfunctioning and appears due to the exposure to a stressor or traumatic event. It may come about in two ways: when the subject is a victim of a serious threat to his/her life or integrity and when the subject witnesses an event seriously affecting a third party. The main stressors may be natural phenomena, such as hurricanes and earthquakes, intentional attacks, such as rape or any form of criminal violence, and, as is the case here, from traumatic events caused by motor vehicles. The etiology of PTSD is multi-factorial and involves genetic, psychological, educational, and environmental aspects. It has three forms: severe, where the disorder appears immediately after the occurrence of the event or until a month later; chronic, lasting between one and three months; and delayed, where symptoms appear six months after the event. Our objective was to establish PTSD frequency in patients with physical injuries caused by motor vehicles accidents who were attended at the Regional Orthopaedics and Trauma Hospital "Adolfo López Mateos". Together with the application of the scales, we were interested in making a description of the socio-demographical side of accidents, comparing the affect profile, and somehow defining the wide range of factors involved in the occurrence of this problem. For this, we devised a transversal and descriptive study with a non-probabilistic sampling. The sample was chosen using the following inclusion criteria: a) Being older than 18 years. b) Having suffered a motor vehicle accident. c) Having received attention for a month at least at the Orthopaedics and Trauma Hospital "Adolfo López Mateos". d) Having the physical and mental conditions to answer a self-report questionnaire or at least to be interviewed instead. The instrument used was a self-report questionnaire consisting of different scales: 1. The Mississippi PTSD Scale for screening, case selection and symptoms severity measurement. This scale has been translated and validated in Mexico. 2. The WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). 3. An instrument to establish the affect profile (PANAS). 4. A socio-demographical data identification schedule. Results from this study show some interesting characteristics from subjects involved in traffic accidents such as the fact that victims are mostly men driving alone at weekends. As has been pointed out, this supports the importance of putting into practice actions to educate drivers involved in such circumstances more often. In addition, policies which allow for the modification of traffic environments as to their adequateness to social contexts should be established. Likewise, data from this work agree with those from other studies as to the existence of an association between the presence of PTSD and the involvement in car accidents. Although the prevalence of the sample of this study is much higher than previous Mexican reports, it shows some interesting figures regarding the fact that most subjects who reported PTSD were women who had an elementary education level and a partner by the time of the accident. Falls from vehicles, people run over by cars and individuals driving alone at the time of accidents were other relevant high-impact findings. While it is true, on the one hand, that the aforementioned results are non-significant, they do give an idea of some aspects which would be useful to bear in mind in providing clinical attention to affected individuals. On the other hand, aspects which did have a statistical significance on the data from this sample should be taken into account. One of these was the fact that the higher rate of PTSD was reported in individuals who suffered an accident while being inside a vehicle, in individuals involved in an accident which had occurred between one and three months before and who in addition tended to present a negative affect profile. These are important findings because they give us the opportunity to consider more specific aspects at the time of developing attention strategies which could alleviate the temporal impact and scale of the problem.