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Objectives: The objective of this study was to identify the characteristics related to crash and victim, as well as the after-effects/disabilities and consequences arising from traffic crashes occurring in the city of Rio Branco-Acre.Methods: This is an analytical descriptive cross-sectional study conducted in the City of Rio Branco-Acre. The study population consisted of 405 residents of the city who were victims of traffic crashes, of all age groups and genders, who were hospitalized for the first time as a result of the crash in public hospitals and the health system network, as recorded in the Hospital Information System, and who were discharged between January 1 and December 31, 2010. The data sources included hospital record consultations and active searches for the victims. Hierarchical logistic regression was performed to evaluate the factors associated with the after-effects.Results: The majority of the study population was motorcycle victims (68.6%), male, and young (20-39 years). Concerning the after-effects, the following were significantly associated: factors related to the presence of a postcrash activity limitation (odds ratio [OR] = 2.39; 95% confidence interval [CI], 2.39-6.76), length of hospital stay in days (OR = 1 03; 95% CI, 1.01-1.06), and surgical treatment (OR = 1.82; 95% CI, 1.03-3.21). Those who suffered damage to soft tissue and nerves or facial injury showed an odds ratio of 2 to 4 times of having an after-effect/disability, independent of the victim's personal attributes.Conclusion: The mechanism, such as the origin of the pattern of injuries, explains the exposure factors shown by each attribute of the victim and their characteristics. Many of the injuries were precursors to after-effects/disabilities, which, due to their nature and extent, result in the modification of the apparently healthy living standards of young victims who are routinely injured in traffic crashes. Therefore, public policies for prevention should be formulated, reformulated, and implemented, taking into account each attribute of the victims and their social conditions, because these are closely related to their habits and customs. This is a starting point for promoting changes to the current reality that traffic crashes present in the morbidity and mortality of the population. [ABSTRACT FROM AUTHOR]

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The article focuses on the control and prevention of violence and injuries from other violent-related causing injuries in Brazil. Violence such as homicide and traffic-related injuries and deaths have accounted almost tow-thirds of overall deaths from external causes. However, domestic violence, though it may not lead to multiple deaths, share the largest part on violence-related morbidity. Brazil has advanced on legislation and actions plans in response to preventing violence and injuries.

This study examines the coping process of infertile couple during diagnostic investigation and treatment, which is held in a public hospital in the Assisted Reproduction Treatment department. This analysis discusses the results of a qualitative research whose goal is to emphasize the importance of integrating the medical and psychological care to infertile couples. To collect the data, it uses a semistructured psychological interview. This feature promotes a differentiated listening emotional aspects experienced by patients, allowing couples to greater reflection about their difficulties before the process of investigation and treatment of infertility. From the data, it appears that in addition to medical treatment, patients require in a psychological intervention centered emotional effects experienced by them throughout the process. Given the complexity of the process of Assisted Reproduction, it is essential to consider both the medical factors, essential for achieving the concept of biological child, as psychological factors, at the individual, marital and social. We conclude that the psychological dimension integrated medical help these patients to maximize their resources and seek more adaptive ways to minimize the possible dilemmas and anxiety experienced.

Suicide is prevalent among people of almost all ages and has a high social and economic cost. It is widely known, however, that its true prevalence is underestimated. This article aims to study suicide in São Paulo based on Public Safety data, compared with mortality information system data (SIM/MS), in order to assess possible information gains. A database (Banco SSP) was assembled from spreadsheets for police reports, complemented with existing Forensic Medicine Institute information, which was compared with the SIM/MS data. The Banco SSP database (2,469) was 7.5% higher than SIM/MS (2,297), with results reflected in the sex and age of the victims, showing the highest rates among elderly men (rate of 12.8 per 100,000 inhabitants). In relation to the method of suicide, there was a predominance of hanging (60.2%); 92.5% of unspecified cases were clarified, with an increase in deaths from exogenous poisoning (55.7%). The police reports revealed variables considered as possible risk factors for suicide, such as the mention of mental disorders (39.4%), other pathologies (5.0%), other problems (23.2%) and earlier attempted suicides (10.0%). The source studied enabled obtaining quantitative and qualitatively enhanced data compared to the SIM/MS data.

Objective: The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals., Methods: A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births., Results: A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition., Conclusions: The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

Objetivo: to describe hospitalization rates and to estimate hospital costs and time spent in hospital due to road traffic accidents (RTA) in Brazil, in 2013., Methods: this is an ecological study conducted using data from the Brazilian National Hospital Information System., Results: in 2013, 170,805 hospitalizations due to RTA were funded by the Brazilian National Health System; 78.2% of the individuals were male, 48.6% were from 20 to 39 years old, and 51.9% were motorcyclists; RTA hospitalization rate was of 85.0 hospitalizations/100,000 inhabitants; total cost was BRL 231,469,333.13, with 1,072,557 hospital inpatient days and average stay of 6.3 days in hospital., Conclusion: the magnitude of hospitalization due to RTA was high; victims hospitalized were mainly men, young adults and motorcyclists; average stay in hospital was almost a week, implying significant costs.

In view of the importance of knowing the circumstances associated with external causes (accidents and violence), this study analyzes the profile of the victims and their families as to the intentionality of the event (intentional or accidental). Cross-sectional study, which population comprise children, adolescents, and young people (age 0 to 24) who lived in Cuiabá, MT, and died from external causes in 2009. The data, processed by the Epi-Info software, were taken from the Declarations of Death and interviews with the families of the victims. The nonparametric chi-square test showed statistically significant differences between accidental and intentional deaths by sex and the type of accident or violence, the occurrence of the previous event external cause, parental education, family type, income, responsible for supporting the house, mother's age and caregiver. Among the victims, male participation (88.7 %) stands out compared to female (11.3 %). 50.0% of the deaths of females were accidental and 50.0% intentional; 68.2% of the deaths of males were intentional, 29.1% accidental and 2.7% from undetermined intent. Among the intentional deaths, 72.5% of the victims had already suffered violence. As the degree of instruction of the parents increases, intentional deaths decrease. The proportion of reconstituted/fragmented families is higher for fatal accidents. Intentional causes increase as family income decreases and the age of the parents increases. The agglomeration of people in the homes is higher for intentional deaths. Analizing the profiles of families and victims as to the intentionality of the event allows directing local prevention and control policies.

CONTEXT AND OBJECTIVE Analysis on accidents from the perspective of population segments shows there is higher incidence among children, adolescents and young adults. Since the characteristics and circunstances of the event are closely related to educational, economic, social and cultural issues, identifying them may contribute towards minimizing the causes, which are often fatal. The aim here was to identify the environmental, chemical, biological and cultural factors associated with deaths due to accidents among children, adolescents and young adults in Cuiabá, in 2009. DESIGN AND SETTING This was a descriptive cross-sectional study conducted in Cuiabá, Mato Grosso, Brazil. RESULTS Thirty-nine accidental deaths of individuals aged 0 to 24 years were examined: 56.4% due to traffic accidents; 25.6%, drowning; 10.3%, aspiration of milk; 5.1%, falls; and 2.6%, accidentally triggering a firearm. Male victims predominated (82.1%). The presence of chemical, environmental and biological risk factors was observed in almost all of the homes. Regarding cultural factors and habits, a large proportion of the families had no idea whether accidents were foreseeable events and others did not believe that the family's habits might favor their occurrence. Delegation of household chores or care of younger siblings to children under the age of 10 was common among the families studied. CONCLUSION The results point towards the need to have safe and healthy behavioral patterns and environments, and to monitor occurrences of accidents, thereby structuring and consolidating the attendance provided for victims.

The study objective was to examine differentials in time trends and predictors of deaths assigned to symptoms, signs and ill-defined conditions in comparison with other ill-defined conditions (ill-defined cardiovascular diseases, cancer and injury) in a population-based cohort study. Of 1,606 baseline participants aged 60 years and over, 524 died during 9-year follow-up and were included in this study. Deaths coded to "symptoms" declined by 77% in the period from 1997-1999 to 2003-2005. Deaths coded to other ill-defined conditions remained unchanged. The calendar period 2003-2005 (RR = 0.25; 95%CI: 0.09-0.70) and in-hospital deaths (RR = 0.16; 95%CI: 0.08-0.34) were independently associated with "symptoms", but not with other ill-defined conditions. Baseline socio-demographic characteristics and chronic diseases were not predictors of these outcomes. International and national agencies have focused on the reduction of deaths assigned to "symptoms" to improve the registration of vital statistics, while other ill-defined conditions have received little attention. Our data provide evidence supporting the need to redress this situation.

Objective: To analyze the characteristics of visits resulting from land transport injuries., Methods: A total of 5,934 visits in four hospital emergency departments (ED) were analyzed, in the state of São Paulo, in 2005. A questionnaire based on the following three models was used to collect data: World Health Organization (WHO), Center for Disease Control and Prevention (CDC), and Pan American Health Organization (PAHO). Variables analyzed were as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist), sex, age group, and type of injury suffered. Logistic regression analysis was employed to test associations between variables. Odds ratios with their respective 95% confidence intervals were calculated., Results: The majority of victims were males (74.2%) in the 20-to-29-year age group (35.0%). Vulnerable road users totaled 72.4% of all cases (29.8% were motorcyclists, 24.1% pedestrians, and 18.5% cyclists). Victims aged between zero and 14 years who had suffered injuries were mostly pedestrians and cyclists; motorcyclists predominated among those aged between 15 and 39 years; and pedestrians among those aged over 50 years. About half of the cases suffered minor injuries (strains, dislocations, contusions and cuts), while the other half was comprised by fractures, traumatic brain injuries and internal injuries. Extremities were the most affected body parts, particularly among motorcyclists. The majority of victims were discharged at triage (87.6%). Compared to women, men were 1.5 times more likely to be admitted or transferred, or to die. Pedestrians, vehicle occupants and motorcyclists were, respectively, 2.7, 2.4 and 1.9 times more likely to be admitted or transferred, or to die than cyclists., Conclusions: Measures aimed to protect vulnerable road users should be among the priorities to reduce land transport-related injuries.

Objective: To describe deaths due to infectious diseases as an underlying or multiple cause, identifying cases of pre-existent infectious diseases or ones developed during pregnancy; deaths due to an indirect obstetric cause and deaths due to Aids or other infectious diseases during pregnancy or post-partum, however difficult to classify., Methods: RAMOS methodology was adopted (by investigation in the household and medical records of the deceased, a new death certificate was filled out with the real causes concerning deaths of women from 10 to 49 years of age, residents in Brazilian capital cities,during the first semester of 2002., Results: A total of 7,332 female cases was analyzed, according to underlying and multiple causes of death, of which 917 were due to infectious diseases (mainly Aids and tuberculosis). In 37 cases, the deceased was pregnant or in an 'extended' puerperium (including) post-partum from 43 days up to one year). Of these, 10 were not indirect obstetric deaths, but the underlying cause was an infectious disease and 14 were classified as indirect obstetric deaths. Regarding multiple causes, 791 cases (neither maternal nor infectious disease as underlying cause) generated 1,016 mentions of infectious diseases (1.28 mentions/death)., Conclusion: As the frequency of maternal deaths is low, investigations on the near miss (severe cases due to complications of pregnancy and puerperium who survived) are recommended, because they occur in larger numbers and are a relevant contribution to studies on maternal mortality.

The objective of this study was to identify direct expenditures for hospitalizations due to external causes in the Unified National Health System (SUS) in the city of São José dos Campos, São Paulo State, Brazil. Admissions to the Dr. José de Carvalho Florence Municipal Hospital resulting from external causes or injuries - ICD-10, chapters XIX and XX respectively - were analyzed for the first semester of 2003. 976 patient admission forms were analyzed, after data evaluation. Admissions with the highest total cost were those resulting from motor vehicle accidents and falls. The highest mean cost for hospitalization for injury was due to motor vehicle accidents (BRL 614.63), followed by assault (BRL 594.90). The highest mean cost for hospitalization due to injury was for cervical fractures (BRL 1,191.42) and head injuries (BRL 1,000.44). Hospitalizations with the highest daily cost were skull and facial fractures (BRL 166.72) and abdominal trauma (BRL 148.26). The study confirmed that motor vehicle accidents, falls, and assault are an important source of costs due to hospitalization for injuries.

The objective of this study was to analyze the characteristics and place of occurrence of injuries treated in emergency departments. A total of 35,107 emergency department visits for injuries were analyzed, excluding traffic injuries, in São Paulo State, Brazil, 2005. The majority of victims were male (59.1%), and from 0 to 29 years of age (62.1%). Leading causes were falls (39.3%) and accidental blows (16.5%). Most injuries occurred in the home (64.7%), followed by public places (19.9%). Assaults were more frequent in public. Women were more likely to suffer injuries at home, as compared to men (OR = 0.51; 95% CI: 0.48-0.53). Men were 1.34 times more likely to be injured in public places, 3.22 times in bars, and 2.82 times in the workplace. A higher proportion of events among children aged 0 to 9 and individuals 60 years or older occurred at home. The results highlighted the home as an important place for the occurrence of injuries, which should be considered when planning injury prevention programs.

One of the main purposes of health information is to help administrative staff and health planners take the best possible decisions for promoting the wellbeing of society. Since 1970, the Brazilian Ministry of Health has been developing and organizing Health Information Systems. This paper presents the progress of the Mortality Information System and the Live Birth Information System since they were first established, building up historical series with accurate figures for these vital events. Their positive and negative aspects are analyzed through quantitative and qualitative evaluations. Steadily improving, they are expected to attain full coverage and adequate quality in the near future.

We analyzed morbidity and mortality rates due to external causes among elderly persons in a city in the South of Brazil. Data about deaths, from 1979 to 1998, and about hospital admissions, from 1995 to 1998, were obtained from the Mortality Information System and the Hospital Information System of the Brazilian Ministry of Health. Population data were based on the national demographic census. Mortality rates due to external causes decreased 16.2%, but levels increased in advanced ages, especially for women. Falls, pedestrian accidents and other road accidents were the most important external causes of death in this population. In the last three years of this study, mortality rates were higher for pedestrian accidents among men and for falls among women (64.8 and 58.3 per 100.000 inhabitants, respectively). Hospital admissions due to injuries and intoxications decreased in the period. Among the 146 admissions in 1998, 45.9% were due to falls. The community has to recognize that elderly persons are exposed to accidents and that preventive measures are needed.

Objective: Increased homicide rates in the city of Sao Paulo, Brazil, in the last two decades points out to the need for better understanding this subject. The purpose of the present study was to link information about homicide from different sources of data., Methods: Homicide data from death certificates, medical examiners and police records of residents in the city of Sao Paulo was linked for the second semester of 2001. Variables about victims, risk factors and homicide circumstances were analyzed using absolute numbers, proportions and coefficients. Statistical differences were tested using Pearson's Chi-square test., Results: Homicide crude rate was 57.2/100,000. Higher rates were observed among men aged 15 to 29 years (56.0% of all cases). The proportion of firearm-related homicides was 88.6%, higher among men than women. Most injuries were to the head (68.9%). Among the victims who underwent to drug screening, 42.5% had high blood alcohol concentrations (44.0% for men and 24.0% for women). Most events occurred at night during weekends and it was found a high correlation (74.6%) between the victim's place of residence and event location., Conclusions: The study findings highlight that linking information provides better quality of data and allows for better understanding of homicides.

Since the early 1980s, external causes have been the second greatest cause of death in Brazil. They also place a growing demand on health care services. The current study analyzes morbidity and mortality from external causes in Brazil. The study material consists of 118,367 deaths and 652,249 hospitalizations due to external causes during the year 2000. The data are from the National Mortality Information System and Hospital Information System. The mortality coefficient from external causes was 69.7/ 100 thousand (119.0/100 thousand for males and 21.8/100 thousand for women). Homicides were the leading cause of death (38.3% of the total), with a high coefficient of 26.7/100 thousand, while falls were the leading cause of hospitalizations (42.8% of the total). Motor vehicle accidents were a major cause of both morbidity and mortality. Fractures, mostly occurring in the upper and lower limbs, accounted for 42.6% of hospitalizations. Based on the findings, preventive programs should aim to decrease both mortality and morbidity, with special emphasis on homicides, traffic accidents, and falls.

Objective: To know the behavior of mortality due to cardiovascular diseases in the elderly living in the municipality of Maringá, in the Brazilian state of Paraná., Methods: The causes of death over 20 years were studied according to sex, age, and groupings of the International Classification of Diseases, 9th and 10th Revisions, using the mortality database of the Ministry of Health., Results: In regard to total deaths in the elderly, the proportional mortality due to cerebrovascular disease and ischemic heart disease decreased 42.5% and 34.4%, respectively, while that due to hypertension increased 119%, increasing from 2.1% to 4.6%. A 51.2%, 44.6%, and 12.5% decrease occurred, respectively, in the risk of death due to cerebrovascular disease, ischemic heart disease, and other forms of heart disease. For cerebrovascular disease and ischemic heart disease, the decrease in the estimate of the risk of death was greater among women, while for the other forms of heart disease, the decrease was greater among men. In regard to age groups, the risk of death increases as age advances for each cardiovascular disease in both sexes., Conclusion: Cardiovascular diseases continue to play an important role in morbidity and mortality in the elderly population, requiring even greater effort from health care providers for their prevention and treatment.

Background: In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil., Setting: Brazil, the last year available was 2000., Methods: The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals)., Results: The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents., Conclusions: It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.