Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence — a population-based study

Prevalence and factors associated with driving under the influence of alcohol in Brazil

OBJECTIVES

To estimate the prevalence and factors associated with Driving Under the Influence of Alcohol (DUIA) among car drivers and motorcyclists in Brazil and to evaluate the association between DUIA and self-reported Road Traffic Injuries (RTIs) in these groups.

METHODS

A cross-sectional study was conducted using data from adults aged 18 or older who participated in the 2019 National Health Survey. Probability sampling was used to recruit participants, and data collection was carried out through home visits. Data from 31,246 car drivers and 21,896 motorcyclists were analyzed. Key indicators included the proportion (%) of car drivers who consumed alcohol and then drove in the past 12 months and the proportion (%) of motorcyclists who consumed alcohol and then drove in the past 12 months. Multiple Poisson regression was used to determine factors associated with DUIA and the association of this variable with RTIs in both groups.

RESULTS

DUIA prevalence was 9.4% (95% Confidence Interval [95% CI] = 8.8-10.0) among car drivers and 11.2% (95% CI = 10.4-12.1) among motorcyclists. Among car drivers, DUIA prevalence was higher in men, young adults, those without a spouse/partner, and lower in individuals with lower income and education level. Among motorcyclists, DUIA prevalence was higher in men, young adults, those living outside the capitals and metropolitan regions, and lower in individuals with lower income. DUIA increased the prevalence of self-reported RTIs in the previous 12 months among car drivers and motorcyclists.

CONCLUSIONS

A high prevalence of DUIA was evident among drivers, particularly motorcyclists. The DUIA was more prevalent among men and young adults. The DUIA was associated with an increased magnitude of self-reported RTIs among car drivers and motorcyclists. Despite the extensive legislation for zero tolerance toward DUIA in the country, actions need stricter enforcement.

Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries

INTRODUCTION

open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR).

METHODS

patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status.

RESULTS

Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score.

CONCLUSIONS

Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

The epidemiology of road traffic accidents and associated factors among drivers in Dilla Town, Southern Ethiopia

Background

Data on the magnitude of road traffic accidents (RTAs) were mostly obtained through police records and hospital registration data. However, insufficient data reporting masked the gravity of the problem, and little attention was paid to the magnitude and correlation of road traffic accidents from the driver's perspective. Therefore, this study aimed to assess the prevalence of RTA and related factors among drivers.

Methods

A community-based cross-sectional study involving 316 drivers was conducted in Southern Ethiopia. The participants were chosen using a systematic random sample technique, and the data were obtained using an interview-administered structured questionnaire. To analyze the data, SPSS software (version 20) was employed. In addition to descriptive statistics, binary logistic regression analysis was also employed to find factors connected to traffic accidents. RTA factors were considered statistically significant if they had a P-value of 0.05 or below in the multivariate analysis.

Result

The RTA among drivers was 126 (39.9%) (95% confidence interval (CI): 34.2-45.6%) in the previous year. The following factors were associated with RTA: vehicle maintenance (AOR = 0.11, 95% CI: 0.09, 0.96), media utilization (AOR = 0.38, 95% CI: 0.18, 0.65), participation in driving-related training (AOR = 0.73, 95% CI: 0.28, 0.91), punishment for prior traffic violations (AOR = 0.56, 95% CI: 0.47, 0.83), and risky driving behavior (AOR = 7.89, 95% CI: 3.22, 12.38).

Conclusion

Two-fifths of the drivers were involved in a traffic accident. Risky driving behaviors, vehicle maintenance, media usage, attending driving-related training in the previous 2 years, and prior experience with traffic police punishment or warning were all strongly linked to road traffic accidents. In light of these statistics, the Federal Ministry of Transport of Ethiopia and other stakeholders should support making it mandatory for drivers to check their vehicles' safety, provide them with safety training, raise awareness about vehicle maintenance and risky driving behaviors, and enforce strict penalties for traffic violations.

Fraturas expostas isoladas da diáfise da tíbia: estudo prospectivo observacional em sete hospitais de dois países da América Latina

RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..

Mortality by road traffic injuries in Brazil (2000-2016): capital cities versus non-capital cities

OBJECTIVES

To compare the magnitude and trend of mortality by road traffic injuries (RTI) in the capitals and other municipalities of each Brazilian state between 2000 and 2016.

METHODS

A time series analysis of mortality rates by RTI standardized by age was performed, comparing the capitals and the cluster of non-capital municipalities in each state. Data on deaths were obtained from the Sistema de Informações sobre Mortalidade (SIM - Mortality Information System). RTI deaths were considered to be those, whose root cause was designated by ICD-10 codes V01 to V89, with redistribution of garbage codes. To estimate mortality rates, we used the population projections of the Brazilian Institute of Geography and Statistics (IBGE) from 2000 to 2015 and the population estimated by polynomial interpolation for 2016. The trend analysis was performed using the Prais-Winsten method, using the Stata 14.0 program.

RESULTS

There were 601,760 deaths due to RTI in the period (114,483 of residents in capital cities). Mortality by RTI did not present an increasing trend in any of the Capitals in the period under study. Among non-capital municipalities, the trend was growing in 14 states. The greatest increase was observed in Piaui (AIR = 7.50%; 95%CI 5.50 - 9.60). There was a decreasing trend in RTI mortality in 14 capitals, among which Curitiba showed the greatest decrease (AIR = -4.82%; 95%CI -6.61 - -2.92). Only São Paulo and Rio Grande do Sul showed a decreasing trend in mortality by RTI in non-capital cities (AIR = 2.32%; 95%CI -3.32 - -1.3 and AIR = 1.2%, 95%CI -2.41 - 0.00, respectively).

CONCLUSIONS

We conclude that RTI mortality rates in non-capital cities in Brazil showed alarming trends when compared with those observed in capital cities. The development of effective traffic safety actions is almost always limited to Brazilian capitals and large cities. Municipalities with higher risk should be prioritized to strengthen public policies for prevention and control.

Drug use and driving behaviors among drivers with and without alcohol-related infractions

INTRODUCTION

Brazil is one of the countries with the highest rates of alcohol-related traffic infractions, but little is known about the profile of the drivers who commit them. Identifying the characteristics of impaired drivers is essential for planning preventive actions.

OBJECTIVE

To compare drug use and driving behavior profiles of drivers with and without alcohol-related infractions.

METHODS

178 drivers stopped at routine roadblocks were assessed by traffic agents who conducted standard roadblock procedures (document verification; request of a breathalyzer test [BT]). Drug use and driving behavior data were collected through semi-structured interviews. Subjects were divided into three groups: drivers who refused the BT (RDs, n = 72), drivers who tested positive on the BT (PDs, n = 34), and drivers who had committed other infractions (ODs, n = 72).

RESULTS

The proportion of alcohol use in the last year was higher among RDs (100%) than in the PD and OD groups (97.1% and 72.2% respectively, p < 0.001). Lifetime prevalence of cannabis and cocaine use for the overall sample was 44.3% and 18.2%, respectively. Fewer individuals in the OD group (31.5%) reported having been stopped at roadblocks in the previous year compared to the PDs (55.9%) and RDs (48.6%, p = 0.03). However, a higher proportion of RDs reported drunk driving in the same period (87.5%; PD 69.7%; OD 26.9%; p < 0.001).

CONCLUSION

Essential differences among groups were observed. RDs had a higher proportion of alcohol use and drunk driving in the previous year; drivers who fit into this particular group may be unresponsive or less responsive to social deterrence and enforcement actions.

Motorcycle accidents: characteristics of victims admitted to public hospitals and circumstances

Background

Motorcycle accidents are a considerable cause of morbidity and mortality in Brazil, with high social and economic costs. Victims are mostly men, young and vulnerable.

Objective

To characterize motorcycle accident victims and circumstances among patients admitted to a public hospital.

Methods

We administered a questionnaire to 74 victims of motorcycle accidents in the period from January through July 2018 among patients admitted to a referral hospital for elective orthopedic surgery in Salvador, Bahia, Brazil.

Results

Most victims were male (98.4%), up to 31 years old (49%), black or brown (84%) and had low educational level (54%). Motorcycling was the occupation of 50.8%. Drinking was less frequent among motorcyclists in the capital compared to the interior of the state (16 vs. 26%) and a larger proportion had a driving license (72 vs. 39%).

Conclusion

Main victims of motorcycling accident victims were male, with low educational level, and without a driving license. Actions are needed to promote road safety, including educational programs to protect life and reduce the social and economic costs of accidents.

Female motorcycle mortality in Brazilian municipalities, 2005, 2010 and 2015

OBJECTIVE

To analyze the spatial distribution of female mortality due to motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period.

METHODS

Female mortality rates for the years 2005, 2010 and 2015 were estimated considering a three-year moving average around the base year, standardized by the direct method. Rates were standardized using the same pattern (Brazilian females in 2010) for each year. Then, the empirical Bayes estimator was used to reduce the effect of the random fluctuation. The percentage variation of the standardized rates was also analyzed for different population sizes (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants).

RESULTS

Bayesian rates showed a clear increase in female mortality due to motorcycle accidents, especially in the North, Northeast and Midwest regions. In the municipalities of the South and Southeast regions, mainly in the period between 2010 and 2015, there was an apparent decrease in mortality. The percentage variation showed a reduction in the indicator analyzed in the period between 2010 and 2015 for the largest municipalities in the South and Southeast regions. For almost all regions and population sizes, the period between 2010 and 2015 showed a deceleration in the growth of rates.

CONCLUSION

The analysis clearly shows concentrations of municipalities with higher mortality, while also showing that the phenomenon has spread to a greater number of municipalities. The studied period allows the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents.

Mortalidade de motociclistas com lesões traumáticas resultantes de acidentes de trânsito na cidade de São José dos Campos, em 2015: estudo de coorte

Resumo Objetivo: Analisar fatores associados à mortalidade por lesões traumáticas entre motociclistas. Métodos: Coorte prospectiva, conduzida no Hospital Municipal de São José dos Campos, Brasil, 2015. Foram incluídos motociclistas com lesões traumáticas, ≥14 anos de idade, hospitalizados. Analisaram-se as variáveis sociodemográficas do acidente e da hospitalização, por modelo de regressão de Poisson, apresentando-se risco relativo (RR) e intervalos de confiança de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%), jovens do sexo masculino, revelaram 422 (41,8%) lesões em extremidades inferiores e superiores. A incidência de óbito foi maior na medida do aumento da gravidade do trauma, fisiológica (RR=9,67 [IC95% 1,46;64,26]; e RR=4,71 [IC95% 1,36;16,26]) e anatômica (RR=31,49 [IC95% 3,72;266,38]); e mostrou-se menor em até uma semana de internação (RR=0,39 [IC95% 0,15;0,98]). Conclusão: A gravidade do trauma e o tempo de internação associaram-se ao óbito de motociclistas, mas novos estudos devem ser conduzidos para confirmar esses achados e analisar essas relações mais detalhadamente.

Acidentes de trânsito com condutores de veículos: incidência e diferenciais entre motociclistas e motoristas em estudo de base populacional

RESUMO: Objetivos: Estimar incidências de acidentes de trânsito entre condutores de veículos a motor e verificar diferenciais do evento entre as vítimas motociclistas e motoristas de automóvel. Métodos: Foi conduzido um inquérito domiciliar no município de Jequié, Bahia, em 2013, com 1.406 condutores selecionados por amostragem por conglomerado. As estimativas de incidência cumulativa de acidentes de trânsito foram ponderadas pelo desenho amostral e, para comparação entre categorias de condutores, foram estimadas razões de incidência (RI) e intervalos de confiança de 95% (IC95%) com regressão de Poisson. Diferenciais do evento entre vítimas motociclistas e motoristas foram avaliados com teste do χ2 de Rao-Scott (p ≤ 0,05). Resultados: O envolvimento em acidentes de trânsito nos 12 meses anteriores à entrevista foi referido por 10,6% dos condutores. Para acidentes que causaram lesão física, a incidência foi de 4,3%. Motociclistas apresentaram o dobro do risco de envolvimento em acidentes (RI = 2,03; IC95% 1,40 - 2,94) e maiores proporções de lesões (p < 0,001), de interrupção de atividades habituais de vida (p = 0,003) e de atendimento em serviços de emergência (p = 0,008). Fatores relacionados ao tempo e local de ocorrência não se diferenciaram entre grupos. Conclusão: Maior incidência de acidentes e proporções mais elevadas de lesões e de outras repercussões desses eventos recaíram sobre motociclistas. Tais achados reafirmam a condição de vulnerabilidade desse grupo e explicitam diferentes impactos que uma causa prevenível de morbimortalidade apresenta em cada grupo de condutores.

[Spatial analysis of motorcycle-related mortalities in Brazilian municipalities]

Analysis of the distribution of motorcycle-related mortality rates in Brazilian municipalities is fundamental to understand and seek to minimize the occurrence of this growing phenomenon. The main objective of this work is to analyze the spatial distribution of motorcycle rider mortality rates in Brazil, based on more robust and reliable estimates. An attempt was also made to identify the presence of spatial clusters in the distribution of such mortality rates in given municipalities. The rates were estimated based on the average number of motorcyclist deaths recorded in the years 2014, 2015 and 2016. These rates were then directly standardized and graduated based on the local empirical Bayesian estimator. A Local Indicator of Spatial Autocorrelation (LISA) indicated the presence of spatial patterns. The Northeast and Mid-West regions concentrated most of the municipalities with high mortality rates as well and most of the clusters of municipalities with a high-high distribution pattern. Graduated Bayesian estimation was effective to deal with the occurrence of extreme values, thereby improving the reliability of the estimates and enhancing the visualization of the rates on the map.

Helmet retention system types as a risk factor to properly attach the chin strap

OBJECTIVES

This study aimed to determine the factors associated with the incorrect use of a helmet retention system (loose or open) and how often this happens.

METHODS

This was an observational transversal study conducted in Curitiba, Brazil. Trained observers positioned at traffic lights collected information about the helmet fixation mode, the helmet model (full-face, open-face, modular, half), and the helmet retention system model (micrometric, double-D, fast-release). Additional data including position on the motorcycle, gender, and function of the motorcycle (as a work vehicle) were collected. The observers, collection site, and periods were randomly selected by lots.

RESULTS

From a total of 3,050 motorcyclists, 1,807 (59.2%) had their helmets fastened correctly, 907 (29.7%) had the retention system fastened loosely, and in 336 (11.0%), the retention system was completely open. Increased odds of incorrect use were observed for the fast-release and double-D buckles compared to the micrometrics buckles, with a fixed odds ratio (OR) of 4.62 (95% confidence interval [CI], 3.89-5.51) and 3.54 (95% CI, 2.46-5.09), respectively (P <.0001). Full-face helmets had a higher chance of incorrect use (P <.0001), and passengers had a higher incidence of incorrect use of the helmet than drivers (P <.0001).

CONCLUSION

An important risk factor related to the incorrect use of the helmet was the type of retention system. The helmet model and being a passenger had a secondary influence on incorrect use of helmets.