O trauma é uma doença que representa um problema de saúde pública de grande magnitude e transcendência no Brasil, que tem causado forte impacto na morbidade e mortalidade da população, com profundas repercussões nas estruturas sociais, econômicas e políticas de nossa sociedade. Diante da necessidade de métodos de diagnóstico e tratamento invasivos e devido à lesão traumática criar um estado de relativa imunossupressão, a evolução clínica do politraumatizado apresenta muitas variáveis que se destacam como fatores de risco para infecções hospitalares, dentre elas a pneumonia hospitalar. Esta investigação tem por objetivo estimar a incidência de pneumonia hospitalar em pacientes com trauma por acidente de transporte, identificar aqueles que desenvolveram a infecção segundo sexo, idade, doenças de base, segmento(s) afetado(s), gravidade da lesão, tempo de permanência da internação hospitalar, condições de alta, intubação endotraqueal e/ou traqueostomia, uso de ventilação mecânica, realização de toracotomia e drenagem torácica, uso de antimicrobianos profiláticos e realização de procedimentos cirúrgicos, e identificar fatores de risco para seu aparecimento. Foi realizado um estudo analítico, transversal, no qual a população estudada foi de pacientes com trauma por acidente de transporte, atendidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo. O processamento dos dados foi realizado utilizando-se programas STATA 2.0 e Epi-Info versão 2002 e para o modelo de regressão logística múltiplo o programa usado foi o SAS versão 8. Do total de 309 registros levantados, 44 foram excluídos do levantamento, resultando em 265 prontuários considerados como a amostra do estudo. Os critérios de inclusão usados foram referentes a todas as vítimas de acidente de transporte, com idade maior ou igual a 12 anos, que permaneceram internados por período mínimo de 48 horas, durante os meses de janeiro a dezembro de 2002. A média de idade foi de 33,4 anos com mediana de 30 (amplitude de variação entre 12 a 80 anos), sendo que 224 (84,5%) eram do sexo masculino e 41 (15,5%) do sexo feminino. A média para o Injury Severity Score (ISS) foi de 13,2 com mediana de 9 (amplitude de variação entre 1 a 75). O tempo médio de internação hospitalar foi de 12,3 dias com mediana de 7 dias (amplitude de variação entre 2 a 80 dias). Dos 265 pacientes da amostra, 59 internaram no Centro de Terapia Intensiva (22,2%) mostrando média de permanência de 14 dias com mediana de 10 (amplitude de variação entre 1 a 75 dias). A taxa de incidência encontrada para a pneumonia hospitalar foi de 15,1%, onde o tempo médio de comprovação do diagnóstico foi de 6 dias. O modelo de regressão logística múltiplo encontrou que a variável sexo apresenta um risco adicional de 1,75 para a pneumonia nas mulheres (Odds Ratio ajustado de 16,0; p = 0,02). Constatou-se também que o ISS, a intubação traqueal e a drenagem torácica apresentaram percentuais maiores no sexo feminino em relação ao masculino. Na amostra total foi encontrado que o trauma de cabeça apresenta um risco adicional de 16,36 (Odds Ratio ajustado de 6,79; p = 0,04). Para a gravidade do nível da lesão o teste mostrou significância para os valores do ISS entre 19 a 22, dando um risco adicional de 82,22 (Odds Ratio ajustado de 59,61; p = 0,04). Para os dias de internação hospitalar ocorreu uma forte significância no reagrupamento, cujo intervalo de permanência hospitalar variou de 16 a 80 dias, apresentando um risco adicional de 48,66 (Odds Ratio ajustado de 135,61; p < 0,01). O procedimento de intubação traqueal mostrou risco adicional de 63,00 (Odds Ratio ajustado de 45,68; p < 0,01) e para a drenagem torácica encontramos um risco adicional de 9,33 (Odds Ratio ajustado de 13,64; p = 0,04). Como conclusão, este estudo indica que a incidência de pneumonia hospitalar se deve principalmente ao fato desta população ter sido submetida a procedimentos invasivos de tratamento, fato demonstrado também na literatura. Entretanto, na população estudada vimos que o nível de gravidade da lesão e o tempo de permanência hospitalar mostram-se menores em relação a outros estudos. Estes resultados fornecem uma linha de base para discussões sobre mudanças na abordagem destes doentes. / Trauma is a disease that represents a public health problem of great magnitude and transcendence in Brazil, with a strong impact on the morbidity and mortality of the population and profound repercussions on the social, economic and political structures of our society. In view of the necessity of invasive diagnostic and treatment methods and considering that traumatic injury creates a state of relative immunosuppression, the clinical course of polytraumatized patients presents many variables that are particularly important as risk factors for hospital infections, among them hospital pneumonia. The objective of the present investigation was to estimate the incidence of hospital pneumonia among patients with traumas due to traffic accidents, to identify those that developed this infection according to sex, age, previous history, type of trauma, severity of the injury, duration of hospitalization, discharge conditions, endotracheal intubation and/or tracheostomy, use of mechanical ventilation, thoracotomy and chest drainage, use of prophylactic antibiotic, and execution of surgical procedures, and to identify risk factors for to appearing. An analytical, cross-sectional study was conducted on a population of patients with trauma due to traffic accidents attended at the Emergency Unity of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Data were processed with the STATA 2.0 and Epi-Info version 2002 software and the multiple logistic regression model was applied using the SAS version 8 software. Of the 309 records surveyed, 44 were excluded, resulting in 265 medical records considered to represent the study sample. The inclusion criterion was: all victims of traffic accidents aged 12 years or older who were admitted for at least 48 hours during the months of January to December 2002. Mean age was 33.4 years and the median was 30 years (range: 12 to 80 years); 224 (84.5%) were males and 41 (15.5%) were females. Mean Injury Severity Score (ISS) was 13.2 and the median 9 (range: 0 to 99). Mean time of hospitalization was 12.3 days, with a median of 7 days (range: 2 to 8 days). Of the 265 patients in the sample, 59 were admitted to the Intensive Care Unit (22.2%), with a mean permanence of 14 days, median of 10 days (range: 1 to 75 days). The rate of incidence of hospital pneumonia detected was 15.1%, with a mean time of diagnostic confirmation of 6 days. The multiple logistic regression model revealed that the sex variable presented an additional risk of 1.75 for pneumonia among women (adjusted Odds Ratio of 16.0; p = 0.02). We also observed higher percentages of ISS, tracheal intubation and chest drainage among women compared to men. For the sample as a whole, head trauma was found to present an additional risk of 16.36 (adjusted Odds Ratio of 6.79; p = 0.04). For the severity of injury level the test showed significance for ISS values between 19 and 22, with an additional risk of 82.22 (adjusted Odds Ratio 59.61; p = 0.04). For the days of hospitalization there was strong significance in regrouping, with hospital permanence ranging from 16 to 80 days, with an additional risk of 48.66 (adjusted Odds Ratio of 135.61; p < 0.01). The procedure of tracheal intubation showed an additional risk of 63.00 (adjusted Odds Ratio of 45.68; p < 0.01) and chest drainage showed an additional risk of 9.33 (adjusted Odds Ratio of 13.64; p = 0.04). We conclude that the present study indicate that the incidence of hospital pneumonia was mainly due to the fact that this population was submitted to invasive treatment procedures, a fact also demonstrated in the literature. However, we observed that in the study population the level of severity of the injury and the time of hospitalization were lower than those reported in other studies. These findings provide a baseline for a discussion of changes in the approach to these patients.

Conclusion. It is probably now appropriate to close a chapter in the history of public communication campaigning. Weaknesses which have usually been seen as instrumental can now be seen for what they are: conceptual failures grounded in compromised ontologies and false epistemologies. As I showed in the last chapter, even when viewed within their own narrow empiricist frame, public communication campaigns fail to satisfy a test of empirical efficacy. But empirical failure reveals a deeper moral failure: the failure of government to properly engage in a conversation with the citizens to whom they are ultimately responsible. Whether public communication campaigns are a symptom or a cause of this failure lies beyond the scope of this thesis. But there can be little doubt that the practice of these campaigns has encouraged the persistence of an inappropriate relation between state and citizens. The originators and managers of mass media public communication campaigns conceive of and execute their creations as persuasive devices aimed at the targets who have been selected to receive their messages. But we do not see ourselves as targets (and there are profound ethical reasons why we should not be treated as such), neither do we engage with the mass media as message receivers. On the contrary, as social beings, we become actively and creatively involved with the communicative events which we attend to and participate in; the mass media, like all other communication opportunities, provide the means for generating new meanings, new ways of understanding, new social realities. But people are constrained from participating fully in public discussion about social issues; the government's construal of individuals as targets and of communication as transmitted messages does not provide the discursive space for mutual interaction. Governments should aim to encourage the active engagement of citizens in public discussion by conceiving of and executing public communication as part of a continuing conversation, not as packaged commodities to be marketed and consumed, or as messages to be received. It is time to encourage alternative practices-practices which open up the possibility of productive conversations which will help transform the relationship between citizens and state. However, as I have argued in this thesis, changed practices must be accompanied by profound changes in thinking, otherwise we continue to reinvent the past. Communication practice is informed by the ontology of communication which is itself embedded within other ontologies and epistemologies. The dominant paradigm of communication is at present in a state of crisis, caught between two views of communication power. On the one hand it displays an obsession with instrumental effectiveness on which it cannot deliver. On the other hand-in an attempt to discard the accumulated baggage of dualist philosophy and mechanistic models of effective communication-it indulges in a humourless critique of language which, as Robert Hughes astutely observes, is little more than an enclave of abstract complaint (Hughes 1993:72). This thesis has been an attempt to open up a space for a new ontology, within which we might create new possibilities.

<p>As one of the highest fatalities causes, traffic accidents and collisions always requires a large amounteffort to be reduced or prevented from occur. Traffic safety management routines therefore always needefficient and effective implementation due to the variations of traffic, especially from trafficengineering point of view apart from driver education.Traffic Accident Prediction Model, considered as one of the handy tool of traffic safety management,has become of well followed with interested. Although it is believed that traffic accidents are mostlycaused by human factors, these accident prediction models would help from traffic engineering point ofview to enlarge the traffic safety level of road segments. This thesis is aiming for providing a guidelineof the accident prediction model implementation in traffic safety management, regarding to trafficengineering field. Discussion about how this prediction models should merge into the existing routinesand how well these models would perform would be given. As well, cost benefit analysis of theimplementation would be at the end of this thesis. Meanwhile, a practical field study would bepresented in order to show the procedures of the implementation of traffic accident prediction model.The field study is about this commercial model set SafeNET, from TRL Limited UK, implemented inRoad Safety Audit procedures combined with microscopic simulation tool. Detailed processing andinput and output data will be given accompany with the countermeasures for accident frequencyreduction finalization.</p>

As one of the highest fatalities causes, traffic accidents and collisions always requires a large amounteffort to be reduced or prevented from occur. Traffic safety management routines therefore always needefficient and effective implementation due to the variations of traffic, especially from trafficengineering point of view apart from driver education.Traffic Accident Prediction Model, considered as one of the handy tool of traffic safety management,has become of well followed with interested. Although it is believed that traffic accidents are mostlycaused by human factors, these accident prediction models would help from traffic engineering point ofview to enlarge the traffic safety level of road segments. This thesis is aiming for providing a guidelineof the accident prediction model implementation in traffic safety management, regarding to trafficengineering field. Discussion about how this prediction models should merge into the existing routinesand how well these models would perform would be given. As well, cost benefit analysis of theimplementation would be at the end of this thesis. Meanwhile, a practical field study would bepresented in order to show the procedures of the implementation of traffic accident prediction model.The field study is about this commercial model set SafeNET, from TRL Limited UK, implemented inRoad Safety Audit procedures combined with microscopic simulation tool. Detailed processing andinput and output data will be given accompany with the countermeasures for accident frequencyreduction finalization.

Introduction Road traffic collisions in developing countries contribute towards the greatest burden of disabilities and fatalities globally. Concern has arisen about the high proportion of pedestrians involved in collisions in South Africa. Aim This study describes the epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality from 2001 to 2006, aiming to identify opportunities for prevention and informing policy. Methods An analytic cross-sectional study design was used. Data was obtained from the eThekwini Transport Authority database (police accident reports), and the Nationallnjury Mortality Surveillance System (mortuary reports). Exposure variables included pedestrian and drivers' demographics and collision environment. Death and injury were the outcome variables measured. Population data was obtained from Statistics South Africa. Results Pedestrians' injuries decreased from 7 445 to 6 288 (incidence risk: 241 to 193 per 100 000) from 200 I to 2006. Annual case fatality rose from 4.9% (366 deaths in 200 I) to 6.8% (430 deaths in 2006). Child pedestrians aged 5 to 9 years had a 77% increased risk of injury relative to other children. The fatality risk ratio of male to female pedestrians was 3.8 (95% Confidence Interval: 1.7 to 9.3). Male drivers aged 30 to 34 years had a 68% increased collision risk relative to all other male drivers and eight times (Incidence risk ratio: 8.0; 95% Confidence Interval: 6.2 to 10.3) the risk of female drivers. Only 3.4% of collisions occurred on freeways but accounted for 19.6% of pedestrian fatalities. Few (1.5%) collisions involving pedestrians occurred at night in unlit conditions but constituted more than four times the number of fatalities as number of collisions in these conditions. / Thesis (MMed.)- University of KwaZulu-Natal, Durban, 2009.

Understandings of the longer-term experiences of recovery from road trauma are limited. Many studies to date have examined the psychological and psychiatric consequences of road accidents in the short term, but few have moved to a focus on the psychosocial and subjective aspects of recovery, and the longer-term challenges of this process. (For complete abstract open document)

Thesis (M.Ed.)--Memorial University of Newfoundland, 1997. / Restricted until June 1998. Bibliography: leaves 98-102.

Made available in DSpace on 2015-05-14T12:47:15Z (GMT). No. of bitstreams: 1 ArquivoTotalAnaPaula.pdf: 4539714 bytes, checksum: e81023113c80e20aab9cc31359a349d7 (MD5) Previous issue date: 2013-08-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Traffic accidents represent, in Brazil, a serious economic and especially social, relevant for magnitude of the mortality and number of people suffering from sequelae arising, thus becoming a serious public health problem. This research aimed to develop a model to support decision making based on fuzzy logic, supported by analyzes spatial and spatio-temporal (Scan method) to categorize neighborhoods according to priority intervention for prevention and control of traffic accidents that produce victims. Secondary data were georeferenced and recorded by Mobile Emergency Care Service in João Pessoa, Paraíba, in the years 2010 and 2011. Throughout study period, João Pessoa was 10,070 traffic accidents with victims. Of this total, 17.8% had breath ethanol and 0.8% died at the scene. The majority of victims were male (74.5%), belonging to the age group 20-29 years (37.7%). The accidents occurred mainly on Sundays (19.2%), Saturdays (18.7%) and on Fridays (14.4%) as well as in the months of December (10%), October (9.8% ) and May (8.9%). Most of the vehicles involved was composed by motorcycles (68.1%) and cars (36.5%). The nature of accident, collision was more frequent (46.2%), followed by fall motorcycle (30.7%) and pedestrian injuries (11.1%). In analysis of the relative risk and spatial distribution of these events, it was found that neighborhoods with high relative risk and formed significant spatial clusters concentrated in the north, northwest and northeast of the municipality. We identified 15 clusters space-time, which concentrated mainly in the northern, northeastern and coastal strip of the municipality. It was observed that neighborhoods reported by Mobile Emergency Care Service were categorized as priority by model, Valentina and Mandacaru were categorized as with tendency to priority, and Mangabeira was categorized as non-priority. The proposed decision model showed good agreement when compared with Mobile Emergency Care Service, thus satisfying the identification and classification of neighborhoods as a priority, with tendency to priority, with tendency to non-priority and non-priority. The results may be of relevance to both Mobile Emergency Care Service as to other public officials linked to road traffic, traffic education and care for victims produced by road traffic in João Pessoa. / Os acidentes de trânsito representam, no Brasil, um grave problema econômico e principalmente social, relevante pela magnitude da mortalidade e do número de pessoas portadoras de sequelas decorrentes, tornando-se assim um grave problema de saúde pública. Este trabalho objetivou elaborar um modelo de apoio à tomada de decisão baseado em lógica fuzzy, apoiado pelas análises espacial e espaço-temporal (método Scan), para categorizar os bairros de acordo com o grau de prioridade de intervenção para a prevenção e combate dos acidentes de trânsito que produzam vítimas. Foram utilizados dados secundários georreferenciados e registrados pelo Serviço de Atendimento Móvel de Urgência na cidade de João Pessoa, Paraíba, nos anos 2010 e 2011. Ao longo do período de estudo, João Pessoa apresentou 10.070 ocorrências de AT com vítimas. Deste total, 17,8% apresentaram hálito etílico e 0,8% morreram no local do acidente. A maioria das vítimas foi do sexo masculino (74,5%), pertencente à faixa etária de 20 a 29 anos (37,7%). Os acidentes ocorreram principalmente aos domingos (19,2%), aos sábados (18,7%) e às sextas-feiras (14,4%), bem como nos meses de dezembro (10%), outubro (9,8%) e maio (8,9%). A maioria dos veículos envolvidos foi composta por motocicletas (68,1%) e carros (36,5%). Quanto à natureza do acidente, a colisão foi mais frequente (46,2%), seguida por queda de motocicleta (30,7%) e atropelamento (11,1%). Na análise do risco relativo e da distribuição espacial destes eventos, verificou-se que os bairros com alto risco relativo e que formaram conglomerados espaciais significativos concentraram-se nas regiões norte, noroeste e nordeste do município. Foram identificados 15 conglomerados espaço-temporais, que se concentraram principalmente nas regiões norte, nordeste e faixa litorânea do município. Observou-se que os bairros relatados pelo SAMU/JP foram categorizados pelo modelo como prioritários, Mandacaru e Valentina, os quais foram categorizados como com tendência a prioritários, e Mangabeira, categorizado como não prioritário. O modelo de decisão proposto apresentou boa concordância quando comparado com o SAMU/JP, sendo assim satisfatório na identificação e classificação dos bairros como prioritários, com tendência a prioritários, com tendência a não prioritários e não prioritários. Os resultados desta pesquisa podem ser de relevância tanto para o SAMU/JP quanto para outros órgãos gestores públicos ligados ao trânsito, educação para o trânsito e atendimento às vítimas produzidas pelo trânsito no município de João Pessoa-PB.

This thesis is concentrated on the research of recent state of the czech highways. The main aim of this work is to find out the reason of mistaken behaviour of the drivers in traffic. During analyzing further details I concerned myself on four basic factors: the influence of the environment, the influence of the car, what the man does while he is driving and the influence of the man himself on his operating. This work also includes the research of the driver as an individua together with external environment which affects him during the journey. The analysis of the influence of each factor was marked out as a field research on the way with the driver whereas were emphasised his transgressions, his sanity and the influence of the environment on himself. Especially monitoring which leaded to the observation of activities of the man in following aspects: respecting the speed limit, the traffic signs and other highway codes, mental condition of the driver in critical situations. Also the influence of the environment on the man was an important point in this work. Were chosen three segments which negatively affects the man ? the driver and there were proposed solutions to reduce them. The influence of the driver himself was characterized in following part. The analytic part summarizes obtained information from measuring and from the observation which are specified in the experimental part. In final part of this work are emphased any recommendations for fractional parts of the traffic which should lead to the improvement of the system thereby to the improvement of the recent state of this issue.

Esta tese busca mapear e analisar elementos e tecer redes de significados relacionados à produção de corpos, masculinidades e suas relações em exercício no espaço do trânsito para conhecer o(s) modo(s) como os homens habitam esse espaço. Para isso, corpo(s) e gênero(s) são instrumentos condição para a constituição de relações entre homens, veículos, vias e o espaço do trânsito em suas coexistências. Interessa-me não somente analisar como se constroem as posições de sujeito e suas relações, tanto com outros sujeitos quanto com as regras desse espaço, mas também como elas incidem no acidente de trânsito. Os acidentes de trânsito são uma condição um tanto paradoxal em que exercícios de masculinidade aproximam homens e serviços de saúde. Esta tese tem como questões norteadoras: que construções corporais são produzidas nas e pelas relações entre corpo, gênero, masculinidade, veículos, seus deslocamentos e suas coexistências e ao mesmo tempo são produtoras dessas relações? Como as relações entre masculinidade e o espaço do trânsito incidem sobre o acidente de trânsito e o produzem? Para construir respostas ao longo dos capítulos, trabalhei com informações do Estado, notícias relacionadas ao trânsito e aos acidentes de trânsito, bem como com campanhas publicitárias de automóveis, articuladas aos dados sobre atendimentos realizados por causa de acidentes de trânsito no HPS e aos tipos de acidentes, para o que foram utilizadas as informações do banco de dados do HPS. Também foram realizadas entrevistas com homens internados no HPS cujo motivo tenha sido o envolvimento em acidentes de trânsito. Tudo isso foi somado à minha experiência como sujeito – condutora de veículo no espaço do trânsito, em deslocamentos urbanos e em rodovias, e pesquisadora desse espaço. Este trabalho cria um espaço singular para problematizar algumas questões relacionadas aos acidentes de trânsito e à (re)produção e exercício de masculinidades no espaço do trânsito e corrobora a tese de que os diferentes modos como os homens são produzidos e fazem uso dos seus corpos e veículos no espaço do trânsito constituem arranjos de masculinidade que configuram uma racionalidade biomecânica para a ocorrência do acidente de trânsito. / This thesis is an attempt to map and analyze elements and weave networks of meanings related to the production of bodies, masculinities and their relationships in the traffic environment in order to know the way(s) that men have inhabited that space. Body(ies) and gender(s) are tools for the constitution of relationships among men, vehicles, pathways and the traffic environment in their coexistence. I am not only interested in analyzing how positions of subject and relationships with other subjects and rules in that environment have been constructed, but also how they have operated on the traffic accident. Traffic accidents are a quite paradoxical situation in which the exercise of masculinity approximates men to health care services. The guiding issues of this thesis are the following: which body constructions have been produced in and by relationships among body, gender, masculinity, vehicles, their displacements and their coexistences, and produced such relationships at the same time? How have the relationships between masculinity and the traffic environment operated on the traffic accident and produced it? To find answers, along the chapters, I worked with State information, news about traffic and traffic accidents, as well as car advertising campaigns, articulated with data about health assistance provided by HPS due to traffic accidents and types of accidents by using information from the HPS database. I also performed interviews with men hospitalized because of traffic accidents. All that was added to my experience as a subject – a driver in the traffic environment, both in urban streets and roads, and a researcher of that space. This study has generated a singular space to problematize some issues concerning traffic accidents and the (re)production and exercise of masculinities in the traffic environment. Furthermore, it corroborates the thesis that the different ways men have been produced as well as the ways they have used their bodies and vehicles in the traffic environment constitute masculinity arrangements that shape a biomechanical rationality for the occurrence of traffic accidents.