BACKGROUND: Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS: A total of 6,134 diagnosed hypertensive subjects aged ≥ 20 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS: Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37-0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35-0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40-0.96). Mexican Americans have a stronger association of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS: The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

BACKGROUND: Numerous studies have suggested that Helicobacter pylori infection in asymptomatic subjects is transmitted from person to person. Its prevalence is higher in the institutionalized setting. If that is the case, persons involved in patient care should have a higher prevalence of the infection. METHODS: We estimated the prevalence of H pylori antibodies among groups of asymptomatic medical and nursing staff and compared them with volunteer blood donors of similar age and sex. RESULTS: One hundred fifty-eight nurses and aides, 59 residents, 46 senior medical students, and 22 senior nursing students were enrolled in this study. Serum samples were tested for IgG antibodies against H pylori by enzyme-linked immunosorbent assay. Sixty-two (39%) of 158 nurses were found to be positive for antibodies to H pylori compared with 114 (26%) of 441 specimens from the blood donor group. Within the youngest age group (20 to 34 years), 13 (25%) of 51 nurses were positive for H pylori antibodies compared with 19 (13%) of 143 age-matched serum samples from the blood donor group. Within the middle age group (35 to 49 years), 32 (39%) of 83 nurses were positive for H pylori antibodies vs 43 (26%) of 167 age-matched blood donors. In the oldest age group (> 50 years), 17 (71%) of 24 nurses were positive for H pylori antibodies compared with 52 (40%) of 131 age-matched blood donors. Twenty-three (27%) of 86 nurses with 1 to 15 years of occupational exposure were positive for H pylori antibodies compared with 40 (56%) of 72 nurses with more than 15 years of occupational exposure. CONCLUSIONS: Nurses have an increased prevalence of H pylori antibodies that is significantly higher than the comparable prevalence of volunteer blood donors and is evident in the youngest age group. In addition, the increased prevalence is related to a longer duration of patient exposure in the nursing group.

Det övergripande syftet med den här avhandlingen har varit att, inom området läkemedelsinformatik, studera utvecklingen av elektroniska stöd inom läkemedelsförskrivning; för klinisk praxis, uppföljning och forskning. Under århundraden har det handskrivna receptet varit det sätt, med vilket läkare förmedlat sina läkemedelsordinationer till apotekare, vilket också för patienten blivit en informationskälla för hur läkemedel ska användas för att göra bästa nytta. Nu genomgår receptet en förändring från pappersbaserat till elektroniskt meddelande och att anpassa en traditionell process till en ny elektronisk era innebär både möjligheter och utmaningar. Studierna som ingår i avhandlingen har visat att exponeringen av förskrivna läkemedel i en allmän befolkning har ökat under de senaste tre decennierna. Risken för potentiella interaktioner mellan läkemedel, varmed avses den risk som finns att olika läkemedel kan påverka varandras effekter och biverkningar, har också visat sig öka starkt desto fler läkemedel som används av en individ. Denna ökade samtidiga användning av flera olika läkemedel, så kallad polyfarmaci, medför att det finns en större anledning för förskrivare och farmacevter att uppmärksamma risken för potentiella interaktioner mellan läkemedel. De nyinrättade nationella receptregistren över uthämtad receptförskriven medicin bör användas bland annat för att upptäcka potentiella läkemedelsinteraktioner, såväl i vårdens utövning som inom läkemedelsepidemiologisk forskning. Den svenska läkemedelsförteckningen, som omfattar information om uthämtade receptförskrivna läkemedel för huvuddelen av den svenska befolkningen, bedöms ha en stor klinisk potential. Den enskilde individens historiska information om uthämtade läkemedel är tillgänglig för individen på Internet med hjälp av e-legitimation; även förskrivare och farmacevter på apotek kan ta del av informationen med den enskildes samtycke. Brist på tillgång till enhetliga och säkra autenticeringsmetoder inom hälso- och sjukvården kan dock fördröja tillgången på individuell läkemedelsinformation för förskrivare. I och med att de flesta recepten i Sverige nu skrivs och överförs elektroniskt är det viktigt att kvalitetsmässiga aspekter tas tillvara så att en iakttagen ökad risk för receptförskrivningsfel inte överförs i informationskedjan. Avhandlingens slutsats är att e-förskrivning, med kommunikation och användning av lagrad information om receptexpeditioner, möjliggör att läkemedelsbehandling som process kan följas och studeras på ett helt nytt / The thesis aimed to study the developments, in the area of pharmacoinformatics, of the electronic prescribing and dispensing processes of drugs - in medical praxis, follow-up, and research. For hundreds of years, the written prescription has been the method of choice for physicians to communicate decisions on drug therapy and for pharmacists to dispense medication. Successively the prescription has also become a source of information for the patient about how to use the medication to maximize its benefit. Currently, the medical prescription is at a transitional stage between paper and web, and to adapt a traditional process to the new electronic era offers both opportunities and challenges The studies in the thesis have shown that the exposure of prescribed drugs in the general population has increased considerably over three decades. The risk of receiving potentially interacting drugs was also strongly correlated to the concomitant use of multiple drugs, polypharmacy. The pronounced increase in polypharmacy over time constitutes a growing reason for prescribers and pharmacists to be aware of drug interactions. Still, there were relatively few severe potential drug interactions. Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically. The Swedish National Pharmacy Register provides prescription dispensing information for the majority of the population. The medication history in the register may be accessed online to improve drug utilization, by registered individuals, prescribers, and pharmacists in a safe and secure way. Lack of widespread secure digital signatures in healthcare may delay general availability. With a relatively high prevalence of dispensed drugs in the population, the National Pharmacy Register seems justified in evaluating individual medication history. With a majority of prescriptions transferred as ePrescriptions, the detected increased risk for prescription errors warrants quality improvement, if the full potential of ePrescriptions is to be fulfilled. The main conclusion of the studies was that ePrescribing with communication of prescribed drug information, storing and retrieving dispensed drug information, offers new opportunities for clinical and scientific

A comunicação escrita consiste, ainda hoje, no principal veículo de divulgação das pesquisas científicas, sendo feita basicamente por meio de documentos convencionais, como livros e artigos de revistas. A mensuração da produção científica de determinada Entidade de Ensino Superior pode contribuir para um melhor direcionamento de verbas ou mesmo de ações acadêmicas. Este trabalho teve por objetivo traçar um panorama da produção científica da Faculdade de Medicina da Universidade de São Paulo (FMUSP), de seus professores titulares (MS-6), ativos entre 2001-2006, usando como referência a base de dados Medline/PubMed. Dos registros encontrados, foram identificadas as revistas científicas, seu fator de impacto e as citações dos artigos. Após identificação dos 66 docentes (MS-6) foram recuperados 1.960 artigos científicos em 630 títulos de revistas científicas, sendo 3,8% em revistas nacionais e 96,2% em internacionais. Nas revistas internacionais o fator de impacto variou de 0.062 a 51.296 (JCR/2006). As citações foram pesquisadas na base de dados Web of Science/ISI Thomson, sendo que 45% dos artigos foram citados por outros pesquisadores, totalizando 9.335 citações. Os resultados desta pesquisa parecem indicar ser possível a análise da produção científica dos professores titulares de uma Instituição, não somente pela posição na carreira acadêmica como também pela chance maior de esses docentes agregarem em seus projetos membros do mesmo departamento ou de outros da Instituição. O elevado número de artigos publicados em revistas científicas nacionais e internacionais com penetração na comunidade científica contribui para a repercussão e visibilidade das publicações e pesquisas desenvolvidas nesta Instituição. / The Scientific production of higher education schools/institutions as well as its dissemination and use by peer institutions are measured by means of quantitative and qualitative measurements, which may also contribute to serving other academic purposes. Variables such as type of evaluation, number of faculty members, whether to include researchers that are not professors are frequently difficult to measure when comparing diverse schools/institutions. The purpose of this study was to assess the 2001-2006 scientific production of tenured faculty from the Universidade de ou São Paulo University Medical School indexed at Medline/PubMed database. The articles found were sorted out according to the journals in which they had been published, their impact factor, and how many times they had been cited. This study identified 66 professors/researchers and 1,960 articles, which were registered on an Excell spreadsheet. There were 630 journals found, 24 of which were national and 606 international. The impact factor of the international journals ranged from 0.062 to 51.296 (JCR/2006). As verified at Web of Science/ISI Thomson database, 45% of these articles were cited by peer researchers, totaling 9,335 citations. The results of this study suggest that it is possible to evaluate the scientific production of a school/institution by means of the production of its tenured faculty, not only because of their academic standing, but also because their projects tend to bring together other faculty members from the same school/department or other schools/departments at the same institution. The large number of articles published in international journals contributes to making this institutions scientific production known to the international academic community.

Objetivos: Avaliar o desempenho visual(DV), por meio da AV logMAR de alto contraste, sensibilidade ao contaste(SC) e análise de frentes de onda(AFO), em míopes, com óculos e três LCG. Métodos: Estudo clínico e prospectivo, em 40 indivíduos míopes(-1,00D e -4,50D). Exames: AV logMAR de alto contraste, avaliação de SC e AFO. Resultados: A AFO detectou diferença na aberração de terceira ordem sem e com as LCG.. Em relação ao nível trifoil houve diferença entre com e sem LCG. Conclusões: Na avaliação do DV com óculos e com LCG, a AFO é uma medida mais sensível da função visual que a AV LogMAR de alto contraste e a SC. / Objective: to evaluate the visual performance(VP) by Visual acuity(VA)Logmar of high contrast, sensibility of contrast(SC) and wavefront (WF) in myopic patients correct with spectacles and 3 SCL Methods: prospective clinical trial was performed in 40 myopic patients(-1,00 D and -4,50 D). Exams: VA, WF and CS. Results: The WF analysis detected a significant difference in a third order aberration with and without SCL. There was significant difference related to trefoil coefficient in VP between with and without SCL. Conclusion: In VP evaluation with spectacles and SCL the wavefront analysis was more sensible measure of VP when compared with high contrast VA Logmar and CS.

INTRODUÇÃO - As manifestações clínicas da hiperplasia prostática benigna envolvem a interação entre três fatores: sintomas miccionais, aumento do volume prostático e obstrução infravesical. A relação entre estes fatores é complexa e parcialmente entendida. O objetivo do presente estudo foi avaliar os achados urodinâmicos de pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3, com ênfase nos parâmetros obstrução infravesical, hiperatividade detrusora e contratilidade detrusora. CASUÍSTICA E MÉTODOS - Os prontuários e exames urodinâmicos de 33 pacientes foram analisados retrospectivamente. A média de idade dos pacientes foi de 60,3 ± 9,3 anos, variando de 40 a 78 anos. Os sintomas do trato urinário inferior foram avaliados com o escore internacional de sintomas prostáticos (IPSS). O volume prostático e os seguintes parâmetros urodinâmicos foram analisados: fluxo máximo, capacidade cistométrica máxima, complacência, presença de hiperatividade detrusora, fluxo máximo no estudo fluxo/pressão, pressão detrusora no fluxo máximo, contratilidade detrusora e resíduo miccional. Analisou-se, também, o impacto da obstrução infravesical, hiperatividade detrusora e volume prostático nos sintomas miccionais e parâmetros urodinâmicos. RESULTADOS - As médias do volume prostático e IPSS foram 26,5 ± 6,9cm3 e 16,8 ± 5,0, respectivamente. Anormalidades urodinâmicas foram encontradas em 30 (90,9%) pacientes, sendo obstrução infravesical e hiperatividade detrusora os achados mais freqüentes, cada qual acometendo 16 (48,5%) pacientes. A prevalência da hiperatividade detrusora foi de 50,0% entre os pacientes obstruídos e de 47,0% nos pacientes sem obstrução infravesical (p = 0,99). Hipocontratilidade detrusora foi observada em 18,8% dos obstruídos e 64,7% dos pacientes sem obstrução (p = 0,013). O índice de contratilidade detrusora foi de 111,7 ± 20,8 nos pacientes obstruídos e de 92,9 ± 17,3 nos pacientes sem obstrução (p = 0,008). Nos pacientes com e sem hiperatividade detrusora, encontrou-se diferença estatisticamente significativa na complacência vesical, que foi de 15,4 ± 9,6ml/cmH2O nos pacientes com hiperatividade detrusora e de 28,8 ± 10,8ml/cmH2O nos pacientes sem hiperatividade detrusora (p = 0,007). CONCLUSÕES - O estudo urodinâmico identifica anormalidades vesicais na maioria dos pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3. Embora a obstrução infravesical seja um achado comum, mais da metade dos pacientes tiveram outras alterações vesicais responsáveis pelos seus sintomas, principalmente hiperatividade detrusora e diminuição da contratilidade detrusora, reforçando o valor dos exames urodinâmicos nesta população. / INTRODUCTION - The clinical manifestations of benign prostatic hyperplasia involve the correlation of three elements: voiding symptoms, prostate enlargement and bladder outlet obstruction. The interaction between these factors is complex and incompletely understood. The objective of this study was to evaluate the urodynamic findings in patients with lower urinary tract symptoms and prostate volumes less than 40cc, focusing on the parameters bladder outlet obstruction, detrusor overactivity and detrusor hypocontractility. PATIENTS AND METHODS - The records and urodynamic studies of 33 patients with lower urinary tract symptoms and prostate volumes less than 40cc were reviewed. Average age of the patients was 60.3 ± 9.3 years (range 40 to 78 years). Lower urinary tract symptoms were evaluated with the International Prostate Symptom Score (IPSS). Prostate volume and the following urodynamic parameters were analyzed: maximum flow rate, maximum cystometric capacity, compliance, presence of detrusor overactivity, maximum flow rate during pressure/flow studies, detrusor pressure at maximum flow rate, detrusor contractility e post void residual volume. We also evaluated the impact of bladder outlet obstruction, detrusor overactivity and prostate volume on the voiding symptoms and urodynamic parameters. RESULTS -Mean prostate volume and IPSS were 26.5 ± 6.9 cc and 16.8 ± 5.0, respectively. Urodynamic abnormalities were found in 30 (90.9%) patients, with a preponderance of bladder outlet obstruction and detrusor overactivity, each affecting 16 (48.5%) patients. The prevalence of detrusor overactivity was 50.0% in the obstructed patients and 47.0% in patients without bladder outlet obstruction (p = 0.99). Detrusor hypocontractility was present in 18.8% of the obstructed patients and 64.7% of the non-obstructed patients (p = 0.013). The detrusor contractility index was 111.7 ± 20.8 in the obstructed patients and 92.9 ± 17.3 in those without bladder outlet obstruction (p = 0.008). In the patients with and without detrusor overactivity there was a statistically significant difference in bladder compliance, which was 15.4 ± 9.6 ml/cmH2O in the patients with detrusor overactivity and 28.8 ± 10.8 ml/cmH2O in those without detrusor overactivity (p = 0.007). CONCLUSIONS - Urodynamic studies identify bladder abnormalities in most patients with lower urinary tract symptoms and prostate volumes less than 40cc. Although bladder outlet obstruction is a common diagnosis, more than half of the patients had other types of bladder dysfunction as the basis for their voiding symptoms, predominantly detrusor overactivity and decreased detrusor contractility, emphasizing the value of urodynamic studies in this population.

As dimensões continentais de alguns países e a distribuição heterogênea da rede hospitalar dificultam o acesso ao atendimento inicial adequado ao trauma de face principalmente aos pacientes residentes em regiões mais remotas. Um modelo de atendimento por telemedicina pode ser uma opção ao atendimento especializado presencial. Os objetivos deste trabalho são apresentar um modelo de atendimento por especialistas à distância, por meio de videoconferência utilizando-se smartphone, e analisar a concordância deste atendimento por telemedicina com o atendimento presencial, considerado padrão ouro. Cinquenta pacientes com trauma de face e suspeita de fratura de face (n=50) foram atendidos, por duas equipes independentes, uma presencialmente e outra por telemedicina. A equipe presencial, que era formada pela equipe de plantão de cirurgia plástica na unidade de emergência, prestou o atendimento à beira do leito (história, exame físico e análise de imagens por tomografia computadorizada). A equipe telemedicina, composta por um médico generalista atendendo à beira do leito, prestou atendimento em conjunto com um cirurgião plástico à distância através de videoconferência com um smartphone. Após cada atendimento as duas equipes responderam a um questionário, com informações sobre dados epidemiológicos, dados do exame físico, sobre indicações de tomografia computadorizada, achados radiológicos da tomografia e conduta. Os dados foram analisados e comparados quanto à concordância das respostas através da análise estatística kappa, cálculo de acurácia, especificidade e sensibilidade. A amostra estudada foi representativa e concordante com a literatura, com predomínio de homens jovens. Acidentes de trânsito e violência interpessoal foram os principais mecanismos causadores do trauma. A concordância das respostas para os achados de exame físico foi considerada substancial (kappa=0,720), para a indicação da tomografia computadorizada foi quase perfeita (kappa=0,957), para os achados na tomografia foi quase perfeita (kappa=0,899) e para definir a conduta também foi quase perfeita (kappa=0,891). A alta concordância dos achados radiológicos nas tomografias computadorizadas de face também foi observada ao se calcular os valores preditivo positivo (VPP=89,9%), preditivo negativo (VPN=99,3%), sensibilidade (94,2%), especificidade (98,8%) e acurácia (98,3%). O estudo concluiu que o modelo de atendimento ao trauma de face à distância por videoconferência via smartphone é factível, encontrando altos índices de concordância quando comparados ao atendimento padrão ouro presencial, sendo uma opção ao atendimento para a triagem de pacientes vítimas de trauma de face em áreas remotas que não têm à disposição o atendimento especializado presencial / The continental size of some countries and heterogeneous distributed hospital network prevent many patients who live in remote areas from getting adequate initial assessment of facial trauma. The author presents a model for trauma assessment through telemedicine, which may be an alternative to face-to-face specialized attending. The goals of this study are presenting a model for non-attending specialized assessment through video conference via smartphones, and analyzing a comparison between telemedicine and face-to-face management, the latter currently being the gold standard. Fifty patients with either a confirmed or suspected diagnosis of facial trauma (n=50) were evaluated by two teams of physicians, one face-to-face and the other one telemedicine-based. The face-to-face team, which was made up by the attending plastic surgery team in the emergency unit, attended the patients at the bedside (physical examination and CT-scan analysis). The telemedicine team was made up by an in-house general practitioner working together with an on-call plastic surgeon through videoconference via smartphones. After each evaluation, both teams answered a similar questionnaire, which contained data concerning the patient\'s epidemiology, physical examination, CT-scan indications and findings, and the treatment option to be followed. The data were analyzed and compared regarding the similarity of answers, with the use of kappa statistics and analysis of data accuracy, sensitivity and specificity. The sample studied was representative and consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The agreement of answers for physical examination findings was considered substantial (kappa=0.720). For CT-scan indications, it was considered almost perfect (kappa=0.957); for CT-scan findings, it was almost perfect (kappa=0.899); and for defining the treatment option, it was also almost perfect (kappa=0.891). High concurrency of face CT-scan findings was also observed after we calculated the positive predictive value (PPV=89.9%), negative predictive value (NPV=99.3%), sensitivity (94.2%), specificity (98.8%) and accuracy (98.3%). The study concluded that the model for non-attending assessment of facial trauma through video conference via smartphones is feasible, showing high concurrence rates when compared to gold-standard in-house assessment, thus being an option for first assessment of facial trauma patients who live in remote areas, where specialized medical teams are not available

OBJETIVOS: Estimar a taxa de falência de desmame, identificar fatores de risco para a falência, estimar a taxa de mortalidade na unidade de terapia intensiva e hospitalar em um grupo heterogêneo de pacientes com ventilação mecânica prolongada. MÉTODOS: Trata-se de um estudo de coorte prospectivo de pacientes adultos consecutivamente internados em 11 unidades de terapia intensiva e que receberam ventilação mecânica por 3 dias ou mais. As variáveis de desfecho incluíram o resultado do desmame (falência ou sucesso) e o desfecho da UTI (alta ou óbito).RESULTADOS: Dos 189 pacientes incluídos, 149 (79%) foram desmamados com sucesso e 40 (21%) necessitaram de reintubação dentro de 48 horas, constituindo o grupo falência.Através da análise de regressão logística, o sexo feminino foi identificado como fator independentemente associado com a falência do desmame. Os pacientes com falência permaneceram por mais tempo na UTI (p < 0,01). A freqüência de traqueostomia foi maior no grupo com falência (p < 0,01). A taxa de mortalidade na UTI foi de 21%; IC de 95%: 15-27%. O modelo de regressão de Cox ajustado para a gravidade à admissão na UTI identificou que a falência do desmame aumentou o risco de morte na UTI (RR: 3,08; p < 0,01). CONCLUSÔES: Após o controle para variáveis clínicas e gravidade à internação na UTI, o sexo feminino apresentou associação independente com a falência do desmame. Pacientes com falência apresentaram maior tempo de internação na UTI, maior taxa de traqueostomia e maior risco de morte na UTI / OBJECTIVE: To determine the rate of weaning failure, risk factors, intensive care unit (ICU) and hospital outcomes in a number of heterogeneous patients with prolonged MV. DESIGN, SETTING, AND SUBJECTS: Prospective cohort of consecutive adult patients admitted to 11 ICU who received MV (³ 72 hours). Study endpoints included weaning failure vs success and ICU death vs survival. RESULTS: Of 189 intubated patients, 149 (79%) were succesfully extubated, and 40 (21%) required reintubation within 48 hours.Using multiple logistic regression, female gender was an independent predictor of weaning failure. The mean ICU length of stay was significantly longer in weaning failure group (p < 0.01). The rate of tracheostomy was higher in the failure group (p < 0.01). The ICU mortality rate was 21%; 95% CI, 15 - 27%. In a Cox model adjusting on severity at ICU admission, weaning failure increased the risk of death in the ICU (RR: 3.08; p < 0,01). CONCLUSION: After adjusting for severity of ilness and medical conditions, female gender had a significant independent association with increased risk of weaning failure (WF). WF had association with prolonged ICU stay and higher rate of tracheostomy. Patients with weaning failure were 3 times more likely to die in the ICU

Os acidentes de trânsito constituem a 13ª causa mais freqüente de morte no Brasil, ocupando o primeiro lugar na faixa de 10 a 14 anos, e o segundo na faixa dos 15 aos 29 anos. Estudos indicam que do total do custo dos acidentes de trânsito, mais de 20% deve-se diretamente ao uso indevido de álcool. Estudos internacionais que relacionam o consumo de álcool com fatalidades no trânsito são freqüentes, mas carecemos de dados epidemiológicos confiáveis e de abrangência nacional que sinalizem a atual e real situação. Portanto, o objetivo do presente estudo é realizar uma análise retrospectiva de dados de vítimas fatais de acidentes de trânsito ocorridos no Município de São Paulo no ano de 2005, para estabelecer a relação do uso do álcool e a morte no trânsito. Nas 907 vítimas avaliadas, notou-se uma associação com o uso de etanol, com 39,4% de casos positivos. Para condutores de veículos, essa porcentagem atinge 55,8%, todos acima do limite máximo permitido para condução à época, de 0,6 g/l. Acidentes em geral, e aqueles relacionados ao álcool, ocorreram com maior frequência aos sábados e domingos, e nos horários das 18hs às 6hs da manhã Os resultados demonstram uma associação do etanol com a ocorrência de vítimas fatais, e devem servir como alerta para o desenvolvimento de políticas públicas visando diminuir este grave problema. / Traffic accidents, in Brazil, account for the 13th most frequent cause of death, being the 1st most frequent among 10 to 14 year olds, and second for those aged 15 to 29. Studies indicate that form the total cost of traffic accidents, over 20% are directly due to the harmful consumption of alcohol. International studies that relate alcohol consumption to traffic fatalities are frequent, but we lack nationwide epidemiological data that present the current and real situation. Thus, the objective of the present study is to carry out a retrospective analysis of data from fatal traffic accident victims, in the city of Sao Paulo, in the year 2005, to establish the relationship between alcohol consumption and traffic deaths. In the 907 evaluated victims, an association with ethanol use was found, with 39.4% of cases being positive. For automobile drivers, this percentage reached 55.8%, all of them above the maximum level allowed at the time, 0.6 g/l. Accidents in general, and those related to alcohol happened in greater frequency on Saturdays and Sunday, and from 6PM to 6AM. The results show an association of alcohol consumption with fatal victims in traffic accidents, and should be a cause for concern. The data present can help in implementing and developing public policies aiming to diminish this grave issue.

Neste trabalho foram analisados trinta processos judiciais, que tramitam pelos Fóruns Regionais Cíveis de São Paulo, capital e interior e Instituições Periciais da Capital. Fez-se as extrações individualizadas de cada processo, objetivando definir as principais causas e documentos juntados ao mesmo e conseqüências de cada condição. Iniciou-se pela importância prática do tema para efeito de evolução médico-social. Buscou-se estudar a visão da relação médico-paciente, mesmo durante a demanda, a informação ao paciente e seus familiares dos procedimentos e limitadores do ato médico; o documental técnico jurídico juntado ao processo; o preparo técnico-jurídico do médico e, se, a propositura de ação depende da formação e especialização do profissional. Foram analisados processos judiciais de primeira instância no período de 1996 a 2002 correlacionados à cirurgias do aparelho digestivo. Usou-se como parâmetro de análise exclusivamente os documentos juntados aos autos onde buscou-se a existência clara da quebra da relação médico-paciente, a existência de consentimento informado, a verificação do documental juntado à defesa pelas partes ou solicitação judicial e a qualificação do profissional envolvido nas ações. Finalmente, analisados os resultados, chegamos a conclusão que a melhor forma para profilaxia da ação cível indenizatória por erro médico é: a boa relação médico-paciente; a manutenção de prontuário médico preenchido, legível, com carimbo e assinatura; o consentimento informado, que, deve ser elaborado, porém, por si só não é suficiente; e a condição técnico curricular do profissional não é fator atenuante para propositura da ação. / Thirty legal proceedings, which are in progress before the Regional Civil Courts both the Capital and the countryside of the State of Sao Paulo, Brazil, besides Examination Institutions in the Capital city of Sao Paulo, have been analyzed in this work Individual excerpts of each case were taken with the purpose of defining the main causes and documentation attached to them as well the consequences of each condition. The practical importance of the subject for the medical-social evolution has been addressed in the first place. The physician/patient relationship view was sought to be studied, even during the claim, as well as the information of the medical procedures and limitations to the patient and his or her family; the technical/legal documentation attached to the case; the physician technical/legal preparation and whether the filing of the action depends on the professional education and specialization. Trial court cases from 1996 to 2002 related to digestive system surgery have been analyzed. The analysis subject hereof has been based exclusively on the documents attached to the case record, where attempts have been made to evidence the clear existence of the breach of the physician/patient relationship, the existence of informed consent, the examination of the documentation attached to the defense by the parties or court request, and the qualification of the professional involved in the actions. Finally, after the results have been analyzed, a conclusion was reached that the best way of avoiding a civil action for damages due to medical malpractice includes: a good relationship between doctors and patients; keeping the patient record completed, legible, stamped, and signed; informed consent, which must be prepared but it is not sufficient on its own; and the professional technical experience and background do not constitute a mitigating circumstance for filing the action.