[Trends in traffic accidents in Campinas, São Paulo State, Brazil: the increasing involvement of motorcyclists]. / Tendência dos acidentes de trânsito em Campinas, São Paulo, Brasil: importância crescente dos motociclistas.

In order to describe trends in traffic accidents, mortality, vehicle types, fleet sizes, and victims' characteristics in Campinas, São Paulo State, Brazil, from 1995 to 2008, this study analyzed vehicle rates, traffic accident rates per inhabitant and per vehicle, case-fatality rates, proportional mortality, mortality rates, and rates ratios. The motorcycle fleet increased 241%. Although the case-fatality rate of motorcycle users from 2000 to 2008 decreased, in 2008 they accounted for 49.3% of fatal accidents on public byways in Campinas. Motorcycles were responsible for the highest run-over rate (66.7 pedestrians/1,000 accidents) and highest pedestrian fatality rate (4 deaths/1,000 accidents). Men showed much higher mortality rates than women. Pedestrian victims were mainly elderly; most vehicle occupants in traffic accidents were in the 15 to 29-year age bracket. From 2006 to 2008, nearly 80% of vehicle users 15 to 39 years of age were motorcyclists. Motorcycle accident prevention should be a priority, using multi-institutional measures.

Tendência dos acidentes de trânsito em Campinas, São Paulo, Brasil: importância crescente dos motociclistas / Trends in traffic accidents in Campinas, São Paulo State, Brazil: the increasing involvement of motorcyclists

Com o objetivo de descrever a tendência de ocorrência de acidentes de trânsito, sua mortalidade, tipo de veículo envolvido, tamanho da frota e perfil das vítimas em Campinas, São Paulo, Brasil, entre 1995 e 2008, foram estimadas taxas de motorização e ocorrência de acidentes, letalidade, mortalidade proporcional, taxas de mortalidade e razões entre taxas. A frota de motocicletas cresceu 241 por cento. Apesar da queda da letalidade dos acidentes de ocupantes de motos entre 2000 e 2008, esta categoria representou 49,3 por cento do total de acidentes fatais em vias públicas em 2008. As motos foram responsáveis pelas maiores taxas de atropelamento (66,7 atropelados/mil acidentes) e de atropelamentos seguidos de morte (4 óbitos/mil acidentes). Os homens mantiveram risco de morrer no trânsito muito superior ao das mulheres. Nos atropelamentos, predominaram elevadas taxas de mortalidade em idosos; entre os ocupantes de veículos, os mais atingidos foram os de 15 a 29 anos. Na faixa de 15 a 39 anos, entre 2006 e 2008, quase 80 por cento eram ocupantes de moto. Ações pluri-institucionais devem priorizar a prevenção de acidentes entre motociclistas.

In order to describe trends in traffic accidents, mortality, vehicle types, fleet sizes, and victims' characteristics in Campinas, São Paulo State, Brazil, from 1995 to 2008, this study analyzed vehicle rates, traffic accident rates per inhabitant and per vehicle, case-fatality rates, proportional mortality, mortality rates, and rates ratios. The motorcycle fleet increased 241 percent. Although the case-fatality rate of motorcycle users from 2000 to 2008 decreased, in 2008 they accounted for 49.3 percent of fatal accidents on public byways in Campinas. Motorcycles were responsible for the highest run-over rate (66.7 pedestrians/1,000 accidents) and highest pedestrian fatality rate (4 deaths/1,000 accidents). Men showed much higher mortality rates than women. Pedestrian victims were mainly elderly; most vehicle occupants in traffic accidents were in the 15 to 29-year age bracket. From 2006 to 2008, nearly 80 percent of vehicle users 15 to 39 years of age were motorcyclists. Motorcycle accident prevention should be a priority, using multi-institutional measures.

[Equity and access to health care for pregnant women in Campinas (SP), Brazil]. / Eqüidade e atenção à saúde da gestante em Campinas (SP), Brasil.

OBJECTIVE: To compare the health care received during pregnancy, delivery, and the puerperium by women belonging to two different per capita family income strata: less than 1 minimum wage, and 1 or more minimum wages. METHOD: This is a cross-sectional observational study that was carried out with a random sample of 248 female residents of the city of Campinas, in the state of São Paulo, Brasil, who had given birth between April 2001 and March 2002. Sociodemographic data, as well as information concerning maternal morbidity and health care during pregnancy, delivery, and the puerperium, were obtained through home interviews. The Kessner index, the Adequacy of Prenatal Care Utilization index, and an index proposed by the authors based on the recommendations of the Brazilian Department of Health were used to assess the adequacy of prenatal care. The minimum wage in Brazil at the time of the study was 180 reais (approximately 71.4 USD). RESULTS: The lower income group included a larger proportion of women with low schooling, as well as adolescents, black women, and single women. Prenatal care was provided by the public Unified Health System to 73.7% of the women in the lower income group, versus 33.3% in the higher income group. The women in the lower income group started attending prenatal care later and had fewer visits in all than higher-income women. However, some health care quality indicators, such as performance of routine laboratory tests and anti-HIV antibody testing, the proportion of cesarean sections, and the frequency of infant rooming-in, showed more favorable figures in the lower income group. Both groups received comparable counseling and had similar rates of clinical testing, post-delivery tubal sterilization, low birthweight children, and premature delivery. Although a significantly higher number of women in the higher income group received optimal prenatal care, the percentage of cases of inadequate care in the lower-income group was still relatively low. The frequency of health problems during pregnancy did not differ significantly between groups, except for anemia and vaginal hemorrhage, which were more frequent among women in the lower-income group (P < 0.001 and P = 0.033, respectively). CONCLUSIONS: Despite marked socio-demographic differences between women in the two income categories, resulting in different living conditions, there were no significant differences between groups in terms of health problems during pregnancy or the quality of the prenatal care received. These results suggest that the organization of public health services in Campinas has succeeded in promoting equity in health care, at least to a certain extent.

Equidade e atenção à saúde da gestante em Campinas (SP), Brasil / Equity and access to health care for pregnant women in Campinas (SP), Brazil

Objetivo. Comparar a atenção à saúde recebida durante a gestação, o parto e o puerpério por mulheres de dois estratos de renda familiar per capita (menos de 1 salário-mínimo e 1 ou mais salários-mínimos). Método. Estudo observacional transversal realizado em amostra aleatória de 248 mulheres residentes no Município de Campinas, Estado de São Paulo, que tiveram filhos entre abril de 2001 e março de 2002. Informações sobre aspectos sócio-demográficos, morbidade materna e atenção à saúde no pré-natal, parto e puerpério foram obtidas por meio de entrevistas domiciliares. O cuidado no pré-natal foi analisado com base no índice de Kessner, no índice de adequação da utilização do cuidado pré-natal (Adequacy of Prenatal Care Utilization) e no índice proposto pelos autores a partir das recomendações do Ministério da Saúde. Na época do estudo, o salário-mínimo correspondia a 180 reais, ou 71,40 dólares. Resultados. As gestantes do grupo de renda inferior tinham menor escolaridade e eram, em maior proporção, adolescentes, pretas ou pardas e solteiras. O pré-natal foi realizado pelo SUS em 73,7% das gestantes de menor renda, contra 33,3% do grupo de maior renda. As gestantes de menor renda iniciaram o pré-natal mais tardiamente e fizeram um número menor de consultas. Entretanto, alguns indicadores de qualidade da atenção, como exames de rotina, teste anti-HIV, percentual de parto cesáreo e permanência do recém-nascido com a mãe em alojamento conjunto, foram melhores nas gestantes de menor renda. Os grupos foram semelhantes em relação a orientações recebidas, exames clínicos, laqueadura no pós-parto e prevalência de baixo peso e de prematuridade. A inadequação do cuidado pré-natal, embora significativamente maior para as mulheres de menor renda, ocorreu num percentual relativamente baixo. Conclusões. As diferenças sócio-demográficas observadas entre os dois grupos não se reproduziram na mesma intensidade e direção nas variáveis relativas às condições e à atenção à saúde. Os resultados sugerem que a organização dos serviços públicos de saúde em Campinas tem viabilizado em alguns aspectos a promoção da eqüidade na saúde.

Objective. To compare the health care received during pregnancy, delivery, and the puerperium by women belonging to two different per capita family income strata: less than 1 minimum wage, and 1 or more minimum wages. Method. This is a cross-sectional observational study that was carried out with a random sample of 248 female residents of the city of Campinas, in the state of São Paulo, Brasil, who had given birth between April 2001 and March 2002. Sociodemographic data, as well as information concerning maternal morbidity and health care during pregnancy, delivery, and the puerperium, were obtained through home interviews. The Kessner index, the Adequacy of Prenatal Care Utilization index, and an index proposed by the authors based on the recommendations of the Brazilian Department of Health were used to assess the adequacy of prenatal care. The minimum wage in Brazil at the time of the study was 180 reais (approximately 71.4 US dollars). Results. The lower income group included a larger proportion of women with low schooling, as well as adolescents, black women, and single women. Prenatal care was provided by the public Unified Health System to 73.7% of the women in the lower income group, versus 33.3% in the higher income group. The women in the lower income group started attending prenatal care later and had fewer visits in all than higher-income women. However, some health care quality indicators, such as performance of routine laboratory tests and anti-HIV antibody testing, the proportion of cesarean sections, and the frequency of infant rooming-in, showed more favorable figures in the lower income group. Both groups received comparable counseling and had similar rates of clinical testing, post-delivery tubal sterilization, low birthweight children, and premature delivery. Although a significantly higher number of women in the higher income group received optimal prenatal care, the percentage of cases of inadequate care in the lower-income group was still relatively low. The frequency of health problems during pregnancy did not differ significantly between groups, except for anemia and vaginal hemorrhage, which were more frequent among women in the lower-income group (P < 0.001 and P = 0.033, respectively). Conclusions. Despite marked socio-demographic differences between women in the two income categories, resulting in different living conditions, there were no significant differences between groups in terms of health problems during pregnancy or the quality of the prenatal care received. These results suggest that the organization of public health services in Campinas has succeeded in promoting equity in health care, at least to a certain extent

Atenção à saúde e mortalidade neonatal: estudo caso-controle realizado em Campinas, SP / Health care and neonatal mortality

Estudo caso-controle desenvolvido para identificar o efeito dos fatores associados à mortalidade neonatal, analisando variáveis socioeconômicas, de morbidade materna e, em especial, aquelas relacionadas à atenção à saúde. O estudo, realizado em Campinas, SP, incluiu 117casos e 234 controles. As informações foram obtidas por meio de entrevistas domiciliares. A análise de regressão logística múltipla com modelo hierarquizado identificou como fatores associados ao óbito neonatal as variáveis de nível socioeconômico e de condições da família ( renda, naturalidade e número de moradores do domicílio); as variáveis de morbidade materna (sangramento vaginal e parto antecipado por problema de saúde); e as variáveis de atenção `a saúde ( número de orientações recebidas durante o pré-natal, escolha do hospital do parto e tempo decorrido entre a internação e o parto) e de condições do recém - nascido (idade gestacional, peso ao nascer e Apgar no quinto minuto). O número de consultas de pré-natal não se manteve associado ao óbito neonatal após este ser controlado pela duração da gestação. O estudo aponta a necessidade de melhora da qualidade da atenção pré-natal, especialmente para as gestantes de pior condição socioeconômica e em risco de parto prematuro