Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance.Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Tribute to R.G. Boutilier: Skin colour and body temperature changes in basking Bokermannohyla alvarengai (Bokermann 1956)

In amphibians solar basking far from water sources is relatively uncommon since the highly permeable amphibian skin does not represent a significant barrier to the accompanying risk of losing water by evaporation. A South American frog, Bokermannohyla alvarengai (Bokermann 1956), however, spends a significant amount of the day exposed to full sun and relatively high temperatures. The means by which this frog copes with potentially high rates of evaporative water loss and high body temperatures are unknown. Thus, in this study, skin colour changes, body surface temperature, and evaporative water loss rates were examined under a mixture of field and laboratory conditions to ascertain whether changes in skin reflectivity play an important role in this animal's thermal and hydric balance. Field data demonstrated a tight correlation between the lightness of skin colour and frog temperature, with lighter frogs being captured possessing higher body temperatures. Laboratory experiments supported this relationship, revealing that frogs kept in the dark or at lower temperatures (20 degrees C) had darker skin colours, whereas frogs kept in the light or higher temperatures (30 degrees C) had skin colours of a lighter hue. Light exhibited a stronger influence on skin colour than temperature alone, suggesting that colour change is triggered by the increase in incident solar energy and in anticipation of changes in body temperature. This conclusion is corroborated by the observation that cold, darkly coloured frogs placed in the sun rapidly became lighter in colour during the initial warming up period (over the first 5 min), after which they warmed up more slowly and underwent a further, albeit slower, lightening of skin colour. Surprisingly, despite its natural disposition to bask in the sun, this species does not possess a 'waterproof' skin, since its rates of evaporative water loss were not dissimilar from many hylid species that live in arboreal or semi-aquatic environments. The natural history of B. alvarengai is largely unknown and, therefore, it is likely that the herein reported colour change and basking behaviour represent a complex interaction between thermoregulation and water balance with other ecologically relevant functions, such as crypsis.