Maternal characteristics during pregnancy and risk factors for positive HIV RNA at delivery: a single-cohort observational study (Brescia, Northern Italy)

<p>Abstract</p> <p>Background</p> <p>Detectable HIV RNA in mothers at delivery is an important risk factor for HIV transmission to newborns. Our hypothesis was that, in migrant women, the risk of detectable HIV RNA at delivery is greater owing to late HIV diagnosis. Therefore, we examined pregnant women by regional provenance and measured variables that could be associated with detectable HIV RNA at delivery.</p> <p>Methods</p> <p>A observational retrospective study was conducted from January 1999 to May 2008. Univariate and multivariable regression analyses (generalized linear models) were used, with detectable HIV RNA at delivery as dependent variable.</p> <p>Results</p> <p>The overall population comprised 154 women (46.8% migrants). Presentation was later in migrant women than Italians, as assessed by CD4-T-cell count at first contact (mean 417/mm³versus 545/mm³, respectively; p = 0.003). Likewise, HIV diagnosis was made before pregnancy and HAART was already prescribed at the time of pregnancy in more Italians (91% and 75%, respectively) than migrants (61% and 42.8%, respectively). A subgroup of women with available HIV RNA close to term (i.e., ≤30 days before labour) was studied for risk factors of detectable HIV RNA (≥50 copies/ml) at delivery. Among 93 women, 25 (26.9%) had detectable HIV RNA. A trend toward an association between non-Italian nationality and detectable HIV RNA at delivery was demonstrated by univariate analysis (relative risk, RR = 1.86; p = 0.099). However, by multivariable regression analysis, the following factors appeared to be more important: lack of stable (i.e., ≥14 days) antiretroviral therapy at the time of HIV RNA testing (RR = 4.3; p < 0.0001), and higher CD4+ T-cell count at pregnancy (per 50/mm³, RR = 0.94; p = 0.038).</p> <p>Conclusions</p> <p>These results reinforce the importance of extensive screening for HIV infection, earlier initiation of antiretroviral therapy and stricter monitoring of pregnant women to reduce the risk of detectable HIV RNA at delivery. Public health interventions should be particularly targeted to migrant women who are frequently unaware of their HIV status at the time of pregnancy.</p

Estratégias adotadas por pessoas com Transtorno Afetivo Bipolar e a necessidade de terapêutica medicamentosa Estrategias adoptadas por personas con Trastorno Afectivo Bipolar y la necesidad del uso de medicamentos Strategies adopted by people with Bipolar Affective Disorder and the need for medication

Este estudo identificou as estratégias adotadas pela pessoa com Transtorno Afetivo Bipolar (TAB) diante da necessidade de uso contínuo de medicamentos. Foi utilizada a abordagem qualitativa, tendo como referencial metodológico a Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB que estavam em acompanhamento em uma Unidade Ambulatorial de Transtornos do Humor de um hospital universitário e 14 familiares indicados pelas mesmas. A entrevista e observação foram as principais formas de obtenção de dados. Os resultados revelaram cinco categorias que descrevem as estratégias adotadas pela pessoa com TAB: aderindo à terapêutica medicamentosa; querendo conhecer melhor o transtorno e os medicamentos; participando do grupo de psicoeducação; buscando seus direitos em relação ao acesso ao medicamento e tendo fé. Constatou-se que apesar da ambivalência em relação à adesão ao medicamento, a pessoa com TAB possui potencialidades para conviver com a situação.<br>Este estudio identificó las estrategias adoptadas por personas con Trastorno Afectivo Bipolar (TAB) ante la necesidad del uso continuo de medicamentos. Se utilizó un planteamiento cualitativo, teniendo como referencia metodológica la Teoría Basada en los Datos, a la luz de Interacción Simbólica. Participaron del estudio 14 personas con TAB, las cuales estaban en seguimiento en una Unidad Ambulatoria de Trastornos del Humor de un hospital universitario, además de 14 familiares indicados por dichas personas. Las principales formas de obtención de datos fueron la entrevista y la observación. Los resultados revelaron cinco categorías que describen las estrategias adoptadas por las personas con TAB: la adhesión a la terapia medicamentosa; el querer conocer mejor el trastorno y los medicamentos; la participación en el grupo de psico-educación; la búsqueda de sus derechos con relación al acceso al medicamento y la fé. Se constató que a pesar de la ambivalencia con relación a la adhesión al medicamento, la persona con TAB posee potencialidades para convivir con la situación.<br>This study identified the strategies adopted by people with bipolar affective disorder (BAD) in face of the need for continuous medication. The qualitative approach was used, and the methodological framework was based on the Data-Based Theory in the light of Symbolic Interactionism. Fourteen people with BAD who were being assisted at the Outpatient Unit for Mood Disorders of a university hospital and 14 relatives indicated by such subjects participated in the study. Interviews and observation were the major forms of data collection. The results showed five categories which described the strategies adopted by people with BAD: adhering to the medication therapy; wanting to learn more about the disorder and the medication; participating in the psychoeducation group; seeking one's rights in relation to access to medication and having faith. It was observed that, in spite of the ambivalence related to medication adherence, people with BAD have the potential to deal with such condition