The association between Zika virus infection and microcephaly in Brazil 2015-2017: An observational analysis of over 4 million births.

BACKGROUND: In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. METHODS AND FINDINGS: We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk < 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. CONCLUSIONS: This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason

Mortality in women for associated feeding and metabolism diseases: a multiple causes analysis

Introdução- A hipertensão arterial é um problema de saúde pública por sua magnitude e dificuldades no controle; é um dos importantes fatores de risco para acidente vascular cerebral e infarto do miocárdio. Diabetes, atualmente, é uma das principais doenças crônicas, sendo um problema de saúde global, acometendo todos os extratos socioeconômicos. A prevalência de obesidade em países desenvolvidos tem aumentado, nas últimas décadas. No Brasil, entre 1974 e 1989, a proporção de obesos aumentou de 21% para 32%. A obesidade é fator de risco para hipertensão arterial, hipercolesterolemia, diabetes e doenças cardiovasculares. A desnutrição é fator agravante, principalmente como indicador socioeconômico e como complicação de outras doenças. Justificativa e objetivo - As doenças mencionadas apresentam-se associadas (exceto a desnutrição). A sua prevalência vem crescendo no país, além de serem fatores de risco para outras enfermidades. Considerando-se estes aspectos, decidiu-se realizar esta investigação cujo objetivo é verificar o ganho da informação em relação a mortalidade em mulheres de 10 a 49 anos por diabetes, desnutrição, obesidade e hipertensão arterial, como causa básica ou associada e reconhecer alguns fatores associados a esta mortalidade, por meio de uma análise por causas múltiplas. Material e métodos- Foi constituída uma base de dados com 7.332 óbitos colhidos no \"Estudo da morbi-mortalidade de mulheres de 10 a 49 anos - Projeto Gravidez, Parto e Puerpério (GPP)\". A metodologia foi de RAMOS (Reproductive Age Mortality Survey) e aplicada em todas as capitais de estados brasileiros e Distrito Federal. Com as informações adicionais, foi preenchida uma nova declaração de óbito. Foram analisadas duas bases (dados da DO-ORIGINAL e da DO-NOVA) e comparações das distribuições de óbitos segundo causa básica e fonte (DO-O, DO-N) foram feitas por meio de programas estatísticos específicos. Resultados- A declaração de óbito, do modo como é preenchida pelo médico, é falha tanto em quantidade quanto em qualidade da informação. Conclui-se que a análise por causas múltiplas permite a obtenção de uma distribuição apurada, em se tratando de informações advindas de declarações de óbito. São necessárias campanhas para melhor preenchimento da declaração de óbito, assim como mais estudos voltados à análise de causa múltipla de morte.Introduction- The primary hypertension is a public health problem due to its magnitude and control difficulties; it is one of the most important risk factor for cerebral vascular accident and infartation of the myocardium. Diabetes, currently, is one of the most frequent chronic diseases, being a problem of global health, attacking all social sets. The prevalence of obesity in developed countries has increased in the last decades. ln Brazil, between 1974 and 1989, the obese ratio increased of 21% to 32%. The obesity is a risk factor for hypercholesterolemia, hypertension, diabetes and cardiovascular diseases. The malnutrition has its importance, mainly as an index of social status and as consequence to other illnesses. Justification and objective- the mentioned diseases are associated (except the malnutrition). Their prevalences have being growing in the country, as also being factors of risk for other diseases. Considering these aspects, it was decided to carry out this inquiry which objective is verify data gain by a multiple cause analysis for mortality in women of 10 the 49 years for diabetes, malnutrition, obesity and arterial hypertension, as underlying or associated cause of death and to recognize some factors associated to this mortality. Material and methods- A data base was constituted with 7,332 deaths collected in the \"Study of mortality and diseases in fertile women (10 to 49 years) - Project Pregnancy, partum and puerperium\'\". The methooology was RAMOS type and it was applied in all the capitals of Brazilian states and Federal District. With the new information, a new death certificate was filled. Two data sets were made (data from the DC-ORIGINAL and the DC-NEW) and comparisons of the distributions of deaths according to underlying causes of death and source (DC-O, DC-N) were analyzed, using statistical software. Results- the death certificate, the way it is filled by the physician, is not perfect both in quantity as in quality of the information. The multiple causes analysis allows the attainment of a refined distribution, concerning information on the death certificate. Campaigns are necessary for a better filling of the death certificate, as well as more studies directed to the analysis of multiple causes of death

Mortalidade feminina por hipertensão: análise por causas múltiplas Mortality due to hypertension in women: a multiple cause analysis

INTRODUÇÃO: A prevalência da hipertensão arterial vem crescendo no país, constituindo-se em um problema de saúde pública por sua magnitude e dificuldades no controle. OBJETIVO: Avaliar a qualidade dos dados sobre hipertensão como causa de morte e verificar o ganho de informação na mortalidade por hipertensão arterial de mulheres de 10 a 49 anos, por meio da metodologia de análise por causas múltiplas de morte. MATERIAL E MÉTODOS: Foi constituída uma base de dados com 7.332 óbitos ocorridos no primeiro semestre de 2002 pertencentes ao "Estudo da Morbi-Mortalidade de Mulheres de 10 a 49 anos". A metodologia RAMOS (Reproductive Age Mortality Survey) foi aplicada em todas as capitais de Estados brasileiros e Distrito Federal. Com as informações adicionais, foi preenchida uma nova declaração de óbito - DO-NOVA. Foram analisados dois conjuntos de dados (DO-ORIGINAL - antes da investigação - e DO-NOVA - após resgate das informações. Foram realizadas comparações segundo causas básicas e múltiplas por fontes dos dados (DO-O, DO-N). RESULTADOS E CONCLUSÃO: A DO-ORIGINAL apresentou algumas falhas quantitativas e qualitativas. Concluiu-se que a análise por causas múltiplas enriquece a informação, com base nas DO. São necessárias ações contínuas para um melhor preenchimento da DO, pelos médicos, e deve haver mais estudos que adotem a metodologia de causas múltiplas.<br>INTRODUCTION: Hypertension is a public health problem due to its magnitude and difficulties in its control. OBJECTIVE: The objectives were to verify the quality of death certificates (DC) and gain in information when the multiple cause of death methodology is performed, in DC of women from 10 to 49 years filled out with hypertension as an underlying or an associated cause of death. METHODS: The database consisted of 7,332 DC of the first semester of 2002 collected in the "Study of women in childbearing age, living in the capitals of all Brazilian States and Federal District". The RAMOS methodology was adopted and household interviews and hospital records were collected. With the new information, a new death certificate was filled out. Two data sets were built (DC-ORIGINAL and DC-NEW) and comparisons of the distributions of deaths according to causes of death and source (DC-O, DC-N) were done. RESULTS: Some physicians are not filling out DC appropriately. The analysis of multiple causes of death allows the attainment of much more information. Campaigns to motivate physicians are necessary to improve the quality of DCs, as well as mortality studies have to be analyzed according to underlying causes of death, and also by means of the multiple causes of death methodology

The study of the mother-child binomium: description and general results

OBJECTIVE: The present study investigated the characteristics of women during pregnancy/immediate postpartum cycles and the product of their pregnancy. METHOD: Data collection was conducted for a period of three months in 2011, in six maternity hospitals in the State of S&#227;o Paulo. The data were obtained in an interview with the women after the end of the pregnancy and collected from hospital records. The sample included 7,058 women hospitalized for abortion or childbirth in five hospitals from SUS (Unified Health System) and from only one hospital for private health insurance patients and their 6,602 conceptuses (live births and stillborns). Statistical analysis was based on &#967;2 tests, with a significance level of &#945; = 5%. RESULTS: It was observed that 6,530 women gave birth and 528 showed interruption of pregnancy. Regarding age, 1,448 were teenagers (20.5%). There were no deaths during hospitalization and 99.8% of women received a medical discharge. Maternal morbidity in the current pregnancy was analyzed, showing urinary tract infection, anemia and excessive vomiting as the main problems. The rate of cesarean sections accounted for 31.1% and complications in childbirth and postpartum were shown, respectively, by 834 (12.8%) and 265 (4.1%) women. The characteristics of the conceptuses were also studied: gestation length (9.3% of preterm among live births, and 68% among the stillborn); birth weight (underweight in 8.2% among live births, and 66% among the stillborn) and morbidity, measured by congenital anomalies and other diseases; these diseases were responsible for ICU stay, transfers to better-equipped hospitals (10 cases) and 37 deaths. Thirteen live births were still hospitalized at the end of the investigation

Características das gestações de adolescentes internadas em maternidades do estado de São Paulo, 2011

OBJETIVO: descrever as características das gestantes adolescentes internadas em hospitais no estado de São Paulo, Brasil. MÉTODOS: estudo transversal realizado em seis maternidades públicas e privadas durante três meses de 2001, com adolescentes gestantes de 10 a 19 anos de idade, mediante entrevistas e consultas aos prontuários e cadernetas de pré-natal. RESULTADOS: foram incluídas 1.448 gestantes adolescentes; houve 71 abortos, 16 natimortos e nove óbitos entre os 1.367 nascidos vivos (0,7%); a maioria das gestantes (79,8%) era primigesta, 11,7% referiram ter fumado, 8,8% consumiram álcool e 1,2% informaram uso de drogas ilícitas durante a gestação; a proporção de adolescentes de 10 a 14 anos que iniciaram o pré-natal ao terceiro trimestre (9,3%) foi maior do que aquela entre 15 e 19 anos (3,3%). CONCLUSÃO: observou-se elevada prevalência de fatores de risco gestacional entre as adolescentes, como tabagismo, consumo de álcool e início tardio do pré-natal