Symptomatic dengue and adverse pregnancy outcomes: a population-based record linkage study

Dengue stands out from other viral mosquito borne diseases because it is the most common; its incidence is growing and it is reaching new geographical areas and spreading worldwide. Indeed, reported cases of negative pregnancy outcomes after dengue infection is not new, however, the evidence of the association between maternal dengue and adverse pregnancy outcomes is limited, controversial and mostly supported by cases reports. The aim of this thesis is to explore the relationship between pregnancy outcome and symptomatic maternal dengue. I conducted a population-based study using routinely-collected Brazilian data from 2006-2012. These data have the information required to expand the existing knowledge on birth outcomes from women with dengue acquired during pregnancy. The linkage process imposed complex challenges, and the final linked data showed a low sensitivity. However, it is unlikely that the linkage error introduced bias on the final analysis since it occurred randomly between cases and the comparison group. Our main findings showed that dengue during pregnancy is associated with adverse maternal and birth outcomes. The effect was higher in the acute disease period (first 10/20 days) and severe disease increased the magnitude of the association. Therefore in areas where dengue virus is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid adverse outcomes

Validating linkage of multiple population-based administrative databases in Brazil

BACKGROUND: Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. METHODS: We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007-2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: Of the 10,259 maternal deaths recorded in 2007-2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. CONCLUSION: Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses

Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil

OBJECTIVES: Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes. // DESIGN AND SETTING: We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012. // PARTICIPATING: We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks' gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome. // RESULTS: We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period. // CONCLUSION: This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers

Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis.

INTRODUCTION: Arthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors. METHODS: We conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses. RESULTS: We identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I2=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I2=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I2=85.2%). CONCLUSION: Evidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions. PROSPERO REGISTRATION NUMBER: CRD42019158572

Interdependence between confirmed and discarded cases of dengue, chikungunya and Zika viruses in Brazil: A multivariate time-series analysis.

The co-circulation of different arboviruses in the same time and space poses a significant threat to public health given their rapid geographic dispersion and serious health, social, and economic impact. Therefore, it is crucial to have high quality of case registration to estimate the real impact of each arboviruses in the population. In this work, a Vector Autoregressive (VAR) model was developed to investigate the interrelationships between discarded and confirmed cases of dengue, chikungunya, and Zika in Brazil. We used data from the Brazilian National Notifiable Diseases Information System (SINAN) from 2010 to 2017. There were three peaks in the series of dengue notification in this period occurring in 2013, 2015 and in 2016. The series of reported cases of both Zika and chikungunya reached their peak in late 2015 and early 2016. The VAR model shows that the Zika series have a significant impact on the dengue series and vice versa, suggesting that several discarded and confirmed cases of dengue could actually have been cases of Zika. The model also suggests that the series of confirmed and discarded chikungunya cases are almost independent of the cases of Zika, however, affecting the series of dengue. In conclusion, co-circulation of arboviruses with similar symptoms could have lead to misdiagnosed diseases in the surveillance system. We argue that the routinely use of mathematical and statistical models in association with traditional symptom-surveillance could help to decrease such errors and to provide early indication of possible future outbreaks. These findings address the challenges regarding notification biases and shed new light on how to handle reported cases based only in clinical-epidemiological criteria when multiples arboviruses co-circulate in the same population

Waleska Paixão: uma biografia a serviço da enfermagem brasileira Waleska Paixão: una biografía al servicio desarrollo de la enfermería brasileña Waleska Paixão: a biography dedicated to the brazilian nursing

Trata-se de estudo sobre dados históricos de vida de Waleska Paixão, elaborado com o objetivo de analisar suas contribuições mais significativas à Enfermagem brasileira e lançar um primeiro olhar sobre as plenitudes de questões envolvendo experiências vividas por esta enfermeira, em seu tempo. As fontes primárias são documentos do Centro de Documentação da Escola Anna Nery da Universidade Federal do Rio de Janeiro e depoimento oral de Waleska Paixão arquivado na instituição. Os resultados demonstram que a trajetória de vida da protagonista focalizada pelo estudo teve caminho marcante na Enfermagem, particularmente no que concerne a avanços da profissão e do ethos primaz do perfil das(os) enfermeiras(os), líderes na construção pedagógica do ensino de Enfermagem e na edificação da Enfermagem brasileira.<br>Se trata de un estudio sobre la historia de vida de Waleska Paixão, elaborado con el objetivo de examinar sus contribuciones más significativas para la enfermería brasileña y lanzar una primera visión sobre la complejidad de los problemas históricos vividos en su tiempo por esta enfermera. Las fuentes primarias son documentos del Centro de Documentación de la Escuela Anna Nery de la Universidad Federal de Río de Janeiro y testimonio oral de Waleska Paixão archivado en la institución. Los resultados indican que el camino de vida de la protagonista centralizada por el estudio, tuvo trayectoria expresiva en la enfermería, particularmente en lo que concierne al avance de la profesión y del ethos, como primacía del perfil de las (los) enfermeras(os), líderes de la educación en la construcción de la enseñanza, la enfermería y la construcción de la enfermería brasileña.<br>This is a study on the life of Waleska Paixão done in order to view her utmost significant contribution to nursing in Brazil and to launch a first look over the complexity of the historical issues of her life during her lifetime. The primary sources came from documents of the Centro de Documentação of Escola Anna Nery at the Universidade Federal do Rio de Janeiro and Waleska Paixão's verbal report archived at the institution. The results, as seen by the study, show that the life path of the protagonist was outstanding, concerning primarily the progress of the profession and the utmost ethos of the nurses' profile, educational leaders in the construction of teaching, nursing and the building of nursing brazilian

Emblemas e rituais: reconstruindo a história da Escola de Enfermagem Hermantina Beraldo Emblemas y rituales: reconstrucción de la historia de la Escuela de Enfermería Hermantina Beraldo Emblems and rituals: rebuilding the history of Hermantina Beraldo School of Nursing

Estudo histórico-social. Objeto: emblemas e rituais instituídos pela Escola de Enfermagem Hermantina Beraldo no período de 1947 a 1950. Objetivos: caracterizar a escola; enumerar os emblemas e rituais por ela utilizados e comentar as implicações da utilização desses emblemas e rituais. As fontes primárias foram documentos escritos e fotográficos pertencentes ao acervo da escola e ao acervo pessoal da professora Maria Aparecida Araújo. As fontes secundárias focalizam a História da Enfermagem Brasileira, a História do Brasil e a história da própria escola. A análise dos dados, feita com base em estudos relativos à temática do estudo, evidenciou que os emblemas e rituais, de inspiração religiosa e militar, instituídos pela escola, apontavam modelos a serem seguidos, inculcando atributos como hierarquia e disciplina, de modo a favorecer a construção da identidade da enfermeira diplomada pela Escola de Enfermagem Hermantina Beraldo.<br>Estudio histórico y social. Objeto: emblemas y rituales instituidos para la escuela del oficio de enfermera Hermantina Beraldo en el período de 1947 el 1950. Objetivos: caracterizar la escuela; enumerar los emblemas y los rituales usados por la escuela y comentar las implicaciones del uso de estos emblemas y rituales. Las fuentes primarias fueron documentos escritos y material fotográfico de la escuela de enfermería Hermantina Beraldo y la relación personal de la profesora Maria Aparecida de Araújo. Las fuentes secundarias enfocan la historia del oficio de enfermera brasileño, la historia de la escuela enfermería Hermantina Beraldo y la historia del Brasil. El análisis de los datos, fue hecho en base de estudios relativos al tema del estudio que evidenció los emblemas y los rituales, de la inspiración religiosa y militar, instituidos para la escuela de enfermería Hermantina Beraldo los modelos que se seguirán, las cualidades inculcando jerarquía y disciplinas, para favorecer la construcción de la identidad de la enfermera del graduado<br>Historical and social study. Object: emblems and rituals instituted for the School of Nursing Hermantina Beraldo in the period of 1947 the 1950. Objectives: to characterize the School of Nursing Hermantina Beraldo; to enumerate the emblems and rituals used for the School and to comment the implications of the use of these emblems and rituals. The primary sources had been documents written and photographic pertaining to the quantity of the School of Nursing Hermantina Beraldo and to the personal quantity of the teacher Maria Aparecida de Araújo. The secondary sources focus the History of the Brazilian Nursing, History of the School of Nursing Hermantina Beraldo and the History of Brazil. The analysis of the data, made on the basis of relative studies to the thematic one of the study evidenced that the emblems and rituals, of religious and military inspiration, instituted for the School of Nursing Hermantina Beraldo pointed models to be followed, inculcating attributes as hierarchy and disciplines, in order to favored the construction of the identity of the diploma nurse for the School of Nursing Hermantina Beraldo