Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study.

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives

Genotypes at the APOE and SCA2 loci do not predict the course of multiple sclerosis in patients of Portuguese origin

Prova tipográfica (In Press)Multiple sclerosis (MS) is a demyelinating disease that affects about one in 500 young Europeans. In order to test the previously proposed influence of the APOE and SCA2 loci on susceptibility to MS, we studied these loci in 243 Portuguese patients and 192 healthy controls and both parents of 92 patients. We did not detect any significant difference when APOE and SCA2 allele frequencies of cases and controls were compared, or when we compared cases with different forms of the disease. Disequilibrium of transmission was tested for both loci in the 92 trios, and we did not observe segregation distortion. To test the influence of the APOE o4 and SCA2 22 CAGs alleles on severity of disease, we compared age at onset and progression rate between groups with and without those alleles. We did not observe an association of the o4 or the 22 CAGs alleles with rate of progression in our total patient population; allele o4 was associated with increased rate of progression of MS in a subset of patients with less than 10 years of the disease. However, globally in the Portuguese population, the APOE and SCA2 genes do not seem to be useful in the clinical context as prognostic markers of this disorder.Fundação para a Ciência e a Tecnologia (FCT) - grant SFRH/BD/9111/2002.Serono Portugal

Perfil da mortalidade materna por aborto no Paraná: 2003-2005 Perfil de la mortalidad materna, por aborto en el Paraná: 2003-2005 Characteristics of maternal mortality by abortion in Parana: 2003-2005

Estudo descritivo cujo objetivo foi identificar o perfil das mulheres que tiveram como causa de morte o aborto, no Estado do Paraná, no período entre 2003 e 2005, com destaque para aspectos sociodemográficos, reprodutivos e relacionados à assistência prestada. Os dados foram obtidos a partir dos estudos de série de casos de óbitos maternos elaborados pelo Comitê Estadual de Prevenção da Mortalidade Materna/Paraná. Foram analisados 17 casos. Os resultados apontaram que 88% dos óbitos poderiam ter sido evitados. O aborto seguido de infecção (59%) foi a causa básica de maior concentração entre as mortes. As mulheres jovens, casadas, com baixo status socioeconômico e reprodutivo foram as mais atingidas. Reafirma-se a importância do acesso a bens sociais, da redução das desigualdades sociais e da educação em saúde voltada para o planejamento reprodutivo de qualidade.<br>Estudio descriptivo cuyo objetivo fue identificar las características de las mujeres que tuvieron como causa de muerte el aborto en el estado de Paraná en el período entre 2003 a 2005, con destaque para aspectos sociodemográficos, reproductivos y al cuidado que recibieron. Los datos fueron obtenidos con la serie de casos de óbitos maternos elaborados por el Comité Estadual de Prevención de la Mortalidad Materna/Paraná. Fueron analizados 17 casos. Los resultados mostraron que 88% de los óbitos podrían haber sido evitados. El aborto seguido de infección (59%) fue a causa básica de mayor concentración, entre las muertes evitables. Las mujeres jóvenes, casadas; con bajo status socioeconómico y reproductivo fueron las más alcanzadas. Se reafirma la importancia del acceso a bienes sociales y a la educación sanitaria hacia un planeamiento reproductivo calificado.<br>A descriptive study whose objective was to identify the characteristics of women who died while having an abortion in the state of Parana between 2003 and 2005, outlining the sociodemographical, reproductive aspects and to the care received. The data was obtained from case series of maternal mortality by the State Committee of Maternal Death Prevention/Parana. There were seventeen cases analyzed and the figures showed 88% of them could have been avoided. The abortion cases followed by infection (59%) were the basic cause of the major concentration of avoidable mortalities. Young married women with a low socio-economic status and fertility were the most affected. This way, it reaffirms the importance of access to social welfare and to health education towards a qualified reproductive planning

Delays in obtaining hospital care and abortion-related complications within a context of illegality.

Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes. This study, nested within the GravSus-NE, analyzed healthcare delays and their association with abortion-related complications in three cities of northeastern Brazil (Salvador, Recife and São Luís). Nineteen public maternity hospitals were involved. All eligible women ≥18 years old hospitalized between August and December 2010 were evaluated. Descriptive, stratified and multivariate analyses were performed. Youden's index was used to determine delay. One model was created with all the women and another with those admitted in good clinical conditions, thus determining complications that occurred during hospitalization and their associated factors. Of 2,371 women, most (62.3%) were ≤30 years old (median 27 years) and 89.6% reported being black or brown-skinned. Most (90.5%) were admitted in good condition, 4.0% in fair condition and 5.5% in poor/very poor condition. Median time between admission and uterine evacuation was 7.9 hours. After a cut-off time of 10 hours, the development of complications increased considerably. Black women and those admitted during nightshifts were more likely to experience a wait time ≥10 hours. Delays were associated with severe complications (OR 1.97; 95%CI: 1.55-2.51), including in the women admitted in good condition (OR 2,56; 95%CI: 1.85-3.55), and even following adjustment for gestational age and reported abortion type (spontaneous/induced). These findings corroborate the literature, highlighting the social vulnerability of women hospitalized within Brazil's public healthcare system in a situation of abortion. The study strongpoints include having objectively measured the time between admission and uterine evacuation and having established a cut-off time defining delay based on conceptual and epidemiological criteria. Further studies should evaluate other settings and new measurement tools for effectively preventing life-threatening complications

Avaliação da qualidade da atenção ao aborto: protótipo de questionário para usuárias de serviços de saúde

No Brasil, s&#227;o escassas as pesquisas sobre a qualidade da aten&#231;&#227;o ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da constru&#231;&#227;o de instrumento para estudo sobre a assist&#234;ncia hospitalar prestada pelo Sistema &#218;nico de Sa&#250;de em tr&#234;s cidades. Foram definidas quatro dimens&#245;es essenciais da aten&#231;&#227;o &#8211; acolhimento e orienta&#231;&#227;o, qualidade t&#233;cnica do cuidado, continuidade da aten&#231;&#227;o, insumos/ambiente f&#237;sico &#8211; e respectivos crit&#233;rios. Procedeu-se &#224; adapta&#231;&#227;o transcultural de conjunto de itens propostos pela Organiza&#231;&#227;o Mundial da Sa&#250;de. Para dar conta de dimens&#245;es e crit&#233;rios n&#227;o contemplados pelo conjunto original de perguntas, optou-se por adaptar quest&#245;es de outros estudos e adicionar outras elaboradas pela pr&#243;pria equipe. O question&#225;rio foi pr&#233;-testado em 52 usu&#225;rias, nas tr&#234;s cidades, para avaliar a aceita&#231;&#227;o e compreens&#227;o, o tempo de aplica&#231;&#227;o e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avalia&#231;&#245;es psicom&#233;tricas em desenvolvimento e que se seguir&#227;o em outros artigos