Zika virus public health crisis and the perpetuation of gender inequality in Brazil

Background In 2015–2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women’s negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. Methods We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18–40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women’s contraceptive use. Results Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male’s participation on Zika prevention and contraceptive management, while failing to take into account Brazil’s large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. Conclusion Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies

Incidencia de delirium perioperatorio en el Hospital Nacional Arzobispo Loayza, octubre a diciembre 2021, Lima Perú: Incidence of perioperative delirium at the hospital nacional arzobispo loayza, october to December 2021, Lima Peru

OBJECTIVE: To determine the incidence of perioperative delirium (POD) at the Hospital nacioanl Arzobispo Loayza, from October to December 2021.   METHODS: Qualitative and prospective observational study, carried out in a population of 910 patients, in which the AMT Test Confusion Assessment Method (CAM) and the Pfeiffer questionnaire (Short Portable Mental Status Questionnaire, SPMSQ) were applied. We used Chi2 to demonstrate the existence of association and Cramer's V and Phi tests to quantify the intensity of said relationship if it existed.   RESULTS: Of the total of patients (910), 18.46% presented perioperative delirium. Sex and religion do not influence this. Age does influence the presentation of POD since 50% (145) of the patients 61 years of age or older presented it, unlike those between 36 -60 years of age only 5.31% and those of 18 - 35 only 0.88% presented POD. According to the level of education: 100% with no education, 73.1% with primary education, 18.5% with secondary education  and 5.8% with higher education, presented DPO. According to the anesthetic technique, POD was found in 28.9% (60) of the spinal type with sedation, 22.4% (11) of the epidural type with sedation, 16.7% (83) of the General TIVA TCI type, 12.9% (4) of the Block type with sedation, 9.5% (10) of the General balanced type; for the types of general anesthesia manual TIVA, General Multimodal and Spinal anesthesia without sedation there were no cases of POD. According to the operative time: 100% (9) of the patients with more than 6 hours of operative time, 27.1% (38) of the patients who have 3 to 6 hours of operative time and 16.5% (121) of the patients who have 1 to 3 hours of operative time presented cases of POD.   According to hospitalization time prior to surgery: 48% (36) of patients with hospitalization time of 16 to 30 days, 20.5% (26) of patients with hospitalization time of 8 to 15 days and 16% (97) of the patients with hospitalization time of 3 to 7 days presented POD. According to the presence of comorbidities: 51.6% (16) with AHT and RD, 41.7% (30) with Diabetes and 40.8% (20) with AHT and DM2 present POD.     According to the presence of dementia: 100% (6) of the patients with a history of dementia and 17.9% (162) of the patients with no history of dementia presented POD. According to psychiatric history, 68.4% (13) of those who did have a history of psychiatric disorder and 17.4% (155) of those who did not have a history of psychiatric disorder presented POD. According to history of psychiatric treatment: 100% (6) of those who do have a history of treatment and 17.9% (162) of those who do not have a history of psychiatric treatment presented POD. According to the pre-surgical and post-surgical PFEIFFER questionnaire: 100% of those with mild, moderate or severe cognitive impairment according to the PFEIFFER PRE QX questionnaire presented POD. According to diagnosis of pre-surgical and post-surgical delirium: 100% presented POD.   CONCLUSIONS: There is no association between sex and religion and the presentation of POD. If there is an association between age, educational level, type of anesthesia, operative time, hospitalization time prior to surgery, comorbidities, history of dementia, history of psychiatric disorder, history of psychiatric treatment, pre-, post-surgical Pfeiffer questionnaire, pre-surgical delirium and post-surgical delirium and the presentation of POD,OBJETIVO: Determinar la incidencia de delirium perioperatorio (DPO) en el Hospital Nacional “Arzobispo Loayza”, de octubre a diciembre del 2021.  MÉTODOS: Estudio observacional cualicuantitativo y prospectivo, realizado en una población de 910 pacientes, en los que se aplicó: AMT Test Confussion Assessment Method (CAM)  y  el cuestionario de Pfeiffer (Short Portable Mental Status Questionnaire, SPMSQ). Utilizamos Chi2 para demostrar la existencia de asociación y las pruebas de V de Cramer y Phi para cuantificar la intensidad de dicha relación en caso existiera.   RESULTADOS: Del total de pacientes (910) el 18,46% presentaron de delirium perioperatorio. El sexo y la religión no influye en esta. La edad si influye en la presentación del DPO puesto que el 50% (145) de los pacientes de 61 años o más la presentaron, a diferencia de los que tenían entre 36 -60 años solo el 5,31 % y los de 18 – 35 solo el 0,88 % presentaron DPO. Según el nivel de instrucción: el 100% sin instrucción presentaron DPO, el 73,1 con primaria presentaron DPO, el 18,5 con secundaria presentaron DPO y el 5,8 % con educación superior presentaron DPO. Según la técnica anestésica se encontró DPO en el 28,9% (60) del tipo raquídea con sedación, el 22,4% (11) del tipo epidural con sedación, el 16,7% (83) del tipo General TIVA TCI, el 12,9% (4) del tipo Bloqueo con sedación, el 9,5% (10) del tipo General balanceada; para los tipos de anestesia General TIVA manual, General Multimodal y Raquídea sin sedación no se presentaron casos de DPO.  Según el tiempo operatorio: el 100% (9) de los pacientes con más de 6 horas de tiempo operatorio, el 27,1% (38) de los pacientes que tienen de 3 a 6 horas de tiempo operatorio y el 16,5% (121) de los pacientes que tienen de 1 a 3 horas de tiempo operatorio presentaron casos de DPO. Según el tiempo de hospitalización previo a la cirugía: el 48% (36) de los pacientes con tiempo de hospitalización de 16 a 30 días, el 20,5% (26) de los pacientes con tiempo de hospitalización de 8 a 15 días y el 16% (97) de los pacientes con tiempo de hospitalización de 3 a 7 días presentaron casos de DPO. Según la presencia de comorbilidades: el 51,6% (16) que tienen HTA y ER, el 41,7% (30) que tienen Diabetes y el 40,8% (20) que tienen HTA y DM2 presentan casos de DPO. Según presencia de demencia: el 100% (6) de los pacientes que  tienen historia de demencia y el 17,9% (162) de los pacientes que no tienen historia de demencia presentaron DPO.  según historia de antecedentes psiquiátricos, el 68,4% (13) de los que si tienen historia de trastorno psiquiátrico y el 17,4% (155) de los que no tienen historia de trastorno psiquiátrico presentaron DPO. Según historia de tratamiento psiquiátrico: el 100% (6) de los que si tienen historia de tratamiento y el 17,9% (162) de los que no tienen historia de tratamiento psiquiátrico presentaron DPO. Según cuestionario PFEIFFER pre-quirúrgico y post-quirúrgico: el 100% de los que tienen deterioro cognitivo leve, moderado o severo según el cuestionario PFEIFFER PRE QX presentaron DPO. Según diagnóstico de delirio pre-quirúrgico y post-quirúrgico:  el 100% presentaron DPO. CONCLUSIONES: No existe una asociación entre el sexo y la religión y la presentación de DPO.  Si existe una asociación entre la edad, grado de instrucción, tipo de anestesia, tiempo operatorio, tiempo de hospitalización previo a la cirugía, comorbilidades, historia de demencia, historia de trastorno psiquiátrico, historia de tratamiento psiquiátrico, cuestionario Pfeiffer pre, post quirúrgico, delirio pre quirúrgico y delirio post quirúrgico y la presentación de DPO