Seroprevalence and factors associated with Human Immunodeficiency virus, Human T lymphotropic virus and Hepatitis B/C infections in parturient women of Salvador - Bahia, Brazil

Abstract Background The heterogeneity in detection rates of Human immunodeficiency virus, (HIV), Human T lymphotropic virus (HTLV) and Hepatitis B and C infections among pregnant women and the continuous exposure to risk factors limits the adoption of preventive and control actions. Objective To evaluate the HIV, HTLV, Hepatitis B and C seroprevalence rates, and associated risk factors in parturient women in Salvador, Brazil. Methods This was a cross-sectional study in 2099 parturient women attended in two public maternity hospitals in Salvador, Brazil. One blood sample was drawn for serological screening and socio-demographic, obstetric and clinical data were collected. Results HIV seroprevalence rate was 1.5% (of which 0.6% were new cases); seroprevalence rates for HTLV, HBV, and HCV were 0.4%, 0.4%, and 0.1%, respectively. Univariate analysis showed a significant association between socio-demographic and behavioral factors with retroviral infections, while viral hepatitis was mainly associated with parenteral exposure. In a multivariate analysis, multiple sexual partners (OR 3.3; 95% CI: 1.1-9.2), history of sexual/domestic violence (OR 2.8; 95% CI: 1.1-6.9), syphilis co-infection (OR 2.6; 95% CI: 1.0-6.9), use of alcohol or drugs (OR 2.5; 95% CI: 1.2-5.5), and low schooling level (OR 2.3; 95% CI: 1.1-4.9) were independent risk factors for HIV infection. History of stillbirth and low birth weight infants was significantly associated with HTLV positive status, showing a negative impact on gestation. Conclusions The seroprevalence rates for HIV, HCV, HBV, and HTLV were similar to that found in previous studies in other Brazilian regions. The high individual, socioeconomic, and social vulnerability detected in seropositive parturient women indicates the need to improve coverage and effectiveveness of STDs control with prevention, detection and monitoring strategies, focusing in pregnant women exposed to high biopsychosocial risk.

Factores asociados al retiro temprano del jadelle® en un programa de planificación familiar

Introducción: investigación que permitió determinar los factores asociados al retiro temprano de Jadelle® en las usuarias que asisten al programa de planificación familiar en la ESE Santiago de Tunja. La relevancia del estudio radica en la importancia de conocer los motivos y las causas de retiro que los profesionales de la salud deben informar a las usuarias para lograr una mayor comprensión y aceptación de las reacciones adversas, para así evitar el retiro temprano del implante. Métodos: estudio descriptivo, cuantitativo, de corte transversal. La información se recolectó mediante la revisión de historias clínicas de 678 usuarias que se retiraron el Jadelle® entre julio de 2013 y junio de 2017. Resultados: el porcentaje de retiro temprano del implante fue de 36,8%, con mayor número de retiro durante el periodo de uso entre 24 y 30 meses y entre 36 y 42 meses. La principal causa de retiro se asoció con la presencia de alguna reacción adversa por el uso del dispositivo, principalmente la hemorragia uterina disfuncional. Conclusión: es frecuente el uso del Jadelle®, especialmente en mujeres jóvenes, y la tasa de continuidad de este dispositivo se puede aumentar si se detectan y se vigilan los factores asociados al retiro temprano, principalmente las reacciones adversas.

Introduction: This research aimed to determine the factors associated with the early removal of Jadelle® in the users who are part of the family planning program at ESE Santiago of Tunja. This is a relevant study aim to identify the reasons and causes of removal which should be inform by health professionals to women in order to achieve a better understanding and acceptance of adverse effects, avoiding early removal of the implant. Methods: Descriptive, quantitative, cross-sectional study. The information was collected by analyzing medical records of 678 subjects who removed the Jadelle® between July 2013 and June 2017. Results: The percentage of the implant early removal was 36.8%, there was a greater amount of removals during the period between 24 and 30 months and 36 and 42 months of use. The main cause of removal was associated with the presence of an adverse reaction produce by the device, mainly dysfunctional uterine bleeding. Conclusion: The use of Jadelle® is common, especially in young women. The continuity rate of this device can be increased if the factors associated with early removal are detected and monitored, especially adverse reactions.

Introdução. Investigação que permitiu determinar os fatores associados à retirada antecipada do implante Jadelle® nos usuários que frequentam o programa de planejamento familiar na ESE Santiago de Tunja. Estudo importante para conhecer os motivos e as causas de retirada que os profissionais de saúde devem informar aos usuários para melhor compreensão e aceitação das reações adversas, evitando a retirada antecipada do implante. Métodos. Estudo descritivo, quantitativo, transversal. As informações foram coletadas através da revisão de registros médicos de 678 usuários que retiraram o Jadelle® entre julho de 2013 e junho de 2017. Resultados. A percentagem de retirada antecipada do implante foi de 36,8%, com maior número de retiradas no período entre 24 e 30 meses e 36 e 42 meses de uso. A principal causa de retirada foi associada à presença de uma reação adversa devido ao uso do dispositivo, principalmente hemorragia uterina disfuncional. Conclusão. O uso do implante Jadelle® é frequente, principalmente em mulheres jovens; a taxa de continuidade deste dispositivo pode ser aumentada se os fatores associados à retirada antecipada forem detectados e monitorados, especialmente as reações adversas.

Modelos de evaluación económica: su aplicación en las decisiones sanitarias / Economic evaluation models and their application in health decision making

Objetivo: Introducir los conceptos clave sobre modelos de evaluación económica en salud como herramientas de toma de decisiones, sector donde la asignación eficiente de recursos se da en ambientes de escasez e incertidumbre. Método: Se desarrolló un análisis simplificado de los principales conceptos empleados en la construcción de un modelo de evaluación económica en salud a partir de las principales referencias sobre toma de decisiones en salud de acuerdo con los portales de evaluación económica como CEA Tufts University, CRD de la Universidad de York, Medline y Pubmed. Desarrollo: Se definieron modelos en el contexto de evaluación económica en salud, necesarios en un sistema cambiante y de incertidumbre. Se analizaron los pasos para el desarrollo de un buen modelo y la estructuración de una evaluación crítica de éstos. Se finalizó con la discusión y conclusiones de la actualización de la información. Como anexo se incluye una lista de revisión para verificar la confiabilidad de los modelos que se van a realizar. Conclusión: Los modelos en evaluación económica aparecen como herramienta de toma de decisiones en salud; por esta razón, y como simplificadores de la realidad, deben ser transparentes y reproducibles de manera que todos los elementos considerados estén respaldados sistemáticamente con descripciones claras y puntuales...

Objective: To introduce the key concepts of economic evaluation models as tools in health decision-making, a sector where the efficient allocation of resources is done in an environment of scarcity and uncertainty. Method: We developed a simplified analysis of the main concepts used in the construction of a model of economic assessment in health from the main references on decision-making in health according to economic assessment portals such as CEA Tufts University, CRD at University of York, Medline, and Pubmed. Development: Models were defined in the context of economic assessment in health as needed in a system of ever-changing requirements and uncertainty. It discusses the steps for developing a good model and the structure for a critical evaluation of it, ending with a discussion and the conclusions of the updated information. Attached is a checklist for verifying the reliability of the models to be executed. Conclusion: Economic evaluation models develop as a tool for decision making in health; for this reason and as simplifications of reality, they must be transparent and reproducible so that all elements are considered systematically backed with clear and precise descriptions...