Mapping health vulnerabilities: exploring territorial profiles to support health policies / Mapeamento de vulnerabilidades de saúde: explorando perfis territoriais para apoiar políticas de saúde

Abstract Vulnerability processes and effects, albeit of great importance to cohesion and territorial policies, are nonetheless still underexplored and narrowly operationalized in scientific research. In particular, most assessments rely on economic indicators and a limited territorial scale, which do not have the same analytic potential of a broader view at a national level with regional/municipal similarities, specificities, and inter-connections. This gap also applies to health-related vulnerabilities, which, stemming from a lack of socioeconomic and environmental resources, has increased during and after the economic crisis of the past decade. This paper aims to analyze the health vulnerability phenomena in Portugal from a spatial perspective. Following a Multiple Correspondence Analysis, different territorial profiles of social vulnerability associated with the population health condition and access to and use of "health services" are identified. We conclude by outlining the importance of adding the spatial context to health policies addressing vulnerabilities and suggest avenues for future research.

Resumo Os processos e os efeitos da vulnerabilidade, embora de grande importância para a coesão e políticas territoriais, ainda são pouco explorados e operacionalizados do ponto de vista científico. Na verdade, a maioria das avaliações baseia-se em indicadores económicos e em contextos territoriais muito específicos, não explorando o potencial analítico de uma visão mais ampla ao nível nacional, tendo por base as especificidades e as interconexões regionais / municipais. Essa lacuna é visível nas vulnerabilidades relacionadas com a saúde, que, decorrentes da falta de recursos sociais, económicos e ambientais, aumentaram durante e após a crise económica iniciada na década passada. O principal objetivo deste artigo consiste em analisar os fenómenos de vulnerabilidade associados à saúde em Portugal numa ótica territorial. Através da realização de uma Análise de Correspondência Múltipla, são identificados diferentes perfis territoriais de vulnerabilidade social associados ao "estado de saúde" dos indivíduos e ao acesso e uso de "serviços de saúde". Na conclusão do artigo, sublinha-se a importância de adicionar o contexto territorial às políticas de saúde que procuram encontrar respostas para fazer face aos desafios decorrentes de vulnerabilidades sociais e sugerem-se pistas para investigação futura.

Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes

ABSTRACT Objective: To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Materials and methods: Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. Results: A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Conclusions: Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.