Variación temporal y distribución geográfica de las cardiopatías congénitas en la Comunitat Valenciana / Temporal variation and geographical distribution: congenital heart defects in the Comunitat Valenciana

Objetivos: El objetivo es estimar la prevalencia de anomalías congénitas cardíacas (ACC) en la Comunitat Valenciana (CV) en menores de un año e identificar si existen variaciones temporoespaciales en la misma. Métodos: Del conjunto mínimo básico de datos hospitalario se seleccionó a los nacidos entre 1999 y 2008, menores de un año y residentes en la CV con al menos un alta en las que el diagnóstico principal y/o alguno de los secundarios fueron codificados como ACC (códigos 745-747 de la Clasificación Internacional de Enfermedades 9.ª revisión Modificación Clínica). Utilizando como identificador el número de tarjeta sanitaria, se seleccionó la primera alta con ACC. Se calcularon la prevalencia y sus intervalos de confianza del 95%. Se obtuvieron la razón de prevalencias (RP) y las RP suavizadas de cada municipio para la elaboración de mapas, permitiendo identificar patrones geográficos. Resultados: Durante 1999-2008 se registraron 6.377 pacientes menores de un año con alguna ACC, representando el 43,2% de los casos de anomalías congénitas. La prevalencia fue de 134,3 por 10.000 nacidos vivos (IC del 95%, 131,1-137,6), observándose un incremento significativo de esta, pasando de 115,8 en el quinquenio 1999-2003 a 149,5 en 2004-2008. El riego más elevado se presentó al norte de la CV y en algunos municipios de la provincia de Alicante. Conclusiones: El incremento temporal de las ACC observado concuerda con lo encontrado en otros países y puede explicarse, al menos en parte, por la mejora de las técnicas diagnósticas. El patrón geográfico identificado requiere un análisis más detallado que permita explicar las variaciones encontradas (AU)

Objectives: The objective of this study is to estimate the prevalence of congenital heart defects (CHD) in the Comunitat Valenciana (CV) in children less than one year old and identify whether there are temporal and geographic variations within this prevalence. Methods: The minimum basic data set from hospital discharge reports was used to select patients, who were born between 1999-2008, were less than one year old, and who lived in the CV with at least one hospital admission in which the primary diagnosis and/or any of the events were coded as CHD (codes 745-747 of the International Classification of Diseases 9 th Revision Clinical Modification). The first hospital discharge report with CHD was selected, using the health card number to detect duplication. The prevalence and 95% confidence intervals were calculated, and the prevalence ratio (PR) and smoothed PR was obtained for each municipality to identify geographic patterns. Results: In the period 1999-2008 there were 6.377 patients younger than one year with some CHD, representing the 43.2% of cases of congenital anomalies. The prevalence was 134.3 per 10.000 live births (95% CI: 131.1-137.6). There was a significant increase in the prevalence, from 115.8 in the 1999-2003 period to 149.5 in the 2004-2008 period. A higher risk was identified in the north of the CV, and in some municipalities of the province of Alicante, in the south. Conclusions: The observed increase in CHD agrees with the findings in other countries and it can be explained, at least in part, by improved diagnostic techniques. The geographic pattern identified requires a more detailed analysis that could explain the geographic variations found (AU)

[Temporal variation and geographical distribution: congenital heart defects in the Comunitat Valenciana]. / Variación temporal y distribución geográfica de las cardiopatías congénitas en la Comunitat Valenciana.

OBJECTIVES: The objective of this study is to estimate the prevalence of congenital heart defects (CHD) in the Comunitat Valenciana (CV) in children less than one year old and identify whether there are temporal and geographic variations within this prevalence. METHODS: The minimum basic data set from hospital discharge reports was used to select patients, who were born between 1999-2008, were less than one year old, and who lived in the CV with at least one hospital admission in which the primary diagnosis and/or any of the events were coded as CHD (codes 745-747 of the International Classification of Diseases 9th Revision Clinical Modification). The first hospital discharge report with CHD was selected, using the health card number to detect duplication. The prevalence and 95% confidence intervals were calculated, and the prevalence ratio (PR) and smoothed PR was obtained for each municipality to identify geographic patterns. RESULTS: In the period 1999-2008 there were 6.377 patients younger than one year with some CHD, representing the 43.2% of cases of congenital anomalies. The prevalence was 134.3 per 10.000 live births (95% CI: 131.1-137.6). There was a significant increase in the prevalence, from 115.8 in the 1999-2003 period to 149.5 in the 2004-2008 period. A higher risk was identified in the north of the CV, and in some municipalities of the province of Alicante, in the south. CONCLUSIONS: The observed increase in CHD agrees with the findings in other countries and it can be explained, at least in part, by improved diagnostic techniques. The geographic pattern identified requires a more detailed analysis that could explain the geographic variations found.

Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: the experience of the Valencian Health Programme (Spain).

This study describes the results of the health programme implemented in the Valencian Community (Spain) to achieve an early diagnosis of Chagas disease in pregnant Latin American women and their newborns. During 2009 and 2010, 1975 women living in the health districts of three university hospitals were enrolled via midwives or at the time of delivery. Diagnosis of disease was performed using two serological tests with different antigens. Congenital infection was diagnosed by parasitological, molecular or serological methods from blood samples obtained at birth or in subsequent controls. The overall seroprevalence of Chagas infection in pregnant women from 16 different endemic countries was 11·4%. Infection was higher in those from countries in the Gran Chaco Region (Bolivia, 34·1%; Paraguay, 7·4%; Argentina, 5·3%). Eight newborn infants from Bolivian mothers had congenital Chagas which represents a vertical transmission rate of 3·7%. In conclusion, this work supports the benefits of offering an early diagnosis to pregnant women and newborns during routine prenatal healthcare.

Factors related to depression during pregnancy: are there gender differences?

OBJECTIVE: To determine gender differences between women and their partners in the effect of psychosocial and personal factors on depression during the third trimester of pregnancy. METHOD: A cross-sectional survey was carried out among 687 women and their partners (n = 669) attending the prenatal programme of Valencia province (Spain). Data collection was carried out by means of a self-reported questionnaire. The outcome variable was depression during the third trimester of pregnancy measured by the Edinburgh Postnatal Depression Scale. Predictor variables were psychosocial (marital dissatisfaction, confidant and affective social support) and personal (previous history of depression, partner depression and unplanned pregnancy) variables. The adjusted odds ratios (aOR) and their 95% confidence intervals were calculated by fitting a logistic regression model. RESULTS: The prevalence of pregnancy depression was higher among women (10.3%) than men (6.5%). In both sexes, the probability of depression during pregnancy was higher in those with marital dissatisfaction (aOR 3.05, 95% CI 1.59 to 5.82 for women and 3.14, 95% CI 1.24 to 7.99 for men) and among those whose with a previous history of depression (aOR 2.18, 95% CI 1.22 to 3.89 for women and 5.22, 95% CI 2.05 to 13.34 for men). Unplanned pregnancy did not increase the risk of pregnancy depression either in women or men. Gender differences were found on the impact of social support and partner's depression. Whereas among men low affective social support and partner depression were associated with a higher probability of reporting depression, none of these variables were related to women's depression. CONCLUSION: Most predictor factors of depression during pregnancy are similar for both sexes but a gender-different impact of social support and partner depression on pregnancy depression was appreciated. Health professionals should be aware of potentially vulnerable groups for early diagnosis of pregnancy depression and to provide effective interventions.