Relación entre características sociodemográficas, obstétricas y psicosociales con el desenlace del parto prematuro en un hospital de alta complejidad / Relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature delivery in a highly complex hospital

INTRODUCCIÓN: La prematuridad es un grave problema de salud pública por la morbilidad, la mortalidad y los costos a ella asociados. OBJETIVO: Evaluar la relación entre las características sociodemográficas, obstétricas y psicosociales con el desenlace de parto prematuro frente a partos de término en el Hospital Guillermo Grant Benavente de Concepción, Chile, entre el segundo semestre de 2016 y el primer semestre de 2017. MÉTODO: Estudio cuantitativo, observacional, de tipo caso-control. La muestra la constituyeron 84 mujeres con parto prematuro y 85 con parto de término. Se utilizó un cuestionario de elaboración propia y la escala de Evaluación Psicosocial Abreviada (EPsA). El estudio fue aprobado por el comité ético científico. Se realizó análisis bivariado, con un nivel de significancia a = 0,05. Los datos se analizaron con el software estadístico SPSS v.25.0. RESULTADOS: No hubo diferencias en los antecedentes sociodemográficos (edad, nivel socioeconómico, estado civil y escolaridad) entre ambos grupos. Solo las mujeres con parto prematuro mantenían en mayor porcentaje que las gestantes de término un trabajo remunerado (43,4% vs. 25,9%). El estado nutricional y el antecedente de parto prematuro previo no se asociaron a un nuevo parto antes de las 37 semanas. La interrupción por cesárea fue significativamente más frecuente en las gestaciones de pretérmino que en el grupo control (p = 0,0377). CONCLUSIONES: En la población estudiada, las características sociodemográficas de las gestantes no tuvieron relación con el desenlace prematuro de la gestación. Algunos factores biomédicos se relacionan significativamente con este riesgo. Es necesario evaluar la pertinencia de aplicar escalas psicosociales en esta población y enfocar los esfuerzos para promover el control preconcepcional en mujeres con antecedentes de parto prematuro o comorbilidad.

INTRODUCTION: Prematurity is a serious public health problem due to morbidity, mortality and associated costs. OBJECTIVE: To evaluate the relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature birth versus term births at the Guillermo Grant Benavente Hospital in Concepción, Chile, between the second semester of 2016 and the first semester of 2017. METHOD: Quantitative, observational case-control study. The sample consisted of 85 women with premature delivery and 85 with term delivery. A self-elaborated questionnaire and Abbreviated Psychosocial Assessment scale (EPsA) were used. The study was approved by the scientific ethics committee. Bivariate and multivariate analysis was performed, with a level of significance a = 0.05. The data were analyzed with the statistical software SPSS v.25.0. RESULTS: There were no differences between the sociodemographic antecedents (age, socioeconomic level, marital status and education) between both groups. Only women with preterm birth had a higher percentage of paid work than full-term pregnant women (43.4% vs. 25.9%). Nutritional status and a history of previous preterm birth were not associated with a new delivery before 37 weeks. Interruption by cesarean section was significantly more frequent in preterm pregnancies than in the control group (p = 0.0377). CONCLUSIONS: In the studied population, the sociodemographic characteristics of the pregnant women were not related to the premature outcome of pregnancy. Biomedical factors are significantly related to this risk. It is necessary to evaluate the relevance of applying psychosocial scales in this population and to focus efforts to promote preconception control in women with a history of preterm birth and/or comorbidities.

Social determinants associated with Zika virus infection in pregnant women

This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil. Methods We recruited women who gave birth between October 2015 and January 2016 to a cross-sectional study at a referral maternity hospital in Salvador, Brazil. We collected information on their demographic, socioeconomic, and clinical characteristics, and evaluated their ZIKV exposure using a plaque reduction neutralization test. Logistic regression was then used to assess the relationship between these social determinants and ZIKV exposure status. Results We included 469 pregnant women, of whom 61% had a positive ZIKV result. Multivariate analysis found that lower education (adjusted Prevalence Rate [aPR] 1.21; 95%CI 1.04–1.35) and food insecurity (aPR 1.17; 95%CI 1.01–1.30) were positively associated with ZIKV exposure. Additionally, age was negatively associated with the infection risk (aPR 0.99; 95%CI 0.97–0.998). Conclusion Eve after controlling for age, differences in key social determinants, as education and food security, were associated with the risk of ZIKV infection among pregnant women in Brazil. Our findings elucidate risk factors that can be targeted by future interventions to reduce the impact of ZIKV infection in this vulnerable population.

Recuperação rápida da infestação domiciliar por Triatoma brasiliensis após pulverização residual de inseticida em região semiárida do Nordeste do Brasil / Fast recovery of house infestation with Triatoma brasiliensis after residual insecticide spraying in a semiarid region of Northeastern Brazil

The northeastern semiarid region stands out in the Brazilian context regarding the eco-epidemiology of Chagas disease, in which Triatoma brasiliensis is the main vector of Trypanosoma cruzi. Persistent house invasion threatens the relative levels of progress achieved over previous decades. We conducted an intervention trial with a five-year follow-up to assess the impacts of residual spraying with pyrethroid insecticides on house infestation with T. brasiliensis in 18 rural villages (242 houses) located in the Tauá, Ceará. House infestations were assessed by systematic manual searches for triatomines in every domestic and peridomestic habitat on five occasions. Triatomines were collected in peridomestic (57.5%), sylvatic (35.8%), and intradomiciliary (6.7%) habitats. The most important ecotopes of T. brasiliensis were containing roofing tiles, bricks or rocks (23.4% ± 9.1). Residual insecticide spraying substantially reduced baseline house infestation rates from 27.9% to 5.9% by 6 months post first spraying (MPS). The decline was substantially greater in intradomiciles (11.2% to 0.8%) than in peridomiciles (16.7% to 5%). The mean relative density of triatomines recovered its preintervention values at 14 MPS in intradomiciles, and in the main peridomestic ecotopes. The house infestation levels recorded at 14 MPS persisted thereafter despite all reinfested houses were selectively sprayed on every occasion. Overall average bug infection rates with T. cruzi in the five occasions were in intradomiciles (11.1%), peridomiciles (4.7%) and wild habitats (3.3%). In peridomicile T. cruzi infection rates decreased significantly at all stages after chemical intervention. In intradomicile, the only significant difference occurred at 20 MPS (7.7% to 30.8%). The vectorial capacity of T. brasiliensis, combined with its invasive potential from sylvatic sources and the limited effectiveness of chemical control in the harsh caatinga landscape, pose serious obstacles to the definite elimination of domestic transmission risks. Systematic vector surveillance supported by community participation and locally adapted environmental management measures are needed to reduce the risks of establishment of domestic transmission with T. cruzi in this region.