Using Respondent-Driven Sampling (RDS) to Identify the Healthcare Needs among Women of Reproductive Age Who Migrated from Venezuela to Brazil, 2018-2021.

In 2021, an RDS survey was conducted among Venezuelan migrant women of reproductive age who migrated to two Brazilian cities (Manaus and Boa Vista) from 2018 to 2021. To start the RDS recruitment, we chose seeds non-randomly in both cities. The study variables were age, educational level, self-rated health, pregnancy, migratory status and use of health services. We estimated the prevalence, confidence intervals and homophily effects by variable category. We used a multivariate logistic regression model to identify the main factors associated with healthcare use. A total of 761 women were recruited in Manaus and 1268 in Boa Vista. Manaus showed more irregular migrants than Boa Vista. The main reasons for using health services were as follows: illness, disease prevention and prenatal care. The logistic regression model showed the use of health services was associated with educational level and healthcare needs but not with migratory status. The social inclusion of Venezuelan migrants is extremely relevant, although many challenges must be overcome. The strategy of the Brazilian Federal Government for providing humanitarian assistance to Venezuelan migrants should be expanded to include and facilitate their integration into labor markets, access to healthcare and education, benefiting both migrants and the Brazilian people by reducing social inequality.

Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

BACKGROUND: The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS: A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS: The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS: Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women's opinions.

This study aimed to describe maternal satisfaction with their experience during childbirth and birth and their association with sociodemographic, clinical and obstetric, and good practice characteristics during childbirth care. The sample included 2,069 women who wanted to express their opinions at the end of the interview of the Stork Network Assessment survey. Exploratory factor analysis was performed to summarize the variables of interest, creating latent variables, for input in the multiple logistic regression model. Six factors were created and tested in the model. Respect for the puerperal women was associated with satisfaction (vaginal delivery: 1.40; cesarean section: 1.47). Regarding those who underwent a cesarean section, satisfaction was associated with living in the Central-West (1.91) and South (2.00) regions and the presence of a companion during hospitalization (1.25). However, for women who had vaginal delivery, satisfaction was inversely associated with large hospitals (0.62) and undergoing interventions during labor and delivery (0.83), but positively with multiparity (1.98), receiving good care practices for labor and delivery (1.24), and having immediate contact with the newborn (1.20). The better understanding of the factors associated with mothers' care satisfaction for labor and delivery can improve care quality provided in public hospitals in the Brazil.

Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women's opinions / Satisfação com a assistência ao parto em maternidades brasileiras que participam da Rede Cegonha: opinião das mulheres / Satisfacción con la atención del parto en maternidades brasileñas que participan de la Red Cigüeña: la opinión de las mujeres

This study aimed to describe maternal satisfaction with their experience during childbirth and birth and their association with sociodemographic, clinical and obstetric, and good practice characteristics during childbirth care. The sample included 2,069 women who wanted to express their opinions at the end of the interview of the Stork Network Assessment survey. Exploratory factor analysis was performed to summarize the variables of interest, creating latent variables, for input in the multiple logistic regression model. Six factors were created and tested in the model. Respect for the puerperal women was associated with satisfaction (vaginal delivery: 1.40; cesarean section: 1.47). Regarding those who underwent a cesarean section, satisfaction was associated with living in the Central-West (1.91) and South (2.00) regions and the presence of a companion during hospitalization (1.25). However, for women who had vaginal delivery, satisfaction was inversely associated with large hospitals (0.62) and undergoing interventions during labor and delivery (0.83), but positively with multiparity (1.98), receiving good care practices for labor and delivery (1.24), and having immediate contact with the newborn (1.20). The better understanding of the factors associated with mothers' care satisfaction for labor and delivery can improve care quality provided in public hospitals in the Brazil.

Este estudo descreve a satisfação das mães com sua experiência no atendimento ao parto e nascimento de seus filhos e sua associação com características sociodemográficas, clínico-obstétricas e de boas práticas durante a assistência ao parto. A amostra incluiu 2.069 mulheres que expressaram sua opinião ao final da pesquisa Avaliação da Rede Cegonha. Foi realizada uma análise fatorial exploratória para resumir as variáveis de interesse, criando variáveis latentes para serem incluídas no modelo de regressão logística múltipla. Seis fatores foram criados e testados no modelo. O respeito pela puérpera foi associado à satisfação (parto vaginal: 1,40; parto cesáreo: 1,47). Para as mães que passaram por cesariana, houve associação com morar nas regiões Centro-oeste (1,91) e Sul (2,00) e com a presença de um acompanhante durante a internação (1,25). Para mulheres que tiveram parto vaginal, a satisfação foi inversamente associada a hospitais grandes (0,62) e à realização de intervenções durante o trabalho de parto e nascimento (0,83). A satisfação foi positivamente associada à multiparidade (1,98), recebimento de boas práticas de assistência durante o trabalho de parto e nascimento (1,24) e contato com o bebê logo após o nascimento (1,20). A melhor compreensão sobre os fatores associados à satisfação das mães com a assistência no trabalho de parto e nascimento pode contribuir para a qualidade do serviço prestado em hospitais públicos no país.

Este estudio describe la satisfacción de las madres con su experiencia en la atención del parto y el nacimiento de sus hijos y su asociación con las características sociodemográficas, clínico-obstétricas y de buenas prácticas durante la atención del parto. La muestra contó con 2.069 mujeres que expresaron su opinión al final de la encuesta Evaluación de la Red Cigüeña. Se realizó un análisis factorial exploratorio para resumir las variables de interés, creando variables latentes para ser incluidas en el modelo de regresión logística múltiple. En el modelo se crearon y probaron seis factores. El respeto por la puérpera se asoció con la satisfacción (parto vaginal: 1,40; parto por cesárea: 1,47). Para las madres sometidas a cesárea, hubo asociación con vivir en las regiones Centro-oeste (1,91) y Sur (2,00) y con la presencia de un acompañante durante la hospitalización (1,25). Para las mujeres que tuvieron parto vaginal, la satisfacción fue inversamente asociada a hospitales grandes (0,62) y a la realización de intervenciones durante el trabajo de parto y nacimiento (0,83). La satisfacción se asoció positivamente con la multiparidad (1,98), recibir buenas prácticas de cuidado durante el trabajo de parto y el nacimiento (1,24) y el contacto con el bebé poco después del nacimiento (1,20). Una mejor comprensión sobre los factores asociados a la satisfacción de las madres con la asistencia en el trabajo de parto y nacimiento puede contribuir para la calidad del servicio prestado en hospitales públicos en el país.

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil".

BACKGROUND: The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce. QUESTION: To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns. METHODS: We used data from the study "Birth in Brazil", a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns. FINDINGS: We found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare. CONCLUSION: Mistreatment during childbirth has broader implications than "maternal mental health", and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.

Avaliação psicométrica do Peritraumatic Dissociative Experience Questionnaire (PDEQ) e proposta de um instrumento para avaliação de reações peritraumáticas / Psychometric evaluation of the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and proposal of an instrument to evaluate Peritraumatic Reactions

O papel das reações vivenciadas durante experiências traumáticas tem sido alvo de interesse nos estudos sobre etiologia e prognóstico do transtorno de estresse pós-traumático. Essa tese avaliou a estrutura dimensional do instrumento mais utilizado para mensurar a dissociação peritraumática, o Peritraumatic Dissociative Experience Questionnaire (PDEQ). Adicionalmente, desenvolveu-se e avaliou-se as propriedades psicométricas do instrumento Peritraumatic Reactions Questionnaire (PTRQ), proposto para mensurar as três principais reações peritraumáticas (RP) no contexto do TEPT: dissociação peritraumática (DP), imobilidade tônica peritraumática (ITP) e reações físicas peritraumáticas (RFP). Os dados utilizados são originários de um estudo transversal realizado entre junho de 2007 e julho 2008 com amostras representativas da população acima de 15 anos das duas maiores cidades brasileiras. A amostra foi de 1.074 participantes no Rio de Janeiro e 2.145 em São Paulo que reportaram ao menos um evento traumático durante a vida. O primeiro artigo investigou a validade estrutural da versão brasileira do PDEQ. Análises de componentes principais indicaram a solução unidimensional corroborada por análises fatoriais confirmatórias (AFC) e de tipo exploratórias realizadas no Mplus. A adequação de ajuste dos modelos foi aceita para valores de CFI, TLI maiores que 0,95 e de RMSEA abaixo de 0,06. Os índices de modificação indicaram uma alta correlação residual entre os itens 9 ('dificuldade para entender o que estava acontecendo') e o item 10 ('desorientação') que foi corroborada nas duas amostras por AFC e sugere redundância de conteúdo. Análises de escalabilidade utilizando H de Loevinger e a hipóstese de dupla monotonicidade indicaram boas propriedades escalares. A versão reduzida com exclusão do item 9 foi proposta para utilização em estudos epidemiológicos. O segundo artigo reportou o processo de desenvolvimento de um instrumento integrado para avaliar RP. A etapa qualitativa avaliou a validade de conteúdo de 36 itens, sendo 30 provenientes das principais escalas utilizadas para mensurar as três principais RP e mais 6 itens elaborados por especialistas. O conjunto de 34 itens resultantes do processo qualitativo teve sua estrutura configural e métrica avaliadas a partir de AFC e de tipo exploratória para as duas amostras no Mplus. Modelos com CFI e TLI acima de 0,95 e de RMSEA menores que 0,06 foram considerados com ajuste satisfatório. A versão proposta do PTRQ conta com 29 itens distribuídos nas três dimensões (DP, ITP e RFP) mostrou boa estrutura fatorial e métrica, sendo recomendado para uso em estudos epidemiológicos. Espera-se que os resultados desta tese contribuam para o refinamento do processo de mensuração das RP, necessário para se avançar o conhecimento sobre o seu papel no desenvolvimento do TEPT, assim como nas propostas de intervenção precoce em indivíduos sob maior risco de desenvolvimento desse transtorno mental

The role of reactions occurring in the course of traumatic experiences has been of interest in studies regarding the etiology and prognosis of the posttraumatic stress disorder (PTSD). This thesis evaluated the dimensional structure of the most used instrument for measuring peritraumatic dissociation (PD) - the Peritraumatic Dissociative Experience Questionnaire (PDEQ). Additionally, we developed and evaluated the psychometric properties of the instrument denominated Peritraumatic Reaction Questionnaire (PTRQ), proposed for evaluating the three main peritraumatic reactions (PR) in the context of PTSD: dissociation (PD), tonic immobility (TIP) and physical panic reaction (PPR). Data were obtained from a cross-sectional study developed between June 2007 and July 2008, including a representative sample of people aged 15 or more from the two largest Brazilian cities. A sample of 3,229 participants reported at least one traumatic event during their lifetime, 1,074 in Rio de Janeiro and 2,145 in São Paulo. The first article investigated the structural validity of the Brazilian version of the PDEQ. Principal component analyzes indicated the one-dimensional solution corroborated by confirmatory and exploratory factor analysis (CFA) performed in Mplus. The models were fit if CFI, TLI values greater than 0.95 and RMSEA values below 0.06. Modification indices indicated a high residual correlation between item 9 ('difficulty understanding what was happening') and item 10 ('disorientation') which was corroborated in both samples by AFC and suggests content redundancy. Scalability analyzes using Loevinger H and double monotonicity hypothesis indicated good scalar properties. The shortened version excluding item 9 has been proposed for use in epidemiological studies. The second article reported on the process of developing an integrated instrument to assess PR. The qualitative stage evaluated the content validity of 36 items, 30 of them from the main scales used to measure the three main PR and 6 more items prepared by experts. The set of 34 items resulting from the qualitative process had their configuration and metric structure evaluated from CFA and exploratory type for both samples in Mplus. Models with CFI and TLI above 0.95 and RMSEA less than 0.06 were considered with satisfactory fit. The proposed version of the PTRQ has 29 items distributed in the three dimensions (PD, ITP and RFP) presented good factorial and metric structure, and is recommended for use in epidemiological studies. We expect that the findings from this thesis may contribute to the refinement of PR measurement necessary to advance the knowledge about its role in PTSD development, as well as proposals for early intervention in individuals at higher risk of developing this mental disorder

Is There an Association Between Exposure to Cats and Occurrence of Visceral Leishmaniasis in Humans and Dogs?

The domestic dog is considered the main reservoir of visceral leishmaniasis (VL) in urban areas, but the identification of cats infected by Leishmania suggests the possibility of these animals also acting as reservoirs. The incrimination of a species as reservoir requires the accumulation of epidemiological evidence on the co-occurrence between such species and the infection in question. This is a systematic review of epidemiological studies evaluating the association between exposure to cats and occurrence of VL in humans (HVL) or dogs (CVL). Among the six studies addressing CVL, one showed a higher chance of CVL in the presence of cats, one showed an inverse relationship between the presence of cats and CVL, and four were inconclusive. Among the four studies evaluating HVL, three were inconclusive, and one showed an association between the presence of cats and HVL among patients with renal transplantation. The inconsistency of the results, associated to the methodological weaknesses of the studies analyzed, does not allow a firm conclusion that there is co-occurrence between exposure to cats and VL. Methodologically robust studies should be performed to elucidate the role of cats in VL transmission.

Frequência cardíaca peritraumática após exposição ao trauma como preditor de transtorno de estresse pós-traumático em adultos: revisão sistemática e metanálise / Peritraumatic heart rate after exposure to trauma as predictor of post-traumatic stress disorder in adults: systematic review and meta-analisys

O transtorno de estresse pós-traumático (TEPT) é um transtorno de ansiedade que pode ser desenvolvido após a ocorrência de um evento traumático, e que costuma vir acompanhado de um significativo comprometimento da qualidade de vida. Indivíduos diagnosticados com o TEPT apresentam níveis de frequência cardíaca mais elevados em situações de exposição a eventos estressores, como sons e imagens que relembram a experiência traumática. No entanto, estudos que avaliaram a frequência cardíaca no momento do trauma como preditor do desenvolvimento de TEPT não apresentam resultados consistentes. Os objetivos deste trabalho foram: verificar se frequência cardíaca (FC) peritraumática de repouso, após exposição ao trauma, é um fator preditor para o desenvolvimento do TEPT e para a gravidade dos sintomas de TEPT em adultos. Foi realizada uma revisão sistemática, seguida de metanálise, utilizando-se as bases eletrônicas PUBMED, LILACS, PILOTS, PsycoINFO e Web of Science. Foram incluídos 17 estudos nesta revisão sistemática. Os resultados de dez estudos foram utilizados para a metanálise das diferenças de médias de FC combinada. Oito estudos foram utilizados para a metanálise das correlações entre a FC e a gravidade dos sintomas de TEPT. Modelos de meta-regressão foram ajustados para identificar variáveis que pudessem explicar a heterogeneidade entre os estudos. A FC peritraumática no grupo de pacientes com TEPT é, em média, 3,98 batimento por mimuto (bpm) (p=0,04) maior em comparação com aqueles sem o transtorno, e o coeficiente de correlação de Pearson combinado foi de 0,14 (p=0,05).Consistente com a hipótese levantada, a frequência cardíaca peritraumática de repouso foi maior em indivíduos que desenvolveram o TEPT. Contudo, mensuração mais próxima do evento traumático e a exclusão de casos dissociativos poderão ampliar a magnitude do efeito encontrado, tornando este biomarcador simples e facilmente obtido um preditor clinicamente útil do desenvolvimento de TEPT

The Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after a traumatic event, and that usually causes a significant decrease in the qualityoflife. Individuals diagnosed with PTSD show higher levels of heart rate (HR) when exposed to stressful events, such as sounds and images reminiscent of the traumatic experience. However, studies evaluating the role of peritraumatic HR as a predictor of the development of PTSD have not produced consistent results. The objectives of this study were to investigate whether peritraumatic resting HR a traumatic experience is a risk factor for the development of PTSD and to the severity of PTSD symptoms in adults. A systematic review followed by meta-analysis was carried out looking for studies in the following electronic databases: PUBMED, LILACS; PILOTS, PsycoINFO and Web of Science. We included 17 studies in this systematic review. The results of ten studies were used to calculate the weighted mean differences of HR. Findings from eight studies results were used to calculate the pooled correlation between HR and severity of PTSD symptoms. Meta-regression models were fitted in an attempt to identify variables that could explain the heterogeneity between studies. Peritraumatic HR in patients with PTSD was, on average, 3.98 bpm (p=0.04) higher compared to those without the disorder and the pooled Pearson correlation coefficient was 0.14 (p = 0.05). Consistent with the hypothesis, the peritraumatic resting heart rate after exposure to trauma was higher in patients who developed PTSD. However, closer measurement of the traumatic event and the exclusion of dissociative cases may increase the magnitude of the found effect, making this simple and easily obtained marker a clinically useful predictor of PTSD development