RESUMEN
BACKGROUND: Acquired syphilis continues to affect millions of people around the world. It is crucial to study it in the context of HIV Pre-Exposure Prophylaxis (PrEP) to achieve the goals set out in the 2030 Agenda since the literature suggests increased risk behaviors for sexually transmitted infections. This study aimed to investigate the incidence and factors associated with acquired syphilis among PrEP users. MATERIALS AND METHODS: This retrospective cohort included data on PrEP users from all over Brazil from 2018 to 2020, retrieved from the national antiretroviral logistics system. We calculated the proportion of syphilis before PrEP, the incidence during the user's follow-up, reinfections, and their possible associated factors. We conducted descriptive, bivariate, and multivariate analysis, estimating the crude Relative Risk, adjusted Odds Ratio (aOR), and their respective confidence intervals (95%CI). RESULTS: Most of the 34,000 individuals who started PrEP were male (89.0%), white (53.7%), self-identified as male (85.2%), homosexual, gay, or lesbian (72.2%), and had 12 schooling years or more (67.8%). Of these, 8.3% had syphilis in the six months before starting PrEP, and 4% had it in the first 30 days of using the prophylaxis. We identified a loss-to-follow-up rate of 41.7%, although the loss and the cohort shared similar characteristics. The proportion of missed syphilis tests was high: 33.4% in the 30 days and 38.8% in the follow-up period. In the 19,820 individuals effectively monitored, the incidence of acquired syphilis was 19.1 cases per 100 person-years, and 1.9% of users had reinfection. The rate of missed syphilis tests at the 30-day follow-up was 33.4%, and the total follow-up test period was 38.8%. The multivariate analysis identified female gender (aOR 0.3; 95%CI 0.2-0.5), being white or Black (aOR 0.9; 95%CI 0.7-0.9 and aOR 0.7; 95%CI 0.7-0.99, respectively) as protective factors for syphilis. Being homosexual, gay, lesbian (aOR 2.7; 95%CI 2.0-3.7), or having a history of syphilis in the six months before PrEP (aOR 2.2; 95%CI 1.9-2.5) were risk factors for syphilis during PrEP use. Behaviors related to the risk of syphilis included accepting something in exchange for sex (aOR 1.6; 95%CI 1.3-1.9), irregular condom use (use in less than half of sexual intercourse sessions; aOR 1.7; 95%CI 1.53-2.1) and recreational drug use (poppers; aOR 1.5; 95%CI 1.53-2.1). CONCLUSION: Syphilis in the context of PrEP has high rates and is associated with sociodemographic and behavioral factors. We recommend additional studies targeting prevention in this population to curb these figures.
Asunto(s)
Infecciones por VIH , Profilaxis Pre-Exposición , Sífilis , Humanos , Sífilis/epidemiología , Sífilis/prevención & control , Masculino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Adulto , Femenino , Incidencia , Factores de Riesgo , Estudios Retrospectivos , Brasil/epidemiología , Persona de Mediana Edad , Adulto Joven , Adolescente , Fármacos Anti-VIH/uso terapéuticoRESUMEN
Atmospheric pollution is a global public health problem. The adverse effects of air pollution are strongly associated with respiratory and cardiovascular diseases and, to a lesser extent, with adverse pregnancy outcomes. This study analyzes the relationship between exposure to PM10 and low birth weight in the city of Santo André, São Paulo State, Brazil. We included babies born to mothers resident in Santo André between 2000 and 2006. Data on daily PM10 levels was obtained from the São Paulo State Environmental Agency. We performed descriptive analysis and logistic regressions. The prevalence rate of low birth weight was 5.9%. There was a dose-response relationship between PM10 concentrations and low birth weight. Exposure to the highest quartile of PM10 (37,50µg/m³) in the third trimester of pregnancy increased the risk of low birth weight by 26% (OR: 1.26; 95%CI: 1.14-1.40) when compared to the first quartile. The same effect was observed in the remaining trimesters. This effect was observed for ambient particle concentrations that met the current air quality standards.
Em todo o mundo a poluição atmosférica é um problema de saúde pública. Os efeitos adversos relacionados aos poluentes atmosféricos estão fortemente associados com doenças respiratórias e cardiovasculares e, em menor grau, com os resultados adversos da gravidez. O objetivo do trabalho foi avaliar a relação entre PM10 e baixo peso ao nascer no Município de Santo André, São Paulo, Brasil. Foram incluídos no estudo recém-nascidos de mães residentes em Santo André (2000-2006). A Agência Ambiental do Estado de São Paulo forneceu dados diários de PM10. Realizou-se análise descritiva e de regressão logística. A prevalência de baixo peso ao nascer foi de 5,9%. Observou-se uma relação dose-resposta entre as concentrações de PM10 e baixo peso ao nascer. As concentrações de PM10 no quartil mais alto (37,50µg/m³) no terceiro trimestre gestacional aumentaram o risco de baixo peso ao nascer em 26% (OR = 1,26; IC95%: 1,14-1,40) quando comparadas com o primeiro quartil. O mesmo efeito foi observado nos demais trimestres. Esse efeito foi verificado mesmo com as concentrações de partículas dentro dos padrões de qualidade do ar.
La contaminación del aire en todo el mundo es un problema de salud pública. Los efectos adversos relacionados con los contaminantes del aire están fuertemente asociados con enfermedades respiratorias y cardiovasculares, pero en menor medida con los resultados adversos del embarazo. En este estudió se evaluó la relación entre PM10 y bajo peso al nacer en el municipio de Santo André, São Paulo, Brasil. Se incluyeron en el estudio los recién nacidos de madres residentes en Santo André (2000-2006). La Agencia ambiental del Estado de São Paulo informó de los índices diarios de PM10. Además, se realizó un análisis descriptivo y por regresión logística. La prevalencia de bajo peso al nacer fue de un 5,9%. Hubo una relación dosis-respuesta entre las concentraciones de PM10 y bajo peso al nacer. Las concentraciones de PM10 en el cuartil más alto (37,50µg/m³) en el tercer trimestre aumentaban el riesgo gestacional de bajo peso al nacer en un 26% (OR = 1,26; IC95%: 1,14-1,40), en comparación con el primer cuartil. El mismo efecto se observó en los trimestres restantes. Este efecto fue observado incluso en partículas con concentraciones que están dentro de los estándares del aire.
Asunto(s)
Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Adulto Joven , Contaminación del Aire/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Recién Nacido de Bajo Peso , Material Particulado/toxicidad , Efectos Tardíos de la Exposición Prenatal/epidemiología , Contaminación del Aire/estadística & datos numéricos , Brasil/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Estudios Longitudinales , Factores SocioeconómicosRESUMEN
Estudo descritivo-exploratório, de abordagem quantitativa, realizado em Quixadá, CE, no período de fevereiro a maio de 2008 com o objetivo de analisar a prevalência de aleitamento materno de mulheres egressas de um Hospital Amigo da Criança, de maio/2007 a maio/2008. Os agentes comunitários de saúde aplicaram um formulário, no domicílio, às mulheres que tiveram filhos. Foram entrevistadas 181 mulheres. Constatou-se uma prevalência de 55,3% de aleitamento materno exclusivo aos quatro meses e 46,2% aos seis meses. Verificou-se que 99,4% realizaram consulta pré-natal e 97,2% receberam orientações sobre aleitamento materno. O estudo aponta baixa prevalência de aleitamento materno exclusivo, apesar da mãe ter tido o filho em um Hospital Amigo da Criança, que institucionalmente apóia o aleitamento materno em diversas etapas. Torna-se evidente a necessidade de um suporte mais efetivo para essas mulheres, após a alta hospitalar, para prevenir o desmame precoce.
This is an exploratory descriptive study, using a quantitative approach, carried out in Quixadá, CE, during the period ofMay/2007 to May/2008 with the aim of analyzing the prevalence of breastfeeding among women attending a Baby-Friendly Hospital. Community health workers interviewed women who had given birth in the former twelve months using a close-endedquestionnaire. A total of 181 women were interviewed. All the interviews were conducted at the mothers home. Results showed that 55.3% of the mothers interviewed exclusively breast-fed for at least 4 months and that 46.2% exclusively breast-fed for 6months. It was found that 99.4% had prenatal visits and 97.2% received guidance on breastfeeding. Our findings showed a low prevalence of exclusive breast feeding among the studied population despite the fact that the mothers, participating in the study, had been recruited from a Baby Friendly Hospital-Maternity, which institutionally supports breastfeeding in several steps. It was made evident the need of a more effective support for such women after leaving hospital so as to prevent early weaning.
Estudio descriptivo- exploratorio, de enfoque cuantitativo, realizado en Quixadá, CE, entre mayo del 2007 a mayo del 2008 con el fin de analizar la prevalencia de la lactancia materna en mujeres que les dieron el alta de un Hospital Amigo del Niño. Los agentes comunitarios de salud aplicaron un cuestionario a las mujeres que tuvieron hijos, que se llevó a cabo en su propio domicilio. Fueron entrevistadas 181 mujeres. Se comprobó un predominio de un 55,3% de amamantamiento materno exclusivo a los cuatro meses y un 46,2% a los seis meses. Se verificó que un 99,4% hicieron el prenatal y un 97,2% recibieron orientaciones sobre la lactancia materna. El estudio señala baja prevalencia de lactancia materna exclusiva, a pesar de la madre haber tenido el hijo en un Hospital Amigo del Niño, que institucionalmente apoya la lactancia materna en varias etapas. Se torna muy evidente la necesidad de un soporte más efectivo para esas mujeres, después del alta del hospital, para prevención del destete precoz.