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1.
Yonsei Med J ; 61(11): 970-975, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107241

RESUMO

We investigated pregnancy morbidities in Korean patients with Takayasu arteritis (TA) in a single tertiary hospital as a pilot study. We retrospectively reviewed the medical records of 12 pregnancies in seven patients with TA. All patients were diagnosed with TA based on the 1990 American College of Rheumatology classification criteria. The medical records of patients were well-documented, allowing review of clinical data including pregnancy morbidities. The angiographic and Ishikawa classifications at diagnosis and TA activity at delivery were assessed. Of the 12 pregnancies, two pregnancies ended in spontaneous abortion (16.7%), and one pregnancy (8.3%) had therapeutic abortion at 9 weeks due to maternal morbidity. Among the remaining nine pregnancies, only one child was delivered via normal spontaneous vaginal delivery, and the remaining eight were delivered by Caesarean section. Two out of nine (22.2%) neonates were born with low birth weight, and one of them was born at 30 weeks of gestation. The most common maternal complication was hypertension affecting 7/12 (58.3%) pregnancies. Preeclampsia occurred in one pregnancy, and gestational diabetes mellitus (GDM) occurred in two pregnancies. At delivery, disease activity of TA was stable in all pregnancies, and glucocorticoids were administered in nine pregnancies. Live birth rate of pregnant Korean patients with TA was 75%. Future studies are needed to reduce pregnancy-related complications.


Assuntos
Glucocorticoides/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Resultado da Gravidez/epidemiologia , Arterite de Takayasu/tratamento farmacológico , Adulto , Coeficiente de Natalidade , Cesárea/estatística & dados numéricos , Criança , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Recém-Nascido , Morbidade , Projetos Piloto , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/epidemiologia
2.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32999054

RESUMO

BACKGROUND: Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants. METHODS: Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020. RESULTS: Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range. CONCLUSION: An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.


Assuntos
Infecções por Coronavirus/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Coeficiente de Natalidade/tendências , Feminino , Humanos , Recém-Nascido , Irlanda/epidemiologia , Pandemias , Gravidez
3.
Sci Total Environ ; 748: 141346, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33113687

RESUMO

Demographic trends will play a role in determining the magnitude of climate disruption and the ability of societies to adapt to it. Yet policy makers largely ignore the potential of fertility changes and population growth when designing policies to limit climate disruption and lessen its impacts. Here we argue that rights-based policy interventions could decrease fertility rates to levels consistent with low population pathways. We review country and global level studies that explore the effects of low population pathways on climate change mitigation and adaptation. We then provide rights-based policy recommendations, such as the expansion of voluntary family planning programs that incorporate elements from successful past programs, and highlight current research gaps. In concert with policies that end fossil fuel use and incentivize sustainable consumption, humane policies that slow population growth should be part of a multifaceted climate response. These policies require attention from scientists, policy analysts and politicians.


Assuntos
Mudança Climática , Crescimento Demográfico , Aclimatação , Coeficiente de Natalidade , Fertilidade
4.
Lancet ; 396(10258): 1135-1159, 2020 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069324

RESUMO

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.


Assuntos
Assistência à Saúde/economia , Carga Global da Doença/economia , Saúde Global/tendências , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Coeficiente de Natalidade , Assistência à Saúde/estatística & dados numéricos , Feminino , Carga Global da Doença/tendências , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/tendências , Fatores de Risco , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia
6.
Cochrane Database Syst Rev ; 9: CD005291, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32898291

RESUMO

BACKGROUND: In in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), selection of the most competent embryo(s) for transfer is based on morphological criteria. However, many women do not achieve a pregnancy even after 'good quality' embryo transfer. One of the presumed causes is that such morphologically normal embryos have an abnormal number of chromosomes (aneuploidies). Preimplantation genetic testing for aneuploidies (PGT-A), formerly known as preimplantation genetic screening (PGS), was therefore developed as an alternative method to select embryos for transfer in IVF. In PGT-A, the polar body or one or a few cells of the embryo are obtained by biopsy and tested. Only polar bodies and embryos that show a normal number of chromosomes are transferred. The first generation of PGT-A, using cleavage-stage biopsy and fluorescence in situ hybridisation (FISH) for the genetic analysis, was demonstrated to be ineffective in improving live birth rates. Since then, new PGT-A methodologies have been developed that perform the biopsy procedure at other stages of development and use different methods for genetic analysis. Whether or not PGT-A improves IVF outcomes and is beneficial to patients has remained controversial. OBJECTIVES: To evaluate the effectiveness and safety of PGT-A in women undergoing an IVF treatment. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in September 2019 and checked the references of appropriate papers. SELECTION CRITERIA: All randomised controlled trials (RCTs) reporting data on clinical outcomes in participants undergoing IVF with PGT-A versus IVF without PGT-A were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed risk of bias, and extracted study data. The primary outcome was the cumulative live birth rate (cLBR). Secondary outcomes were live birth rate (LBR) after the first embryo transfer, miscarriage rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, proportion of women reaching an embryo transfer, and mean number of embryos per transfer. MAIN RESULTS: We included 13 trials involving 2794 women. The quality of the evidence ranged from low to moderate. The main limitations were imprecision, inconsistency, and risk of publication bias. IVF with PGT-A versus IVF without PGT-A with the use of genome-wide analyses Polar body biopsy One trial used polar body biopsy with array comparative genomic hybridisation (aCGH). It is uncertain whether the addition of PGT-A by polar body biopsy increases the cLBR compared to IVF without PGT-A (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.66 to 1.66, 1 RCT, N = 396, low-quality evidence). The evidence suggests that for the observed cLBR of 24% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 17% and 34%. It is uncertain whether the LBR after the first embryo transfer improves with PGT-A by polar body biopsy (OR 1.10, 95% CI 0.68 to 1.79, 1 RCT, N = 396, low-quality evidence). PGT-A with polar body biopsy may reduce miscarriage rate (OR 0.45, 95% CI 0.23 to 0.88, 1 RCT, N = 396, low-quality evidence). No data on ongoing pregnancy rate were available. The effect of PGT-A by polar body biopsy on improving clinical pregnancy rate is uncertain (OR 0.77, 95% CI 0.50 to 1.16, 1 RCT, N = 396, low-quality evidence). Blastocyst stage biopsy One trial used blastocyst stage biopsy with next-generation sequencing. It is uncertain whether IVF with the addition of PGT-A by blastocyst stage biopsy increases cLBR compared to IVF without PGT-A, since no data were available. It is uncertain if LBR after the first embryo transfer improves with PGT-A with blastocyst stage biopsy (OR 0.93, 95% CI 0.69 to 1.27, 1 RCT, N = 661, low-quality evidence). It is uncertain whether PGT-A with blastocyst stage biopsy reduces miscarriage rate (OR 0.89, 95% CI 0.52 to 1.54, 1 RCT, N = 661, low-quality evidence). No data on ongoing pregnancy rate or clinical pregnancy rate were available. IVF with PGT-A versus IVF without PGT-A with the use of FISH for the genetic analysis Eleven trials were included in this comparison. It is uncertain whether IVF with addition of PGT-A increases cLBR (OR 0.59, 95% CI 0.35 to 1.01, 1 RCT, N = 408, low-quality evidence). The evidence suggests that for the observed average cLBR of 29% in the control group, the chance of live birth following the results of one IVF cycle with PGT-A is between 12% and 29%. PGT-A performed with FISH probably reduces live births after the first transfer compared to the control group (OR 0.62, 95% CI 0.43 to 0.91, 10 RCTs, N = 1680, I² = 54%, moderate-quality evidence). The evidence suggests that for the observed average LBR per first transfer of 31% in the control group, the chance of live birth after the first embryo transfer with PGT-A is between 16% and 29%. There is probably little or no difference in miscarriage rate between PGT-A and the control group (OR 1.03, 95%, CI 0.75 to 1.41; 10 RCTs, N = 1680, I² = 16%; moderate-quality evidence). The addition of PGT-A may reduce ongoing pregnancy rate (OR 0.68, 95% CI 0.51 to 0.90, 5 RCTs, N = 1121, I² = 60%, low-quality evidence) and probably reduces clinical pregnancies (OR 0.60, 95% CI 0.45 to 0.81, 5 RCTs, N = 1131; I² = 0%, moderate-quality evidence). AUTHORS' CONCLUSIONS: There is insufficient good-quality evidence of a difference in cumulative live birth rate, live birth rate after the first embryo transfer, or miscarriage rate between IVF with and IVF without PGT-A as currently performed. No data were available on ongoing pregnancy rates. The effect of PGT-A on clinical pregnancy rate is uncertain. Women need to be aware that it is uncertain whether PGT-A with the use of genome-wide analyses is an effective addition to IVF, especially in view of the invasiveness and costs involved in PGT-A. PGT-A using FISH for the genetic analysis is probably harmful. The currently available evidence is insufficient to support PGT-A in routine clinical practice.


Assuntos
Aneuploidia , Fertilização In Vitro , Testes Genéticos/métodos , Diagnóstico Pré-Implantação/métodos , Injeções de Esperma Intracitoplásmicas , Aborto Espontâneo/epidemiologia , Viés , Biópsia , Coeficiente de Natalidade , Blastocisto/patologia , Feminino , Humanos , Nascimento Vivo , Idade Materna , Corpos Polares/patologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
PLoS One ; 15(9): e0239031, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941493

RESUMO

BACKGROUND: Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature. METHODS: We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013-July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis. RESULTS: Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health. CONCLUSIONS: We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants' influence.


Assuntos
Indicadores Básicos de Saúde , Saúde/estatística & dados numéricos , Saúde/tendências , Coeficiente de Natalidade , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Emprego , Humanos , Renda , Expectativa de Vida , Política , Dinâmica Populacional , Classe Social , Fatores Socioeconômicos
8.
PLoS One ; 15(9): e0239846, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986747

RESUMO

OBJECTIVE: To examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis. METHODS: This retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate. RESULTS: Seventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13-6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage. CONCLUSIONS: EST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.


Assuntos
Coeficiente de Natalidade , Endometriose/terapia , Etanol/uso terapêutico , Fertilização In Vitro/métodos , Nascimento Vivo , Escleroterapia/métodos , Adulto , Transferência Embrionária/métodos , Feminino , Seguimentos , Humanos , Infertilidade Feminina/terapia , Recuperação de Oócitos/métodos , Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/métodos
9.
Reprod Biomed Online ; 41(3): 428-430, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753362

RESUMO

RESEARCH QUESTION: Discontinuation of IVF cycles has been part of the radical transformation of healthcare provision to enable reallocation of staff and resources to deal with the COVID-19 pandemic. This study sought to estimate the impact of cessation of treatment on individual prognosis and US population live birth rates. DESIGN: Data from 271,438 ovarian stimulation UK IVF cycles was used to model the effect of age as a continuous, yet non-linear, function on cumulative live birth rate. This model was recalibrated to cumulative live birth rates reported for the 135,673 stimulation cycles undertaken in the USA in 2016, with live birth follow-up to October 2018. The effect of a 1-month, 3-month and 6-month shutdown in IVF treatment was calculated as the effect of the equivalent increase in a woman's age, stratified by age group. RESULTS: The average reduction in cumulative live birth rate would be 0.3% (95% confidence interval [CI] 0.3-0.3), 0.8% (95% CI 0.8-0.8) and 1.6% (95% CI 1.6-1.6) for 1-month, 3-month and 6-month shutdowns. This corresponds to a reduction of 369 (95% CI 360-378), 1098 (95% CI 1071-1123) and 2166 (95% CI 2116-2216) live births in the cohort, respectively. Th e greatest contribution to this reduction was from older mothers. CONCLUSIONS: The study demonstrated that the discontinuation of fertility treatment for even 1 month in the USA could result in 369 fewer women having a live birth, due to the increase in patients' age during the shutdown. As a result of reductions in cumulative live birth rate, more cycles may be required to overcome infertility at individual and population levels.


Assuntos
Betacoronavirus , Coeficiente de Natalidade , Infecções por Coronavirus/epidemiologia , Fertilização In Vitro/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Nascimento Vivo/epidemiologia , Idade Materna , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
10.
Artigo em Russo | MEDLINE | ID: mdl-32827367

RESUMO

The methodological approaches to total birth rate prognostication based on the study of births order-predicted patterns. The article considers issues of forecasting total birth rate as key indicator characterizing intensity of demographic processes. This problem is also relevant to the Russian Federation, since birth rates are evaluation criteria of social economic situation governing in regions. The lacking of available data in scientific methodological publications describing forecasting methods complicates understanding of demographic processes and reduces management efficiency. The methodology of predicting total birth rate states construction of causal relationships for birth rates differentiated by mother's age and birth order. The forecasting technique involves construction of multiple regression models for dependencies between the births' distributions for different birth order with the time lag parameters. To determine the delay values, iterative procedure using correlation analysis with data offset in 1-year increments was applied. To determine the time lag, offset corresponding to the maximum reliable correlations between the total birth rates depending on the children's birth of the current and subsequent order was implemented. The results obtained via correlation and regression analysis as system of equations allowed to predict total birth rate for given sequence of births from previous ones. At the same time, frequency of first births must be set following statistical series of this data. The proposed methodological approach used extrapolation of previous period trend as exponential function. Methodical approaches were tested using actual data on birth rates in a large region of the Russian Federation with a population close to 3 million people. State statistical observation form was used to perform the forecast. The results of forecasting total birth rate revealed period of temporary increase and subsequent decrease of indicator. The forecast of temporary increasing of total fertility rate is based on time lag observed between birth of the first child and subsequent children. The decreasing of studied indicator is based on negative dynamics of first births, but if the process is managed it is likely to stabilize indicator that results in its subsequent increasing.


Assuntos
Coeficiente de Natalidade , Criança , Previsões , Humanos , Morbidade , Dinâmica Populacional , Federação Russa
11.
Artigo em Russo | MEDLINE | ID: mdl-32827373

RESUMO

The article presents results of analysis of demographic indices in the Republic of Bashkortostan. The primary data for analysis was acquired from official public statistics. The dynamics of fertility and mortality indices in 1985-2018 is described. The prognostication of indices dynamics up to 2025 was made. The distribution of mortality indices by gender, age, causes of death, place of residence is proposed for 2012, 2015 and 2018. Four periods with increasing or decreasing of fertility and mortality was allocated. The linear correlation made up to r = -0.492, p<0.01, i.e., with decreasing of birth rate increasing in mortality occurred. The assessment of dynamics of mortality in 2015-2018 established that young age groups (15-29 years old) are characterized by significant increasing of mortality in every subsequent age group as compared with previous age group. Between 2012 and 2018, total mortality decreased from 13.2 ‰ to 12.4 ‰. Males and females aged 40-44 and females aged 45-49 and 50-54 had such negative trend as increasing of mortality as compared with 2012 and 2015. The decreasing of indices of overall mortality occurred only among males. In males, mortality rate exceeded mortality rate in females up to 1.33 times in 2012, up to 1.29 times in 2015 and up to 1.23 times in 2018. The mortality rate of rural population is 1.3 times higher than mortality rate of urban population. While mortality rate of able-bodied population is 1.4 times higher. The increasing of mortality occurred due to malignant neoplasms, while the growth rate was more pronounced among rural population as compared with urban population. The mortality of respiratory diseases is more than 2 times higher in rural areas and of diseases of the digestive system is 1.5 times higher among rural population. The established growth trends in mortality among rural population due to respiratory and digestive diseases and decreasing of mortality of diseases of the circulatory system and significant decreasing of such cases as "elder age" can be explained by probability of defects in encoding of causes of death.


Assuntos
Coeficiente de Natalidade , População Rural , Adolescente , Adulto , Idoso , Bashkiria , Feminino , Fertilidade , Humanos , Masculino , Mortalidade , Dinâmica Populacional , População Urbana , Adulto Jovem
12.
Buenos Aires; s.n; ago. 2020. 75 p. graf, tab.
Não convencional em Espanhol | LILACS, InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1119087

RESUMO

Actualización de los avances ocurridos durante el año 2019, relacionados con las acciones de la Coordinación Salud Sexual, Sida e ITS, del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, destinada principalmente al equipo de salud involucrado en la política de salud sexual y reproductiva de la Ciudad. Continúa el modelo de análisis del informe 2016-2018, basado en las dimensiones: Determinantes (elementos que dan cuenta del contexto en el que se desarrolla la respuesta ), Población (indicadores que permiten caracterizar la población objetivo de la política pública), Acciones Programáticas (desarrollo institucional del Programa), y Utilización de los servicios (encuentro entre el sistema de salud y las personas usuarias). Incluye un documento anexo que presenta, a modo de Resumen Ejecutivo, una tabla que permite observar el comportamiento de algunos indicadores seleccionados para los años 2016-2019.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/epidemiologia , Coeficiente de Natalidade , Dispositivos Anticoncepcionais/provisão & distribução , Serviços de Saúde Reprodutiva/provisão & distribução , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Direitos Sexuais e Reprodutivos , Saúde Sexual e Reprodutiva , Serviços Públicos de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos
13.
PLoS One ; 15(8): e0237794, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845930

RESUMO

AIMS: This study explores the differences in sickness absence trends in women according to reproductive age group and medical diagnoses. METHODS: Data were obtained from two administrative registries: the Continuous Working Life Sample and the Catalonian Institute of Medical Evaluations from 2012 to 2014, containing 47,879 female employees. Incidence rates and incidence risk ratios derived from Poisson and negative binomial models were calculated to compare sickness absence trends among reproductive age groups based on Catalonian birthrates: early-reproductive (25-34 years old), middle-reproductive (35-44) and late-reproductive (45-54), according to diagnostic groups, selected diseases, type of contract, occupational category, and country of origin. RESULTS: Younger women show a higher incidence of overall sickness absence compared to late-reproductive-aged women. Incidence risk ratios of sickness absence decreased significantly from early-reproductive to late-reproductive age for low back pain, hemorrhage in early pregnancy, nausea and vomiting, and abdominal and pelvic pain. DISCUSSION: The higher incidence of sickness absence due to pregnancy-related health conditions in early-reproductive women compared to other reproductive age groups, may explain the sickness absence differences by age in women. Proper management of sickness absence related to pregnancy should be a goal to reduce the sickness absence gap between younger and older women.


Assuntos
Coeficiente de Natalidade , Complicações na Gravidez/epidemiologia , Comportamento Reprodutivo/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Gravidez , Sistema de Registros/estatística & dados numéricos , Espanha
14.
Am J Public Health ; 110(10): 1466-1471, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816548

RESUMO

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women.Methods. We reexamined the 2004-2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios.Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the "missing" births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the "missing" births required to create a significant increase associated with the storm was generally not as great as for White women.Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.


Assuntos
Coeficiente de Natalidade , Resultado da Gravidez , Medição de Risco , Alabama/epidemiologia , Coeficiente de Natalidade/etnologia , Coeficiente de Natalidade/tendências , Tempestades Ciclônicas/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Louisiana/epidemiologia , Mississippi/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/etnologia , Saúde Pública
15.
Am J Perinatol ; 37(11): 1077-1083, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32615621

RESUMO

OBJECTIVE: This study aimed to determine the rate of preterm birth (PTB) during hospitalization among women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 23 and 37 weeks of gestation and whether this rate differs by gestational age at diagnosis of infection. STUDY DESIGN: Retrospective, cross-sectional study of all women diagnosed with SARS-CoV-2 infection between 23 and 37 weeks of gestation within a large integrated health system from March 13 to April 24, 2020. Cases with severe fetal structural malformations detected prior to infection were excluded. Women were stratified into two groups based on gestational age at diagnosis: early preterm (230/7 to 336/7 weeks) versus late preterm (34 to 366/7 weeks). We compared the rate of PTB during hospitalization with infection between the two groups. Statistical analysis included use of Wilcoxon rank sum and Fisher exact tests, as well as a multivariable logistic regression. Statistical significance was defined as a p-value <0.05. RESULTS: Of the 65 patients included, 36 (53.7%) were diagnosed in the early preterm period and 29 (46.3%) were diagnosed in the late preterm period. Baseline demographics were similar between groups. The rate of PTB during hospitalization with infection was significantly lower among women diagnosed in the early preterm period compared with late preterm (7/36 [19.4%] vs. 18/29 [62%], p-value = 0.001). Of the 25 patients who delivered during hospitalization with infection, the majority were indicated deliveries (64%, 16/25). There were no deliveries <33 weeks of gestation for worsening coronavirus disease 2019 and severity of disease did not alter the likelihood of delivery during hospitalization with SARS-CoV-2 infection (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.24-1.59). Increased maternal age was associated with a lower likelihood of delivery during hospitalization with SARS-CoV-2 infection (aOR: 0.77; 95% CI: 0.58-0.96), while later gestational age at diagnosis of infection was associated with a higher likelihood of delivery during hospitalization (aOR: 2.9; 95% CI: 1.67-8.09). CONCLUSION: The likelihood of PTB during hospitalization with SARS-CoV-2 infection is significantly lower among women diagnosed in the early preterm period compared with late preterm. Most women with SARS-CoV-2 infection in the early preterm period recovered and were discharged home. The majority of PTB were indicated and not due to spontaneous preterm labor. KEY POINTS: · Preterm delivery is less likely among women diagnosed in the early preterm compared with late preterm.. · Most women infected in the early preterm period recovered and were discharged home undelivered.. · The majority of preterm birth were indicated and not due to spontaneous preterm labor..


Assuntos
Betacoronavirus/isolamento & purificação , Coeficiente de Natalidade , Infecções por Coronavirus , Trabalho de Parto Prematuro/epidemiologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estudos Transversais , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Idade Materna , New York/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal/métodos , Fatores de Tempo
16.
Natl Vital Stat Rep ; 69(6): 1-12, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730736

RESUMO

Objectives-This report presents changes in state-specific birth rates for teenagers between 2017 and 2018 by race and Hispanic origin of mother. Methods-Data are from birth certificates of the 50 states and the District of Columbia (D.C.). Teen birth rates, the number of births to females aged 15-19 per 1,000 females aged 15-19, are shown by state for all births and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic females for 2017 and 2018. Results-Birth rates for females aged 15-19 declined in 38 states between 2017 and 2018; nonsignificant declines were reported in eight additional states and D.C. Among non-Hispanic white teenagers, rates declined in 29 states between 2017 and 2018; nonsignificant declines were reported in 16 additional states. Teen birth rates for non-Hispanic black females declined in 10 states between 2017 and 2018; nonsignificant declines were seen in 21 additional states and D.C. For Hispanic teenagers, birth rates declined in 10 states between 2017 and 2018; nonsignificant declines were reported in 30 additional states and D.C. The magnitude of change between 2017 and 2018 varied by state for each race and Hispanic-origin group.


Assuntos
Coeficiente de Natalidade/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Gravidez na Adolescência/etnologia , Adolescente , Coeficiente de Natalidade/tendências , Feminino , Humanos , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Cochrane Database Syst Rev ; 7: CD001298, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32683695

RESUMO

BACKGROUND: Adhesions are fibrin bands that are a common consequence of gynaecological surgery. They are caused by conditions that include pelvic inflammatory disease and endometriosis. Adhesions are associated with comorbidities, including pelvic pain, subfertility, and small bowel obstruction. Adhesions also increase the likelihood of further surgery, causing distress and unnecessary expenses. Strategies to prevent adhesion formation include the use of fluid (also called hydroflotation) and gel agents, which aim to prevent healing tissues from touching one another, or drugs, aimed to change an aspect of the healing process, to make adhesions less likely to form. OBJECTIVES: To evaluate the effectiveness and safety of fluid and pharmacological agents on rates of pain, live births, and adhesion prevention in women undergoing gynaecological surgery. SEARCH METHODS: We searched: the Cochrane Gynaecology and Fertility Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and Epistemonikos to 22 August 2019. We also checked the reference lists of relevant papers and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials investigating the use of fluid (including gel) and pharmacological agents to prevent adhesions after gynaecological surgery. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. We assessed the overall quality of the evidence using GRADE methods. Outcomes of interest were pelvic pain; live birth rates; incidence of, mean, and changes in adhesion scores at second look-laparoscopy (SLL); clinical pregnancy, miscarriage, and ectopic pregnancy rates; quality of life at SLL; and adverse events. MAIN RESULTS: We included 32 trials (3492 women), and excluded 11. We were unable to include data from nine studies in the statistical analyses, but the findings of these studies were broadly in keeping with the findings of the meta-analyses. Hydroflotation agents versus no hydroflotation agents (10 RCTs) We are uncertain whether hydroflotation agents affected pelvic pain (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.52 to 2.09; one study, 226 women; very low-quality evidence). It is unclear whether hydroflotation agents affected live birth rates (OR 0.67, 95% CI 0.29 to 1.58; two studies, 208 women; low-quality evidence) compared with no treatment. Hydroflotation agents reduced the incidence of adhesions at SLL when compared with no treatment (OR 0.34, 95% CI 0.22 to 0.55, four studies, 566 women; high-quality evidence). The evidence suggests that in women with an 84% chance of having adhesions at SLL with no treatment, using hydroflotation agents would result in 54% to 75% having adhesions. Hydroflotation agents probably made little or no difference to mean adhesion score at SLL (standardised mean difference (SMD) -0.06, 95% CI -0.20 to 0.09; four studies, 722 women; moderate-quality evidence). It is unclear whether hydroflotation agents affected clinical pregnancy rate (OR 0.64, 95% CI 0.36 to 1.14; three studies, 310 women; moderate-quality evidence) compared with no treatment. This suggests that in women with a 26% chance of clinical pregnancy with no treatment, using hydroflotation agents would result in a clinical pregnancy rate of 11% to 28%. No studies reported any adverse events attributable to the intervention. Gel agents versus no treatment (12 RCTs) No studies in this comparison reported pelvic pain or live birth rate. Gel agents reduced the incidence of adhesions at SLL compared with no treatment (OR 0.26, 95% CI 0.12 to 0.57; five studies, 147 women; high-quality evidence). This suggests that in women with an 84% chance of having adhesions at SLL with no treatment, the use of gel agents would result in 39% to 75% having adhesions. It is unclear whether gel agents affected mean adhesion scores at SLL (SMD -0.50, 95% CI -1.09 to 0.09; four studies, 159 women; moderate-quality evidence), or clinical pregnancy rate (OR 0.20, 95% CI 0.02 to 2.02; one study, 30 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Gel agents versus hydroflotation agents when used as an instillant (3 RCTs) No studies in this comparison reported pelvic pain, live birth rate or clinical pregnancy rate. Gel agents probably reduce the incidence of adhesions at SLL when compared with hydroflotation agents (OR 0.50, 95% CI 0.31 to 0.83; three studies, 538 women; moderate-quality evidence). This suggests that in women with a 46% chance of having adhesions at SLL with a hydroflotation agent, the use of gel agents would result in 21% to 41% having adhesions. We are uncertain whether gel agents improved mean adhesion scores at SLL when compared with hydroflotation agents (MD -0.79, 95% CI -0.82 to -0.76; one study, 77 women; very low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Steroids (any route) versus no steroids (4 RCTs) No studies in this comparison reported pelvic pain, incidence of adhesions at SLL or mean adhesion score at SLL. It is unclear whether steroids affected live birth rates compared with no steroids (OR 0.65, 95% CI 0.26 to 1.62; two studies, 223 women; low-quality evidence), or clinical pregnancy rates (OR 1.01, 95% CI 0.66 to 1.55; three studies, 410 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. AUTHORS' CONCLUSIONS: Gels and hydroflotation agents appear to be effective adhesion prevention agents for use during gynaecological surgery, but we found no evidence indicating that they improve fertility outcomes or pelvic pain, and further research is required in this area. It is also worth noting that for some comparisons, wide confidence intervals crossing the line of no effect meant that clinical harm as a result of interventions could not be excluded. Future studies should measure outcomes in a uniform manner, using the modified American Fertility Society score. Statistical findings should be reported in full. No studies reported any adverse events attributable to intervention.


Assuntos
Anticoagulantes/uso terapêutico , Glucocorticoides/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Substitutos do Plasma/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Soluções para Reidratação/uso terapêutico , Aderências Teciduais/prevenção & controle , Coeficiente de Natalidade , Soluções para Diálise/uso terapêutico , Feminino , Géis/uso terapêutico , Humanos , Icodextrina/uso terapêutico , Infertilidade Feminina/prevenção & controle , Dor Pélvica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia de Second-Look , Aderências Teciduais/epidemiologia
19.
PLoS One ; 15(7): e0235707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628729

RESUMO

BACKGROUND: Dual-trigger for final oocyte maturation has been applied on the women with poor ovarian response or diminished ovarian reserve. However, the results were controversial. The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) stratification is a set of newly established criteria for low prognosis patients. The aim of this study was to examine the effectiveness of dual-trigger for final oocyte maturation on the in vitro fertilization (IVF) outcomes of patients who fulfill the POSEIDON group 4 criteria. METHODS: This retrospective cohort study investigated 384 cycles fulfilling the POSEIDON group 4 criteria. The patients underwent IVF treatment using the gonadotropin-releasing hormone (GnRH) antagonist protocol. The study group contained 194 cycles that received dual-trigger (human chorionic gonadotropin [hCG] plus GnRH-agonist) for final oocyte maturation. The control group included 114 cycles where final oocyte maturation was performed with only hCG. Baseline characteristics and cycle parameters, as well as IVF outcomes of both groups were compared. RESULTS: Baseline characteristics were similar between the dual trigger group and the control group. In terms of IVF outcomes, the dual trigger group demonstrated significantly higher number of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day-3 embryos, and top-quality day-3 embryos. A statistically significant improvement in clinical pregnancy rate and live birth rate was also observed in the dual trigger group. CONCLUSIONS: Our data suggests that dual trigger for final oocyte maturation might improve clinical pregnancy rates and live birth rates of IVF cycles in patients fulfilling the POSEIDON group 4 criteria.


Assuntos
Gonadotropina Coriônica/farmacologia , Fertilização In Vitro/métodos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Reserva Ovariana/efeitos dos fármacos , Adulto , Coeficiente de Natalidade , Feminino , Humanos , Razão de Chances , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
20.
Lancet ; 396(10258): 1285-1306, 2020 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-32679112

RESUMO

BACKGROUND: Understanding potential patterns in future population levels is crucial for anticipating and planning for changing age structures, resource and health-care needs, and environmental and economic landscapes. Future fertility patterns are a key input to estimation of future population size, but they are surrounded by substantial uncertainty and diverging methodologies of estimation and forecasting, leading to important differences in global population projections. Changing population size and age structure might have profound economic, social, and geopolitical impacts in many countries. In this study, we developed novel methods for forecasting mortality, fertility, migration, and population. We also assessed potential economic and geopolitical effects of future demographic shifts. METHODS: We modelled future population in reference and alternative scenarios as a function of fertility, migration, and mortality rates. We developed statistical models for completed cohort fertility at age 50 years (CCF50). Completed cohort fertility is much more stable over time than the period measure of the total fertility rate (TFR). We modelled CCF50 as a time-series random walk function of educational attainment and contraceptive met need. Age-specific fertility rates were modelled as a function of CCF50 and covariates. We modelled age-specific mortality to 2100 using underlying mortality, a risk factor scalar, and an autoregressive integrated moving average (ARIMA) model. Net migration was modelled as a function of the Socio-demographic Index, crude population growth rate, and deaths from war and natural disasters; and use of an ARIMA model. The model framework was used to develop a reference scenario and alternative scenarios based on the pace of change in educational attainment and contraceptive met need. We estimated the size of gross domestic product for each country and territory in the reference scenario. Forecast uncertainty intervals (UIs) incorporated uncertainty propagated from past data inputs, model estimation, and forecast data distributions. FINDINGS: The global TFR in the reference scenario was forecasted to be 1·66 (95% UI 1·33-2·08) in 2100. In the reference scenario, the global population was projected to peak in 2064 at 9·73 billion (8·84-10·9) people and decline to 8·79 billion (6·83-11·8) in 2100. The reference projections for the five largest countries in 2100 were India (1·09 billion [0·72-1·71], Nigeria (791 million [594-1056]), China (732 million [456-1499]), the USA (336 million [248-456]), and Pakistan (248 million [151-427]). Findings also suggest a shifting age structure in many parts of the world, with 2·37 billion (1·91-2·87) individuals older than 65 years and 1·70 billion (1·11-2·81) individuals younger than 20 years, forecasted globally in 2100. By 2050, 151 countries were forecasted to have a TFR lower than the replacement level (TFR <2·1), and 183 were forecasted to have a TFR lower than replacement by 2100. 23 countries in the reference scenario, including Japan, Thailand, and Spain, were forecasted to have population declines greater than 50% from 2017 to 2100; China's population was forecasted to decline by 48·0% (-6·1 to 68·4). China was forecasted to become the largest economy by 2035 but in the reference scenario, the USA was forecasted to once again become the largest economy in 2098. Our alternative scenarios suggest that meeting the Sustainable Development Goals targets for education and contraceptive met need would result in a global population of 6·29 billion (4·82-8·73) in 2100 and a population of 6·88 billion (5·27-9·51) when assuming 99th percentile rates of change in these drivers. INTERPRETATION: Our findings suggest that continued trends in female educational attainment and access to contraception will hasten declines in fertility and slow population growth. A sustained TFR lower than the replacement level in many countries, including China and India, would have economic, social, environmental, and geopolitical consequences. Policy options to adapt to continued low fertility, while sustaining and enhancing female reproductive health, will be crucial in the years to come. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Coeficiente de Natalidade/tendências , Carga Global da Doença/tendências , Migração Humana/tendências , Mortalidade/tendências , Crescimento Demográfico , Feminino , Previsões , Humanos , Masculino
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