RESUMEN
Registou-se um avanço significativo em Moçambique na prevenção da transmissão vertical de mãe para filho (PTV), desde o lançamento do primeiro Plano de Eliminação da Transmissão Vertical em 2012: a testagem e tratamento do HIV em mulheres grávidas e lactantes estão totalmente integrados nos serviços de Saúde Materno-infantil (com uma cobertura muito elevada de testagem e início do TARV), a Opção B+ foi expandida para praticamente todas as unidades sanitárias do país, com uma cobertura de 97% de todas US TARV do país a oferecer esta opção, o acesso ao Diagnóstico precoce infantil aumentou substancialmente. No entanto, apesar de todas estas realizações, estima-se que durante o ano de 2018, no país, 16.000 novas infecções pelo HIV tenham ocorrido em crianças, através da transmissão de mãe para filho (Spectrum Versao 5.754). A fraca adesão ao TARV em mulheres grávidas e lactantes que vivem com o HIV, resultando em baixos níveis de supressão viral , foi identificada como sendo o maior desafio. O actual Plano de Eliminação da Transmissão Vertical do HIV, Sífilis e Hepatite B em Moçambique 2020-2024 tenta analisar os factores subjacentes à situação actual e propor estratégias e actividades com vista a colocar Moçambique "no caminho" para eliminação da transmissão vertical das três doenças. Relativamente ao HIV, estas estratégias abordam a necessidade de reduzir novas infecções pelo HIV em mulheres em idade reprodutiva, melhorar o manejo geral de mulheres jovens HIV+ a nível das unidades sanitárias, aumentar a testagem da carga viral para monitorar a resposta ao TARV, simplificar as recomendações e práticas que podem afectar a retenção no tratamento do HIV, reforçar a prevenção da TV durante o período de amamentação, e alinhar os esforços de monitoria e avaliação com o novo foco na retenção e supressão viral.
Asunto(s)
Humanos , Femenino , Embarazo , Lactante , Adolescente , Sífilis/diagnóstico , Sífilis/mortalidad , Sífilis/transmisión , VIH , Transmisión Vertical de Enfermedad Infecciosa , Carga Viral , Hepatitis B/tratamiento farmacológico , Lactancia Materna , Sífilis/prevención & control , Sífilis/terapia , Prevalencia , Estrategias de Salud , Servicios de Salud Materno-Infantil/organización & administración , MozambiqueRESUMEN
Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (Pâ<â.05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.
Asunto(s)
Sepsis Neonatal/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/diagnóstico , Sífilis Congénita/diagnóstico , Sífilis/diagnóstico , Estudios de Casos y Controles , China , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/mortalidad , Sepsis Neonatal/microbiología , Sepsis Neonatal/mortalidad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/mortalidad , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Sífilis/microbiología , Sífilis/mortalidad , Serodiagnóstico de la Sífilis , Sífilis Congénita/mortalidadRESUMEN
BACKGROUND: Before penicillin, the syphilis case-fatality rate was 10% within 40 years. Late complications, such as cardiovascular syphilis, were still common in the 1950s but now seem quite rare even though some infections likely go undetected. We studied trends in syphilis mortality as an indicator of trends in severe complications of syphilis. METHODS: We assessed underlying cause of death from US death certificates for 1968 to 2015. We examined death trends by type of syphilis (cardiovascular, neuro, congenital, other). We compared trends in deaths with trends in primary and secondary syphilis from national STD surveillance data. RESULTS: During 1968 to 2015, there were 6498 deaths attributed to syphilis, 4149 males and 2349 females. Annual syphilis deaths decreased from 586 in 1968 to 94 in 1984, then leveled off to between 24 and 46 since 1998. Between 1968 and 2015, the decrease in annual cardiovascular syphilis deaths (from 338 to 3) exceeded the decrease in annual neurosyphilis deaths (from 191 to 33). Congenital syphilis deaths (which do not include stillbirths) generally decreased from 28 to 2 per year. An increase in primary and secondary syphilis among women in the late 1980s was accompanied by a 4-fold increase in congenital syphilis deaths (from 9 in 1986 to 35 in 1990), but there was no subsequent increase in syphilis deaths among women. CONCLUSIONS: Adults now rarely die from syphilis. Increases in infections in the late 1980s did not lead to an increase in adult syphilis deaths. Congenital syphilis deaths still increase when syphilis increases among women.
Asunto(s)
Sífilis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/mortalidad , Sífilis/complicaciones , Sífilis Cardiovascular/mortalidad , Sífilis Congénita/mortalidad , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To evaluate mother and infant outcomes in the largest prevention of mother-to-child-transmission (PMTCT) programme in Haiti in order to identify gaps towards elimination of HIV and syphilis. METHODS: Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999 to 2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery as well as infant enrolment in PMTCT, HIV testing and HIV infection. Four PMTCT programme periods were compared: period 1 (1999-2004, mono ARV), period 2 (2005-2009, dual ARV), period 3 (2010-2012, Option B) and period 4 (Oct 2012-2014, Option B+). Kaplan-Meier methods were used to assess retention in PMTCT care. RESULTS: Among 4665 pregnancies, median age was 27 years and median CD4+ was 494 cells/µl (IQR 328-691). A total of 75% of women received antiretrovirals before delivery, and 73% were retained in care through delivery. Twenty-two percent of women were lost before delivery, <1% died and 6% had stillbirths or abortions. Ninety-four percent of infants who were born alive enrolled in PMTCT, of whom 92% had complete HIV testing. One hundred and sixty-one infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8% and 3.6% in periods 1-4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (P < 0.001). Syphilis infection among women decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. CONCLUSION: Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis.
Asunto(s)
Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Evaluación de Resultado en la Atención de Salud , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/normas , Sífilis/prevención & control , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Infecciones por VIH/transmisión , Haití/epidemiología , Humanos , Recién Nacido , Servicios de Salud Materno-Infantil/normas , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/mortalidad , Diagnóstico Prenatal , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Sífilis/epidemiología , Sífilis/mortalidad , Sífilis/transmisión , Adulto JovenRESUMEN
BACKGROUND: After reaching an all time low in 2000, the rate of syphilis in the United States has been steadily increasing. Parallel benchmarking of the disease's mortality burden has not been undertaken. METHODS: Using ICD-10 classification, all syphilis-related deaths in the national Multiple Cause of Death dataset were examined for the period 2000-2014. Descriptive statistics and age-adjusted mortality rates were generated. Poisson regression was performed to analyze trends over time. A matched case-control analysis was conducted to assess the associations between syphilis-related deaths and comorbid conditions listed in the death records. RESULTS: A total of 1,829 deaths were attributed to syphilis; 32% (n = 593) identified syphilis as the underlying cause of death. Most decedents were men (60%) and either black (48%) or white (39%). Decedents aged ≥85 years had the highest average mortality rate (0.47 per 100,000 population; 95% confidence interval [CI], 0.42-0.52). For the sampled period, the average annual decline in mortality was -2.90% (95% CI, -3.93% to -1.87%). However, the average annual percent change varied across subgroups of interest. CONCLUSIONS: Declines in U.S. syphilis mortality suggest early detection and improved treatment access likely helped attenuate disease progression; however, increases in the disease rate since 2000 may be offsetting the impact of these advancements.
Asunto(s)
Sífilis/epidemiología , Sífilis/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medición de Riesgo , Análisis de Supervivencia , Estados Unidos/epidemiología , Adulto JovenAsunto(s)
Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo , Atención Prenatal/métodos , Prevención Primaria/métodos , Sífilis/transmisión , Cuba/epidemiología , Femenino , Infecciones por VIH/mortalidad , Infecciones por VIH/prevención & control , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/mortalidad , Complicaciones Infecciosas del Embarazo/terapia , Sífilis/mortalidad , Sífilis/prevención & controlRESUMEN
Although several studies have reported an increase of syphilis incidence over the last decade in Western Europe, information concerning syphilis epidemiology in Portugal remains scarce. Therefore, we sought to characterise acquired syphilis-associated hospitalisations in Portugal according to demographic and clinical data. We used a database containing all hospitalisations that occurred in mainland Portugal public hospitals with discharges between 2000 and 2014. We analysed all hospitalisations associated with ICD-9-CM codes 091-097.x (corresponding to acquired syphilis diagnosis) concerning inpatients' gender, age and comorbidities. The median length of stay and in-hospital mortality rates were also studied. Between 2000 and 2014, there were a total of 8974 syphilis-related hospitalisations in mainland Portugal. The rate of acquired syphilis hospitalisations per 100,000 inhabitants increased by 33 % during the studied period. Syphilis hospitalisation rates increased by 70 % in males and 139 % among patients aged over 55 years. On the other hand, they declined by 10 % in females and 20 % among patients younger than 55 years old. The percentage of syphilis episodes presenting cardiovascular and neuropsychiatric comorbidities increased, while the percentage of syphilis episodes presenting HIV co-infection decreased by 69 %. A fatal outcome was reported in 5 % of episodes; 4.6 % of them had acquired syphilis as the main reason for hospitalisation. This study illustrates that, despite being a preventable infection, syphilis remains a public health problem. The analysis of hospitalisation and administrative data helps to understand syphilis epidemiology and provides a supplement to traditional case notifications.
Asunto(s)
Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Sífilis/epidemiología , Adolescente , Adulto , Anciano , Coinfección , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Sífilis/microbiología , Sífilis/mortalidad , Treponema pallidum , Adulto JovenRESUMEN
En Guatemala se llevaron a cabo experimentos por entidades de salud de Estados Unidos de Norte América, inoculando infecciones de transmisión sexual (gonorrea, sífilis y cancroide) a poblaciones vulnerables con el objetivo de generar un modelo humano para estudio de este tipo de enfermedades. Estos experimentos permanecieron ocultos durante 64 años, cuando la Dra. Susan Reverby los descubrió al revisar los archivos de quien fuera el investigador de los mismos, Dr. John C. Cutler. Fueron inoculados 1308 personas y reportadas fallecidas 83. Al hacerse pública esta nefasta noticia, se condenaron los hechos acontecidos entre 1946-1948 por múltiples organizaciones y el gobierno, nombrándose una Comisión Presidencial en Guatemala y por su parte el gobierno de Estados Unidos también conformó una Comisión Presidencial. Los informes y dictámenes de ambas Comisiones coinciden en que se violaron los principios éticos y morales, que la desigualdad social y racismo existente en esa época fueron condicionantes muy importantes, que lo acontecido puede ser catalogado como crímenes de lesa humanidad y que las personas que planificaron, aprobaron, condujeron, facilitaron y financiaron estos experimentos son moralmente culpables. A la fecha no se ha otorgado ningún resarcimiento a los afectados o familiares, ni compensación alguna a Guatemala...(AU)
In Guatemala, experiments were carried out by health entities in the United States of America, inoculating sexually transmitted infections (gonorrhea, syphilis and canker) into vulnerable populations with the aim of generating a human model for the study of this type of disease. These experiments remained hidden for 64 years, when Dr. Susan Reverby discovered them by reviewing the files of whoever was their researcher, Dr. John C. Cutler. 1308 people were inoculated and 83 were reported deceased. When this ominous news was made public, the events occurred between 1946-1948 by multiple organizations and the government were condemned, a Presidential Commission was appointed in Guatemala and for its part the government of the United States also formed a Presidential Commission. The reports and opinions of both Commissions agree that ethical and moral principles were violated, that the social inequality and racism that existed at that time were very important conditions, that what happened can be classified as crimes against humanity and that the people who planned , approved, conducted, facilitated and financed these experiments are morally culpable. To date no compensation has been granted to those affected or relatives, nor any compensation to Guatemala ... (AU)
Asunto(s)
Adulto , Sífilis/mortalidad , Enfermedades de Transmisión Sexual/mortalidad , Sujetos de Investigación/historia , Experimentación Humana/historia , Experimentación Humana/ética , Estados Unidos , GuatemalaRESUMEN
BACKGROUND: Global Burden of Disease Study is a research database containing systematically compiled information from vital statistics and epidemiologic literature to inform research, public policy, and resource allocation. OBJECTIVE: We sought to compare mortality among conditions with skin manifestations in 50 developed and 137 developing countries from 1990 to 2010. METHODS: This was a cross-sectional study to calculate mean age-standardized mortality (per 100,000 persons) across countries for 10 disease categories with skin manifestations. We compared differences in mortality from these disorders by time period (year 1990 vs year 2010) and by developing versus developed country status. RESULTS: Melanoma death rates were 5.6 and 4.7 times greater in developed compared with developing countries in 1990 and 2010, respectively. Measles death rates in 1990 and 2010 were 345 and 197 times greater in developing countries, and corresponding syphilis death rates were 33 and 45 times greater. LIMITATIONS: Inability to adjust for patient-, provider-, and geographic-level confounders may limit the accuracy and generalizability of these results. CONCLUSION: The mortality burden from skin-related conditions differs between developing and developed countries, with the greatest differences observed for melanoma, measles, and syphilis. These results may help prioritize and optimize efforts to prevent and treat these disorders.
Asunto(s)
Carcinoma Basocelular/mortalidad , Carcinoma de Células Escamosas/mortalidad , Salud Global , Melanoma/mortalidad , Neoplasias Cutáneas/mortalidad , Distribución por Edad , Varicela/mortalidad , Estudios Transversales , Dengue/mortalidad , Países Desarrollados , Países en Desarrollo , Humanos , Sarampión/mortalidad , Sífilis/mortalidadRESUMEN
Durante siglos la sífilis ha sido objeto de investigación por parte de los médicos, dado que la etiología, la forma de contagio, la profilaxis y el tratamiento eran desconocidos. En muchas ocasiones las investigaciones se han alejado de los estándares éticos actuales. En este artículo hemos revisado desde un punto de vista histórico y ético las investigaciones que sobre esta enfermedad se han ido realizando a lo largo de los siglos, centrándonos sobre todo en aquellos experimentos realizados en el siglo XX. Describimos con detalle los estudios realizados en los años que tuvieron lugar alrededor de la Segunda Guerra Mundial: experimentos realizados por los médicos norteamericanos en prisiones de Estados Unidos, la sífilis en la Alemania nazi o los ensayos realizados por los japoneses en centros de experimentación creados a tal fin en los territorios ocupados
Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there
Asunto(s)
Humanos , Historia del Siglo XX , Sífilis/diagnóstico , Sífilis/mortalidad , Sífilis/transmisión , Proyectos de Investigación/normas , Proyectos de Investigación/estadística & datos numéricos , Alemania/etnología , Japón/etnologíaRESUMEN
BACKGROUND: The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. METHODS AND FINDINGS: Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. CONCLUSIONS: Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary.
Asunto(s)
Salud Global , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis Congénita/epidemiología , Sífilis/epidemiología , Antibacterianos/uso terapéutico , Prestación Integrada de Atención de Salud , Diagnóstico Precoz , Femenino , Muerte Fetal/epidemiología , Muerte Fetal/prevención & control , Mortalidad Fetal , Edad Gestacional , Accesibilidad a los Servicios de Salud , Humanos , Mortalidad Infantil , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/mortalidad , Complicaciones Infecciosas del Embarazo/terapia , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Atención Prenatal , Pruebas Serológicas , Mortinato/epidemiología , Sífilis/diagnóstico , Sífilis/mortalidad , Sífilis/terapia , Sífilis/transmisión , Sífilis Congénita/diagnóstico , Sífilis Congénita/mortalidad , Sífilis Congénita/terapia , Sífilis Congénita/transmisión , Factores de TiempoRESUMEN
OBJECTIVE: To describe the epidemiology and trends of hospitalizations due to syphilis over a ten-year period (1997-2006) in Madrid, Spain. METHODS: Retrospective study using data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD). Hospitalized patients suffering from syphilis were identified through the corresponding ICD-9-CM codes (090-097). RESULTS: Between 1997 and 2006, 1265 hospitalizations related to syphilis were recorded in Madrid. The annual hospitalization rate was 2.3 per 100,000 inhabitants, the mortality rate was 0.09 per 100,000 inhabitants, and the case fatality rate was 4.03%. The rate of hospitalization and the case fatality rate were significantly higher among men and patients over the age of 80 years. CONCLUSION: We found a significant increase in hospitalization rates during study period. Syphilis continues to be an important public health problem in Madrid, especially among men. Policies designed to control the course and transmission of sexually transmitted diseases needs to be improved.
Asunto(s)
Hospitalización/estadística & datos numéricos , Sífilis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitalización/tendencias , Humanos , Lactante , Clasificación Internacional de Enfermedades , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Sífilis/mortalidad , Adulto JovenRESUMEN
In this article the authors highlight the behaviour of government authorities in the nineteenth century in Italy and especially in Ferrara to implement those measures deemed necessary to stem the spread of syphilis in epidemic form through the control of prostitution. Albeit discontinuously and until 1865, corrupted and infected women in Ferrara were assisted and treated by charitable institutions (Congregation of Charity, the Congregation of the Ladies of St. Vincent and the Sisters of Charity at the complex St. Mary of Consolation) since the Ferrara public hospital (Arcispedale S. Anna) could not accept or treat infected prostitutes for economic reasons and lack of beds. Subsequently, the hospital only treated prostitutes free of charge if they bore a certificate of poverty. The other infected prostitutes were sent to the sifilicomio in Modena. The authors also study mortality from syphilis in Ferrara from 1813 to 1899 in order to detect any significant differences according to age, sex and professional status and attempt to identify the stage of the disease (primary, secondary and tertiary), according to the terminology used by the doctors of that time.
Asunto(s)
Sífilis/historia , Adolescente , Adulto , Organizaciones de Beneficencia/historia , Femenino , Historia del Siglo XVI , Historia del Siglo XIX , Humanos , Recién Nacido , Italia/epidemiología , Masculino , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Trabajo Sexual/historia , Trabajo Sexual/legislación & jurisprudencia , Problemas Sociales/historia , Sífilis/clasificación , Sífilis/mortalidad , Sífilis/prevención & control , Sífilis Congénita/epidemiología , Sífilis Congénita/historia , Terminología como Asunto , Salud Urbana/historiaRESUMEN
OBJECTIVE: To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa. DESIGN: Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models. SETTING: Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania. POPULATION: N=1,078 women enrolled between 12 and 27 weeks of gestation. MAIN OUTCOME MEASURES: Stillbirth (delivery of dead baby > or = 28 weeks' gestation), fresh stillbirth, and macerated stillbirth. RESULTS: Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late (> or = 21 weeks' gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count > or = 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count > or = 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth. CONCLUSIONS: Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.
Asunto(s)
Gonorrea/complicaciones , Infecciones por VIH/complicaciones , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/mortalidad , Mortinato/epidemiología , Sífilis/complicaciones , Adulto , Estudios de Cohortes , Intervalos de Confianza , Países en Desarrollo , Femenino , Edad Gestacional , Gonorrea/mortalidad , Infecciones por VIH/mortalidad , Hospitalización , Humanos , Recuento de Linfocitos , Análisis Multivariante , Oportunidad Relativa , Paridad , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Estudios Prospectivos , Factores de Riesgo , Sífilis/mortalidad , Sífilis Congénita/complicaciones , Sífilis Congénita/mortalidad , Tanzanía/epidemiología , Adulto JovenAsunto(s)
Antibacterianos/historia , Penicilinas/historia , Sífilis/historia , Antibacterianos/uso terapéutico , Historia del Siglo XX , Humanos , Resistencia a las Penicilinas , Penicilinas/uso terapéutico , Sífilis/tratamiento farmacológico , Sífilis/mortalidad , Sífilis/prevención & control , Treponema pallidumRESUMEN
In high-income countries after World War II, the widespread availability of effective antimicrobial therapy, combined with expanded screening, diagnosis, and treatment programmes, resulted in a substantial decline in the incidence of syphilis. However, by the turn of the 21st century, outbreaks of syphilis began to occur in different subpopulations, especially in communities of men who have sex with men. The reasons for these outbreaks include changing sexual and social norms, interactions with increasingly prevalent HIV infection, substance abuse, global travel and migration, and underinvestment in public-health services. Recently, it has been suggested that these outbreaks could be the result of an interaction of the pathogen with natural immunity, and that syphilis epidemics should be expected to intrinsically cycle. We discuss this hypothesis by examining long-term data sets of syphilis. Today, syphilis in western Europe and the USA is characterised by low-level endemicity with concentration among population subgroups with high rates of partner change, poor access to health services, social marginalisation, or low socioeconomic status.
Asunto(s)
Brotes de Enfermedades , Sífilis/epidemiología , Europa (Continente)/epidemiología , Humanos , Incidencia , Conducta Sexual , Factores Socioeconómicos , Sífilis/mortalidad , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
This research delineates the historical evolution of death in custody. A retrospective, exploratory analysis of 145,425 cases from Maryland's Office of the Chief Medical Examiner, occurring from 1939 to 2004, was conducted. Two hundred and two custodial deaths were identified and subsequently examined relative to time, agency, decedent characteristics, and cause and manner of death. Results indicate that there have been substantive changes in custodial deaths over time. Cardiovascular disease was the most frequent cause of death from the 1930s to the 1970s, except for the 1940s, when syphilis and tuberculosis took precedence. Asphyxia, the predominant cause of death in the 1980s, reflected an increase in suicidal hangings. Emerging in the 1980s, drug intoxication deaths were prevalent in the 1990s and 2000s. Sudden unexplained deaths involving violent behavior, the use of multiple restraints, and drug intoxication were not identified until the 1980s, coinciding with periods of increased cocaine abuse nationally.
Asunto(s)
Causas de Muerte/tendencias , Policia , Prisioneros/estadística & datos numéricos , Accidentes/mortalidad , Adulto , Distribución por Edad , Asfixia/mortalidad , Enfermedades Cardiovasculares/mortalidad , Traumatismos Craneocerebrales/mortalidad , Muerte Súbita/epidemiología , Muerte Súbita/etiología , Femenino , Medicina Legal , Homicidio/estadística & datos numéricos , Homicidio/tendencias , Humanos , Masculino , Maryland/epidemiología , Servicios de Salud Mental , Persona de Mediana Edad , Traumatismos del Cuello/mortalidad , Grupos Raciales/estadística & datos numéricos , Restricción Física , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Suicidio/tendencias , Sífilis/mortalidad , Tuberculosis/mortalidad , Violencia/estadística & datos numéricosAsunto(s)
Humanos , Carbunco/mortalidad , Brucelosis/mortalidad , Tos Ferina/mortalidad , Cólera/mortalidad , Difteria/mortalidad , Enfermedad de Chagas/mortalidad , Morbilidad , Notificación Obligatoria , Chile , Equinococosis/mortalidad , Fiebre Paratifoidea/mortalidad , Fiebre Tifoidea/mortalidad , Gonorrea/mortalidad , Hepatitis A/mortalidad , Hepatitis B/mortalidad , Hepatitis/mortalidad , Malaria/mortalidad , Parotiditis/mortalidad , Rubéola (Sarampión Alemán)/mortalidad , Sarampión/mortalidad , Sífilis/mortalidad , Síndrome Pulmonar por Hantavirus/mortalidad , Triquinelosis/mortalidad , Tuberculosis/mortalidad , Tétanos/mortalidadRESUMEN
In early modern Venice, establishing the cause of a disease was critical to determining the appropriate cure: natural remedies for natural illnesses, spiritual solutions for supernatural or demonic ones. One common ailment was the French disease (syphilis), widely distributed throughout Venice's neighborhoods and social hierarchy, and evenly distributed between men and women. The disease was widely regarded as curable by the mid-sixteenth century, and cases that did not respond to natural remedies presented problems of interpretation to physicians and laypeople. Witchcraft was one possible explanation; using expert testimony from physicians, however, the Holy Office ruled out witchcraft as a cause of incurable cases and reinforced perceptions that the disease was of natural origin. Incurable cases were explained as the result of immoral behavior, thereby reinforcing the associated stigma. This article uses archival material from Venice's Inquisition records from 1580 to 1650, as well as mortality data.