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To assess the correlation between vitamin D status and body composition variables in adult women of childbearing age, a cross-sectional study was conducted involving women aged 20-49 years. The participants were categorized based on their vitamin D status and further divided according to body mass index (BMI). Anthropometric and biochemical data were collected to compute body composition indices, specifically body fat and muscle mass. The sample included 124 women, with 63.70% exhibiting vitamin D inadequacy. Women with inadequate vitamin D status demonstrated a higher waist-to-height ratio (WHtR) and body adiposity index (BAI), along with a lower BMI-adjusted muscle mass index (SMI BMI), compared to those with adequate levels of vitamin D (p = 0.021; p = 0.019; and p = 0.039, respectively). A positive correlation was observed between circulating concentrations of 25(OH)D and SMI BMI, while a negative correlation existed between circulating concentrations of 25(OH)D and waist circumference (WC), WHtR, conicity index (CI), fat mass index (FMI), body fat percentage (% BF), and fat-to-muscle ratio (FMR). These findings suggest that inadequate vitamin D status may impact muscle tissue and contribute to higher body adiposity, including visceral adiposity. It is recommended that these variables be incorporated into clinical practice, with a particular emphasis on WHtR and SMI BMI, to mitigate potential metabolic consequences associated with vitamin D inadequacy.
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Tecido Adiposo , Adiposidade , Composição Corporal , Índice de Massa Corporal , Músculo Esquelético , Deficiência de Vitamina D , Vitamina D , Humanos , Feminino , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto Jovem , Deficiência de Vitamina D/sangue , Tecido Adiposo/metabolismo , Músculo Esquelético/metabolismo , Circunferência da Cintura , Estado NutricionalRESUMO
BACKGROUND: Vitamin B deficiencies are involved with several outcomes in fertility and pregnancy. In Brazil, the national prevalence rates of these micronutrient deficiencies in women of reproductive age were not known. This study aims to systematically identify, select, evaluate, analyze, and report the prevalence rates of vitamin B complex deficiencies in women of reproductive age in Brazil and identify variables that may modify the outcome rates. METHODS: A systematic review will be conducted guided by the following question: "What is the prevalence of vitamin B deficiencies in women of reproductive age in Brazil?". The studies will be identified and selected from a literature search using electronic databases, consultation with researchers/specialists, and reference lists of eligible studies and reviews on the topic. Major eligibility criteria include observational cross-sectional and cohort studies carried out in Brazil and performed in women 10-49 years old, or pregnant and lactating mothers, and investigated the deficiency of vitamin B complex by laboratory test. Two reviewers independently will perform the screening and selection of the studies, data extraction, and risk of bias assessment. For the data report, a narrative approach will be used to present the characteristics of the included studies and individual findings. A random meta-analysis model will be implemented to summarize the individual prevalence rates in a global value if the studies are sufficiently homogeneous. DISCUSSION: This study aims to identify the national and regional prevalence rates of vitamin B complex deficiencies in women of reproductive age; allow the policymakers discuss, plan, and implement public policies to screen; and prevent and/or treat these malnutrition conditions. This also aims to know the rates of nutritional deficiencies over the years, serving as an indirect indicator of the socioeconomic and dietary patterns of the population. Specifically for folate, this study allows to compare the prevalence rates of deficiency of this vitamin before and after the mandatory fortification of wheat and corn flours implemented since 2004 in Brazil, in this specific population. The evidence gathered may highlight the need for population-based studies to investigate the deficiency of these vitamins. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188474.
Assuntos
Desnutrição , Complexo Vitamínico B , Deficiência de Vitaminas do Complexo B , Gravidez , Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Lactação , Prevalência , Brasil/epidemiologia , Estudos Transversais , Ácido Fólico , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
Resumen Entender cómo las personas construyen y modifican sus decisiones y acciones en materia de salud, es indispensable para el abordaje del sobrepeso y la obesidad. El objetivo fue diseñar una intervención en salud que fomente el cambio de comportamientos que favorezcan la adherencia a un plan de alimentación y actividad física en mujeres en edad fértil. Se realizó un análisis mixto que incluyó la revisión de 193 expedientes clínicos en un consultorio privado de nutrición y la aplicación de 16 entrevistas semiestructuradas a mujeres con sobrepeso y obesidad, entre 20 y 49 años, con intención y sin intención de perder peso, para identificar factores relacionados con el aumento de peso. A partir de esto se diseñó una intervención en salud que busca fomentar el cambio de comportamientos para la pérdida de peso, a partir de modelos de cambio de comportamiento. Se encontró que factores relacionados con actitudes, normas percibidas y agencia personal estructuran el cambio de comportamiento y estos fueron distintos cuando sí hay intención de perder peso. Las intervenciones para control de peso deberían buscar la adherencia terapéutica; fomentar el fortalecimiento y creación de redes de apoyo; identificar y abordar las barreras de adherencia y adaptarse a las necesidades individuales.
Abstract To understand how people construct and modify their decisions and actions in health matters, is an essential requirement for the treatment of overweight and obesity. The objective was designing a health intervention that encourages behavior change that favors adherence to a diet and a physical activity plan in women of childbearing age. A mixed analysis was carried out that included the review of 193 clinical records in a private nutrition practice and the application of 16 semi-structured interviews to women with overweight, between 20 and 49 years old, with and without intention of losing weight, to identify factors related to the development of overweight. Based on this, a health intervention was designed to promote behavior change for weight loss, from de thranstheoretical model of change and integrated behavior. Factors related to attitudes, perceived norms, and personal agency were found to structure behavior change, and these were different when there is an intention to lose weight. Weight control interventions should seek adherence; promote the strengthening and creation of support social networks; identify and address barriers to adherence; adapt to the needs of the individual.
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La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerada como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se utilizó una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento cuantitativo diseñado el cual fue validado por juicio de expertos. Se encuestó a 20 mujeres auto medicadas con anticonceptivo oral e inyectable, seleccionado de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicados a la muestra que representa esta investigación(AU)
La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerado como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se obtuvo una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento diseñado cuantitativamente el cual fue validado por juicio de expertos. Se encontró a 20 mujeres automedicadas con anticonceptivo oral e inyectable, seleccionadas de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4 de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicado a la muestra que representa esta investigación(AU)
Assuntos
Humanos , Feminino , Automedicação , Anticoncepcionais Orais/efeitos adversos , Uso de Medicamentos , Condições Sociais , Mulheres , Fármacos para a Fertilidade Feminina , Serviços de SaúdeRESUMO
BACKGROUND: The recognition of the causal association between Zika virus (ZIKV) infection during pregnancy and congenital abnormalities including microcephaly underlines the importance of preventing this disease in pregnant women (PW) and women of childbearing age (WCA). Although Brazil and other Latin American countries reported a significant reduction in the number of ZIKV infections in recent years, epidemic waves can recur in settings with previous outbreaks as conditions for transmission remain optimal and susceptible populations are continuously replenished. METHODS: In this cross-sectional study, we enrolled 64 PW and 260 non-pregnant WCA attending routine medical appointments in two primary care units in Sao Paulo, Brazil, and assessed knowledge and attitudes about ZIKV infection and prevention. RESULTS: Most women reported knowing that ZIKV is transmitted through the bite of Aedes mosquitos, and most knew that acute symptoms are similar to those seen in Dengue infection. Furthermore, most participants correctly described that ZIKV infection during pregnancy may cause detrimental outcomes for the newborn. However, most ignored that ZIKV infection can be asymptomatic, and only 15% knew about the risk of ZIKV sexual transmission. We found no statistically significant differences between PW and WCA regarding knowledge about ZIKV sexual transmission. Knowledge about ZIKV sexual transmission was significantly associated with education; among participants with ≤12 schooling years, only 9.0% (95%CI 3.4-18.5%) correctly answered that ZIKV can be sexually transmitted, compared to 12.9% (95%CI 8.2-18.8%) among participants with 12-14 schooling years, and to 24.4% (95%CI 15.9-34.9%) of participants with ≥15 schooling years (p = 0.015). Education remained independently associated with knowledge about sexual transmission of ZIKV in a multivariate logistic regression model adjusted for age, race and pregnancy status (p = 0.022). CONCLUSION: Our findings underscore the urgent need of educational and family planning programs that may help prevent detrimental outcomes of ZIKV infection in an endemic area of Brazil.
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Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Aedes/virologia , Animais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controleRESUMO
Background: Dietary exposure to mercury in women of childbearing age could result in neurological effects on the fetus. A health risk assessment of total mercury by fishery products intake has not been conducted in this population group in Bogota, Colombia. On the other hand, it has been suggested that selenium content on fishery products may have a protective effect against mercury toxicity. Nevertheless, selenium content on fish species marketed in Bogota has not been determined. Objective: Exposure risk to total mercury and selenium content on fishery products consumed by women of childbearing age from Bogota, Colombia, were assessed. Methods: Total mercury and selenium concentrations for products available at fish stores and supermarkets were determined. The exposure risk to total mercury was estimated considering the intake of these products by women of childbearing age group. Results: Total mercury highest concentrations were 0.8166 mg/kg in mota (Calophysusmacropterus), and 0.6275 mg/kg in catfish (Pseudoplatystoma tigrinum). On the other hand, the highest selenium concentration was 0.6471 mg/kg in nicuro (Pimelodus blochii). Finally, it was established that for women of childbearing age group, health risk of exposure to total mercury due to mota intake exceeded by 8.56-fold the reference dose. Conclusions:Mota intake considerably increases exposure risk to total mercury on women of childbearing age from Bogota, Colombia. The selenium levels established in the fishery products assessed, except for catfish and mota, are theoretically suggestive of a protective effect of selenium against mercury toxicity. Consequently, continuous total mercury concentrations monitoring is required to protect health of women of childbearing age and the general population from Bogota, Colombia
Antecedentes: La exposición dietética al mercurio en mujeres en edad fértil podría provocar efectos neurológicos en el feto. En Bogotá, Colombia no se han realizado evaluaciones de riesgo por la exposición al mercurio total debido a la ingesta de productos de la pesca en este grupo de la población. Por otro lado, ha sido sugerido que el contenido de selenio en los productos de la pesca podría tener un efecto protector frente a la toxicidad por mercurio, sin embargo, el contenido de selenio en las especies de peces comercializadas en Bogotá, Colombia no ha sido determinado. Objetivo: Evaluar el riesgo de exposición al mercurio total y el contenido de selenio en los productos de la pesca consumidos por las mujeres en edad fértil de Bogotá, Colombia. Métodos: Se determinaron las concentraciones de mercurio total y selenio en distintos productos de la pesca disponibles en pescaderías y supermercados. El riesgo de exposición a mercurio total se estimó considerando la ingesta de estos productos por parte de un grupo de mujeres en edad fértil. Resultados: Las concentraciones más altas de mercurio total fueron de 0.8166 mg/kg en mota (Calophysus macropterus) y 0.6275 mg/kg en bagre (Pseudoplatystoma tigrinum). Por otro lado, la concentración más alta de selenio fue de 0.6471 mg/kg en nicuro (Pimelodus blochii). Finalmente, se estableció que el riesgo de exposición a mercurio total, debido a la ingesta de mota, excedió en 8.56 veces la dosis de referencia en el grupo de mujeres en edad fértil. Conclusiones: La ingesta de mota aumenta el riesgo de exposición al mercurio total en las mujeres en edad fértil de Bogotá, Colombia. Por otro lado, los niveles de selenio identificados en los productos evaluados, excepto en bagre y mota, teóricamente sugieren un posible efecto protector del selenio contra la toxicidad por mercurio. Considerando lo indicado, es necesario realizar un monitoreo continuo de las concentraciones de mercurio total en los productos de la pesca, con el fin de proteger la salud de las mujeres en edad fértil y de la población general de Bogotá, Colombia
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Humanos , Medição de Risco , Selênio , Mulheres , Fertilidade , MercúrioRESUMO
RESUMEN Propósito: Relacionar la ingesta dietaria de hierro con el estado nutricional de éste en una muestra de mujeres en edad fértil de Santiago de Chile. Método: A 51 mujeres entre 18 - 35 años se aplicó una Encuesta de Tendencia de Consumo para estimar el aporte de hierro dietario, junto con la medición de los biomarcadores bioquímicos a modo de determinar el estado de los depósitos de hierro. Mediante prueba estadística de Mann-Whitney se analizaron diferencias significativas entre los grupos según estado nutricional del hierro y sus parámetros sanguíneos. Resultados: Treinta y siete de las participantes (72,5%) no cumple con la ingesta recomendada de hierro diario. Dos de las mujeres presentaron anemia, 2 deficiencia de hierro sin anemia y 12 tenía los depósitos de hierro depletados. Tres de las mujeres que presentaron depósitos deficientes tuvieron una ingesta de hierro adecuada, mientras que el 71% de las mujeres con depósitos normales presentaron una ingesta de hierro insuficiente. Conclusiones: Hay un bajo cumplimiento de los requerimientos diarios de hierro y no se observan mejores valores hematológicos a mayor ingesta de hierro, a pesar de presentar un alto porcentaje con depósitos normales de hierro. Se requiere mayor análisis de la alimentación de este grupo de la población para identificar el tipo de hierro que se está aportando principalmente y si hay otros factores dietarios y no dietarios afectando los depósitos de hierro.
ABSTRACT Objectives: To relate dietary intake of iron with iron status in a sample of women of childbearing age from Santiago de Chile. Methods: A Food Frequency Survey was applied to 51 women between 18 - 35 years of age to estimate intake of dietary iron, together with the measurement of biochemical biomarkers to determine iron stores. Using the Mann-Whitney statistical test, significant differences were analyzed between the groups according to nutritional status of iron and its blood parameters. Results: Thirty seven of the participants (72.5%) do not meet the recommended daily iron intake. Two had anemia, 2 had iron deficiency without anemia, and twelve had depleted iron stores. Three women with deficient iron stores had an adequate iron intake, while 71% of women with normal iron stores showed an insufficient iron intake. Conclusions: We observed a low compliance with the daily iron requirements and no better hematological values were associated with higher iron intake, despite a high percentage of women with normal iron stores. To identify the type of iron mainly contributed by the diet and if there are other dietary and non-dietary factors affecting iron stores, further analysis of this population group is required.
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The effects of ambient fine particulate matter (PM2.5) exposure on blood pressure have been widely reported. However, there remains uncertainty regarding the underlying roles of particulate matter components. We aimed to investigate the association between ambient PM2.5 exposure and blood pressure, as well as the potential effects of trace metal(loid)s, in a repeated-measurement study that enrolled women of childbearing age. Our study included 35 participants from Hebei Province, China, each of whom was visited for five times. During each visit, we conducted questionnaire surveys, measured blood pressure, and collected blood. The daily PM2.5 exposure of participants was estimated according to their residential addresses using a spatiotemporal model that combined monitoring data with satellite measurements and chemical-transport model simulations. This model was used to calculate average PM2.5 concentrations in 1, 3, 7, 15, 30, and 60 days prior to each visit. Serum concentrations of various trace metal(loid)s were measured. A linear mixed-effects model was used to investigate associations among study variables. Overall, the mean (standard deviation) 60 days PM2.5 concentration over all five visits was 108.1(43.3) µg/m3. PM2.5 concentration was positively associated with both systolic and diastolic blood pressures. Likewise, ambient PM2.5 concentration was positively associated with serum concentrations of manganese and arsenic, and negatively associated with serum concentrations of nickel, tin, and chromium. Only the serum concentration of molybdenum was negatively associated with systolic blood pressure. We concluded that ambient PM2.5 exposure may contribute to elevated blood pressure, potentially by interfering with internal intake of various metal(loid)s in the human body.
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Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pressão Sanguínea , China , Exposição Ambiental , Feminino , Humanos , Metais , Material Particulado/análiseRESUMO
ABSTRACT Background The recognition of the causal association between Zika virus (ZIKV) infection during pregnancy and congenital abnormalities including microcephaly underlines the importance of preventing this disease in pregnant women (PW) and women of childbearing age (WCA). Although Brazil and other Latin American countries reported a significant reduction in the number of ZIKV infections in recent years, epidemic waves can recur in settings with previous outbreaks as conditions for transmission remain optimal and susceptible populations are continuously replenished. Methods: In this cross-sectional study, we enrolled 64 PW and 260 non-pregnant WCA attending routine medical appointments in two primary care units in São Paulo, Brazil, and assessed knowledge and attitudes about ZIKV infection and prevention. Results: Most women reported knowing that ZIKV is transmitted through the bite of Aedes mosquitos, and most knew that acute symptoms are similar to those seen in Dengue infection. Furthermore, most participants correctly described that ZIKV infection during pregnancy may cause detrimental outcomes for the newborn. However, most ignored that ZIKV infection can be asymptomatic, and only 15% knew about the risk of ZIKV sexual transmission. We found no statistically significant differences between PW and WCA regarding knowledge about ZIKV sexual transmission. Knowledge about ZIKV sexual transmission was significantly associated with education; among participants with ≤12 schooling years, only 9.0% (95%CI 3.4-18.5%) correctly answered that ZIKV can be sexually transmitted, compared to 12.9% (95%CI 8.2-18.8%) among participants with 12-14 schooling years, and to 24.4% (95%CI 15.9-34.9%) of participants with ≥15 schooling years (p = 0.015). Education remained independently associated with knowledge about sexual transmission of ZIKV in a multivariate logistic regression model adjusted for age, race and pregnancy status (p = 0.022). Conclusion: Our findings underscore the urgent need of educational and family planning programs that may help prevent detrimental outcomes of ZIKV infection in an endemic area of Brazil.
Assuntos
Humanos , Animais , Feminino , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Zika virus , Infecção por Zika virus/prevenção & controle , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Aedes/virologiaRESUMO
Latin American (LA) women have been exposed to demographic and epidemiologic changes that have transformed their lifestyle, with increasing sedentary and unhealthy eating behaviors. We aimed to identify characteristics of LA women to inform public policies that would benefit these women and their future children. The Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples in eight Latin American countries (n = 9218) with a standardized protocol to investigate dietary intake, anthropometric variables, physical activity, and socioeconomic characteristics. Here we included the subsample of all 3254 women of childbearing age (15 to <45 years). The majority of ELANS women had a low socioeconomic status (53.5%), had a basic education level (56.4%), had a mostly sedentary lifestyle (61.1%), and were overweight or obese (58.7%). According to the logistic multiple regression model, living in Peru and Ecuador predicts twice the risk of being obese, and an increased neck circumference is associated with a 12-fold increased obesity risk. An increased obesity risk was also predicted by age <19 years (Relative Risk (RR) 19.8) and adequate consumption of vitamin D (RR 2.12) and iron (RR 1.3). In conclusion, the identification of these risk predictors of obesity among Latin American women may facilitate targeted prevention strategies focusing on high-risk groups to promote the long-term health of women and their children.
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Dieta , Estilo de Vida , Estado Nutricional , Obesidade/prevenção & controle , Adolescente , Adulto , Antropometria , Estudos Transversais , Ingestão de Alimentos , Escolaridade , Ingestão de Energia , Exercício Físico , Feminino , Humanos , América Latina/epidemiologia , Obesidade/epidemiologia , Comportamento Sedentário , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: In Mexico, there is an increase recorded in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. OBJECTIVE: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). METHOD: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. RESULTS: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the "very high" stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality. CONCLUSIONS: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.
INTRODUCCIÓN: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. OBJETIVO: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). MÉTODO: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. RESULTADOS: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato "muy alto", en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. CONCLUSIONES: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.
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Parto Obstétrico , Recursos em Saúde , Feminino , Humanos , México , GravidezRESUMO
Resumen Introducción: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. Objetivo: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). Método: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. Resultados: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato muy alto (470 municipios), en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. Conclusiones: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.
Abstract Introduction: In Mexico, there is an increase in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. Objective: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). Method: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. Results: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the very high stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality Conclusions: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.
Assuntos
Humanos , Feminino , Gravidez , Parto Obstétrico , Recursos em Saúde , MéxicoRESUMO
Recent studies from the Madre de Dios region of Peru report elevated mercury exposure among the general population. Our objective was to assess mercury exposure, risk factors, risk perceptions, and knowledge among women of childbearing age, a population of concern due to risks to infant and fetal health. We collected hair samples and administered a survey among 200 women aged 18-49 years residing in Madre de Dios. Hair total mercury (THg) concentrations were analyzed in accordance with EPA Method 7473. Associations between exposures and potential risk factors were analyzed using generalized linear mixed models. Geometric mean hair THg concentration (±standard deviation) for all participants was 1.62⯱â¯2.54⯵g/g (range: 0.01-30.12⯵g/g), and 67 participants (33.5%) had concentrations above the 2.2⯵g/g reference dose established by the World Health Organization (WHO). Higher exposure was significantly associated with higher fish consumption (pâ¯=â¯0.03) and less mercury knowledge (pâ¯<â¯0.0001), but not with age or educational attainment. Most participants (86.2%) expressed concern about mercury contamination, but few (26.2%) had knowledge of the health risks associated with exposure. Many residents consumed fish species previously found to have low mercury concentrations, but more than 25% of participants reported consuming fish species with high mercury concentrations. We did not observe cross-sectional differences in fish intake among women who were pregnant or breastfeeding at the time of data collection.
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Exposição Ambiental/estatística & dados numéricos , Ouro , Mercúrio , Mineração , Adolescente , Adulto , Animais , Estudos Transversais , Feminino , Peixes , Contaminação de Alimentos , Humanos , Pessoa de Meia-Idade , Peru , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Women's health during their reproductive years and whilst pregnant has implications for their children's health, both in utero and during childhood. Associations of women's pre-pregnancy dietary patterns (DP) with maternal socio-demographic characteristics and nutrient intake were investigated in ProcriAr cohort study in São Paulo/Brazil, 2012. METHODS: The DPs of 454 women were investigated by principal component factor analysis, using dietary information from a validated 110-item food frequency questionnaire. Multiple linear regression models identified independent associations between DPs and maternal socio-demographic characteristics and Spearman's correlation determined associations between DPs and nutrients intake. RESULTS: Participants' mean age was 26.1 years (standard deviation = 6.3), 10.3% had more than 8 years of formal education, 30% were migrants from outside of the Southeast of Brazil, 48% were employed, 13% were smokers, and 51% were overweight/obese. Four DPs were derived: 'Lentils, whole grains and soups,' 'Snacks, sandwiches, sweets and soft drinks,' 'Seasoned vegetables and lean meats,' and 'Sweetened juices, bread and butter, rice and beans'. The 'Lentils, whole grains and soups' score was positively related to maternal age, being non-smoker and born in the South, North or Midwest of Brazil. The 'Snacks, sandwiches, sweets and soft drinks' score was positively related to higher maternal education, and negatively related to age, lack of formal work and being born in the Northeast region. The 'Seasoned vegetables and lean meats' score was positively related to higher maternal education. The 'Sweetened juices, bread and butter, rice and beans' score was positively related to unemployment and to no family history of hypertension, and negatively related to maternal overweight and obesity. Dietary intake of fruits and vegetables, foods that require preparation, nutrients from one-carbon metabolism, protein, iron, calcium and vitamin D were correlated with the 'Seasoned vegetables and lean meats'. Dietary intake of sugar-sweetened and alcoholic beverages, industrialized and takeaway foods, and foods rich in sugar, energy, fat, and synthetic folate were correlated with the 'Snacks, sandwiches, sweets and soft drinks'. CONCLUSIONS: Findings from this study add perspectives to be considered in the implementation of health interventions, which could improve women's nutritional status and provide an adequate environment for the developing fetus.
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Dieta/psicologia , Dieta/estatística & dados numéricos , Ingestão de Energia , Comportamento Alimentar , Adolescente , Adulto , Brasil , Estudos de Coortes , Inquéritos sobre Dietas , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Análise de Componente Principal , Fatores Socioeconômicos , Adulto JovemRESUMO
Background: Folate deficiency, vitamin B-12 deficiency, and anemia can have adverse effects on birth outcomes. Also, low vitamin B-12 reduces the formation of metabolically active folate.Objectives: We sought to establish the baseline prevalence of and factors associated with folate deficiency and insufficiency, vitamin B-12 deficiency, and anemia among women of childbearing age (WCBA) in Belize.Methods: In 2011, a national probability-based survey was completed among Belizean nonpregnant WCBA aged 15-49 y. Blood samples for determination of hemoglobin, folate (RBC and serum), and vitamin B-12 (plasma) and sociodemographic and health information were collected from 937 women. RBC and serum folate concentrations were measured by microbiologic assay (MBA). Folate status was defined based on both the WHO-recommended radioproteinbinding assay and the assay adjusted for the MBA.Results: The national prevalence estimates for folate deficiency in WCBA, based on serum and RBC folate concentrations by using the assay-matched cutoffs, were 11.0% (95% CI: 8.6%, 14.0%) and 35.1% (95% CI: 31.3%, 39.2%), respectively. By using the assay-matched compared with the WHO-recommended cutoffs, a substantially higher prevalence of folate deficiency was observed based on serum (6.9% absolute difference) and RBC folate (28.9% absolute difference) concentrations. The prevalence for RBC folate insufficiency was 48.9% (95% CI: 44.8%, 53.1%). Prevalence estimates for vitamin B-12 deficiency and marginal deficiency and anemia were 17.2% (95% CI: 14.2%, 20.6%), 33.2% (95% CI: 29.6%, 37.1%), and 22.7% (95% CI: 19.5%, 26.2%), respectively. The adjusted geometric means of the RBC folate concentration increased significantly (P-trend < 0.001) in WCBA who had normal vitamin B-12 status relative to WCBA who were vitamin B-12 deficient.Conclusions: In Belize, the prevalence of folate and vitamin B-12 deficiencies continues to be a public health concern among WCBA. Furthermore, low folate status co-occurred with low vitamin B-12 status, underlining the importance of providing adequate vitamin B-12 and folic acid intake through approaches such as mandatory food fortification.
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Deficiência de Ácido Fólico/epidemiologia , Ácido Fólico/sangue , Estado Nutricional , Deficiência de Vitamina B 12/epidemiologia , Vitamina B 12/sangue , Complexo Vitamínico B/sangue , Adolescente , Adulto , Anemia/sangue , Anemia/epidemiologia , Belize/epidemiologia , Eritrócitos/metabolismo , Feminino , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/complicações , Hemoglobinas/metabolismo , Humanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Fatores de Risco , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/complicações , Adulto JovemRESUMO
Analizar la patología médica de las mujeres en edad fértil que fueron atendidas en el Hospital General del Oeste de Caracas, Venezuela. Métodos: se realizó un estudio descriptivo, transversal, de pacientes con edades entre 14 y 44 años evaluadas desde 1º Octubre 2015 al 1º Mayo 2016. Tratamiento estadístico: Se realizó estadística descriptiva con medidas de tendencia central en las variables continuas y de proporción en las cualitativas. Resultados: Se evaluaron 910 pacientes con edad promedio de 25,63 ± 6,69 DS. El grupo entre 14 y 19 años fue el 33,40% y el 17,5% eran adolescentes. El promedio de edad de las embarazadas fue de 23,31 ± 6,08 DS, mientras que en las no gestantes 30,57 ± 7,97 DS. Según el Graffar modificado por Méndez Castellanos predominó la clasificación III en 57,06%. El promedio de la menarquia fue 12,7 ± 1,75 DS y de la sexarquia 16,54 ± 4,04 DS. La edad promedio del primer parto fue 18 ± 1,33 DS. El 73,62% no cumplía control ginecológico anual. Eran gestantes 78% y de ellas, el 80% eran sanas. Las patologías médicas del embarazo fueron preeclampsia 39%, anemia 35,93%, diabetes gestacional 12%, síndrome de HELLP 11%, hiperemesis gravídica 1,56%. Los diagnósticos médicos no relacionados con el embarazo fueron: asma 41,77%, HTA crónica 16,45%, ITU 12,65%, obesidad 7,59%, anemia 5,09%. La violencia doméstica se documentó en 3,4% y 20% ocurrió durante la gestación. En las no gestantes el diagnóstico médico predominó en 48% y los mas frecuentes fueron: anemia 34,84%, ITU 27,77%, HTA crónica 7,57%. Conclusión: La atención médica de la mujer en edad reproductiva debe ser adecuadamente abordada(AU)
To analyze the medical conditions in women of childbearing age who consulted at the Hospital General del Oeste, Caracas, Venezuela. Methods: This is an analitycal, transverse case design, of female patients in a non probabilistic sample, of intentional selection, that included 100% of patients aged 14 - 44 years, who consulted between October 1st 2015 and May 1st 2016- We included hospitalized and outpatients of internal medicine, as well as obstetrics and gynecology. A previous informed consent was obtained. The sample was divided in two groups, pregnant and not pregnant, classified as healthy and with any medical or gynecological pathology. The variables studied were: age, menarche, sexarche, parity, demographics, and final diagnoses, as well as associated complications. Results: We studied 910 patients, with an average age of 25,63 ± 6,69 DS. The group of 14 to 19 years was 3,40% and 17,5% of them were adolescents. The average age of the pregnant women was 23,31 ± 6,08 DS, and in the non-pregnant 30,57 ± 7,97 DS The Graffar score modified by Méndez Castellanos showed a class III in 57,06%. The average age of menarche was 12,7 ± 1,75 DS and of the first sexual intercourse 16,54 ± 4,04 DS. The average age of the first delivery 18 ± 1,33 DS. An important 73,62% did not have an annual gynecological consultation. The pregnant women were 78%. Among them, 80% were healthy. Their pathological conditions of pregnancy were: preeclampsia 39%, anemia 35,93%, gestational diabetes 12%, HELLP syndrome 11%, hyperemesis gravídarum 1,56%. The medical conditions not related to pregnancy were: asthma 41,77%, chronic hypertension 16,45%, UTI 12,65%, obesity 7,59%, anemia 5,09%. Doméstic violence was documented in 3,4%, and 20% ocurred during pregnancy. In non pregnant women there was 48% of medical conditions, being the most frequent anemia 34,84%, UTI 27,77%, chronic hypertension 7,57%, Conclusion: Women in childbearing age must be adequately approached and treated(AU)
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Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Manutenção da Gravidez , Gravidez/fisiologia , Estatísticas de Assistência Médica , Medicina Reprodutiva , Ginecologia , Medicina Interna , ObstetríciaRESUMO
Las mujeres en edad fértil presentan una serie de características que definen no solo su salud y bienestar, sino que también se convierten en factores positivos o negativos predictores de la salud de las futuras generaciones. De ahí la relevancia del estudio de las condiciones en las cuales transcurre la vida de las mujeres durante la etapa biológica de fertilidad en la cual, potencialmente podrían convertirse en madres. Para su estudio, el análisis de la adolescencia femenina y sus retos es imprescindible dada la cantidad de embarazos no planificados que ocurren durante esta etapa con consecuencias para la vida futura de las mujeres y sus hijos. Esta revisión tiene como objetivo explorar los diferentes aspectos de la etapa de fertilidad femenina dentro del marco de la prevención de enfermedades de la mujer y del futuro hijo que pueda concebir. Dichos aspectos son: 1- Entornos de vulnerabilidad 2- Enfermedades de transmisión sexual 3- Estado nutricional y 4- Embarazo no planificado Conclusión: Los avances en la comprensión de la vulnerabilidad en la cual transcurre la vida de una gran proporción de mujeres en edad fértil ha sido importante, sin embargo todavía los retos en el mejoramiento del bienestar de estas mujeres y sus hijos son importantes. Existe una ventana de oportunidad para realizar esfuerzos mancomunados para trabajar en pro del desarrollo de las mujeres con visión de logro de los objetivos de desarrollo sostenible al 2030(AU)
Women of childbearing age show characteristics that define not only their health and well-being, but are also potential positive or negative predictors of the health of future generations. Hence the relevance of the study of the conditions in which life of women takes place through the biological stage of fertility during which they could possibly become mothers. For the study of this phase, the understanding of female adolescence and its challenges is essential, given the number of unplanned pregnancies that occur during this stage with consequences for the future life of women and their children. The objective of this review is to explore the different aspects of the period of female fertility within the framework of the prevention of diseases of women and of the future child that can conceive. These aspects are: 1- Vulnerability environments 2- Sexually transmitted diseases 3- Nutritional status and 4- Unplanned pregnancy Conclusion: Progress in understanding the vulnerability in which the life of a large proportion of women of childbearing age It has been important, but still the challenges in improving the well-being of these women and their children are important. There is a window of opportunity for joint efforts to work towards the development of women with a vision of achieving sustainable development goals by 2030(AU)
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Humanos , Feminino , Criança , Adolescente , Saúde da Mulher , Adolescente , Período Fértil , Gravidez não Planejada , Fertilidade , Infecções Sexualmente Transmissíveis , Vulnerabilidade a Desastres , Nutrição da GestanteRESUMO
BACKGROUND: The World Health Organization recently released recommendations stating that red blood cell (RBC) folate concentrations should be above 400 ng/L (906 nmol/L) for optimal prevention of folate-sensitive neural tube defects (NTDs). The objective of this study was to determine the distribution of folate insufficiency (FI) (<906 nmol/L) and potential risk of NTDs based on RBC folate concentrations among nonpregnant women of child-bearing age in Guatemala. METHODS: A national and regional multistage cluster probability survey was completed during 2009 to 2010 among Guatemalan women of child-bearing age 15 to 49 years of age. Demographic and health information and blood samples for RBC folate analyses were collected from 1473 women. Prevalence rate ratios of FI and predicted NTD prevalence were estimated based on RBC folate concentrations comparing subpopulations of interest. RESULTS: National FI prevalence was 47.2% [95% confidence interval, 43.3-51.1] and showed wide variation by region (18-81%). In all regions, FI prevalence was higher among indigenous (27-89%) than among nonindigenous populations (16-44%). National NTD risk based on RBC folate concentrations was estimated to be 14 per 10,000 live births (95% uncertainty interval, 11.1-18.6) and showed wide regional variation (from 11 NTDS in the Metropolitan region to 26 NTDs per 10,000 live births in the Norte region). CONCLUSION: FI remains a common problem in populations with limited access to fortified products, specifically rural, low income, and indigenous populations. However, among subpopulations that are most likely to have fortified food, the prevalence of FI is similar to countries with well-established fortification programs. Birth Defects Research (Part A) 106:587-595, 2016. © 2016 Wiley Periodicals, Inc.
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Eritrócitos/metabolismo , Deficiência de Ácido Fólico , Ácido Fólico/sangue , Defeitos do Tubo Neural/epidemiologia , Adolescente , Adulto , Feminino , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/epidemiologia , Guatemala/epidemiologia , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Las Infecciones de Transmisión Sexual (ITS) se encuentran entre las cinco razones de consulta más frecuente en adultos. En Paraguay existe un conocimiento limitado sobre frecuencia de ITS especialmente en mujeres no gestantes en edad fértil. Por ello, este estudio piloto descriptivo de corte transverso analizó la frecuencia de sífilis, de infección por el Virus de la Inmunodeficiencia Humana (VIH) de factores de riesgo asociados en 100 mujeres en edad fértil (18-48 años) no gestantes que acudieron al Hospital Regional de Villa Hayes. La detección de sífilis se realizó mediante el método inmunocromato-gráfico y la confirmación por la Prueba de Absorción de Anticuerpos Treponémicos Fluorescentes. La infección por VIH fue detectada mediante el método inmunocromatográfico y el Ensayo por Inmunoabsorción Ligado a Enzimas. Se consideró un conocimiento aceptable sobre prevención y transmisión de estas ITS si el 60% de las preguntas se contestaban correctamente. Se observó una alta frecuencia de sífilis, de 13% (IC95%7,1-21,2%) y una asociación entre el bajo nivel educativo y la presencia de sífilis (p=0,002). No se encontró ningún resultado positivo para VIH. El 11% de las mujeres presentó un nivel inaceptable de conocimiento, sin embargo se evidenció una alta frecuencia de mujeres (58%) que no utilizaba preservativo, lo cual indica falta de buenas prácticas. Es preciso fortalecer las medidas de control y manejo de ITS ya existentes en esta región especialmente en las mujeres no gestantes en edad fértil.
Sexually Transmitted Infections (STIs) are among the five most frequent reasons forconsultation in adults. In Paraguay there is a limited knowledge about STIs frequencyespecially in non pregnant women of childbearing age. Therefore, this pilot descriptivecross-sectional study analyzed the frequency of syphilis, HIV infection and associatedrisk factors in 100 women of childbearing age (18-48 years) non pregnant who went tothe Regional Hospital of Villa Hayes. Syphilis screening was performed using the immu nochromatography method and confirmation by the Test Fluorescent Treponemal AntibodyAbsorption. HIV infection was detected by the immunochromatographic methodand the test for enzyme-linked immunosorbent. An acceptable knowledge about preventionand transmission of these STIs were considered if 60% of the questions wereanswered correctly. A high frequency of syphilis, about 13% (CI95%7.1-21.2%) and anassociation between low educational level and the presence of syphilis (p = 0.002) wasobserved. No positive result for HIV was found. 11% of women presented an unacceptablelevel of knowledge, however a high frequency of women (58%) who did not usecondoms was evident, indicating lack of good practices. It is necessary to strengthencontrol measures and management of STIs existing in this region especially in nonpregnantwomen of childbearing age.
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Humanos , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Doenças Transmissíveis , Fatores de Risco , Infecções por HIV , Sífilis/diagnósticoRESUMO
INTRODUCTION: Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency. METHODS: A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15-49 years of age). Primary data collection was carried out in 2009-2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality. RESULTS: National prevalence estimates for deficient serum [<10 nmol per liter (nmol/L)] and RBC folate (<340 nmol/L) concentrations were 5.1 % (95 % CI 3.8, 6.4) and 8.9 % (95 % CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5 % (95 % CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0 vs. 2.0 % and 13.5 vs. 3.9 %, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2-24.9 %) and by wealth index (4.1-15.1 %). The prevalence of vitamin B12 deficiency also varied among regions (12.3-26.1 %). CONCLUSIONS: In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.