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[PMID]:28449651
[Au] Autor:Devkota R; Khan GM; Alam K; Sapkota B; Devkota D
[Ad] Endereço:Department of Drug Administration, Kathmandu, Nepal. rameshlog@hotmail.com.
[Ti] Título:Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy.
[So] Source:BMC Pregnancy Childbirth;17(1):131, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. METHODS: Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. RESULTS: Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). CONCLUSION: Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy.
[Mh] Termos MeSH primário: Aconselhamento/métodos
Conhecimentos, Atitudes e Prática em Saúde
Conhecimento do Paciente sobre a Medicação
Gestantes/psicologia
Cuidado Pré-Natal/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Nepal
Gravidez
Cuidado Pré-Natal/psicologia
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1316-6


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[PMID]:29494566
[Au] Autor:Nguyen HTT; Tran CH; Dang AD; Tran HGT; Vu TD; Pham TN; Nguyen HV; Nguyen ANK; Pieracci EG; Tran DN
[Ti] Título:Rabies Vaccine Hesitancy and Deaths Among Pregnant and Breastfeeding Women - Vietnam, 2015-2016.
[So] Source:MMWR Morb Mortal Wkly Rep;67(8):250-252, 2018 Mar 02.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Human rabies deaths are preventable through prompt administration of postexposure prophylaxis (PEP) with rabies immune globulin and rabies vaccine after exposure to a rabid animal (1); there are no known contraindications to receiving PEP (1,2). Despite widespread availability of PEP in Vietnam, in 2015 the Ministry of Health (MoH) received reports of pregnant and breastfeeding women with clinically diagnosed rabies. MoH investigated factors associated with these rabies cases. MoH found that, during 2015-2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeeding mothers and four in pregnant women, all of whom had been bitten by dogs. All six patients died. Three of the four pregnant women had cesarean deliveries. One of the three newborns died from complications believed to be unrelated to rabies; the fourth pregnant woman contracted rabies too early in pregnancy for the fetus to be viable. Two of the patients sought care from a medical provider or traditional healer; however, none sought PEP after being bitten. In each case, families reported the patient's fear of risk to the fetus or breastfed child as the primary barrier to receiving PEP. These findings highlight the need for public health messaging about the safety and effectiveness of PEP in preventing rabies among all persons with exposures, including pregnant and breastfeeding women.
[Mh] Termos MeSH primário: Profilaxia Pós-Exposição/utilização
Vacinas Antirrábicas/administração & dosagem
Raiva/mortalidade
Vacinação/psicologia
[Mh] Termos MeSH secundário: Adulto
Animais
Mordeduras e Picadas
Aleitamento Materno/estatística & dados numéricos
Cães
Feminino
Seres Humanos
Gravidez
Gestantes/psicologia
Raiva/prevenção & controle
Vietnã/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Rabies Vaccines)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180302
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6708a4


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[PMID]:29215421
[Au] Autor:Merrigan JL
[Ad] Endereço:Joyce L. Merrigan is a Resolve Through Sharing® National Faculty member, Clinton, New Jersey. The author can be reached via e-mail at joyce.merrigan@yahoo.com.
[Ti] Título:Educating Emergency Department Nurses About Miscarriage.
[So] Source:MCN Am J Matern Child Nurs;43(1):26-31, 2018 Jan/Feb.
[Is] ISSN:1539-0683
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Miscarriage is the unwanted ending of a pregnancy before 20 weeks gestation. Women experiencing miscarriage require specialized care from nurses and other healthcare professionals. Many women are dissatisfied with emergency care related to miscarriage and desire honest communication, validation of urgency, and more robust information at discharge. Perinatal bereavement education offers an opportunity for emergency department nurses to acquire specific knowledge and communication skills that assist with understanding the individualized experience of early pregnancy loss. For many women, a miscarriage is devastating, whereas for some, a part of life. Therefore, assessing the meaning of miscarriage is an essential step to providing sensitive, supportive care. Education was offered to emergency department nurses based on a 4-hour Resolve Through Sharing curriculum. Education focused on knowledge of policy and practice, medical aspects of pregnancy loss, information on how to assess the meaning of the miscarriage, respectful handling and disposition of the remains, and communication strategies to initiate and sustain a meaningful relationship with the woman and her family, within the barriers to care that are exclusive to the emergency department. Participants embraced the information and actively participated in dialogue of an evaluation process to identify needed revisions in current policies and practices for caring for this patient population. Recommendations and guidance for emergency room nurses who care for women experiencing miscarriage are offered.
[Mh] Termos MeSH primário: Aborto Espontâneo/enfermagem
Luto
Enfermagem em Emergência/educação
Gestantes/psicologia
[Mh] Termos MeSH secundário: Serviço Hospitalar de Emergência/organização & administração
Feminino
Pessoal de Saúde/psicologia
Seres Humanos
Gravidez
Revelação da Verdade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/NMC.0000000000000391


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[PMID]:29215420
[Au] Autor:Catlin A
[Ad] Endereço:Anita Catlin is Manager, Research and Redesign, Kaiser Santa Rosa, and Consultant, Ethics Committee, Santa Rosa, CA. The author can be reached via e-mail at acatlin@napanet.net.
[Ti] Título:Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department With Pregnancy Loss.
[So] Source:MCN Am J Matern Child Nurs;43(1):13-18, 2018 Jan/Feb.
[Is] ISSN:1539-0683
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In April 2016, the National Perinatal Association and Kaiser Permanente Northern California Nursing Research Community Benefits Grant sponsored an interdisciplinary summit to explore the needs of women who present with actual or potential pregnancy loss to the emergency department (ED). Thirty-two experts in the field of pregnancy loss, 17 of whom represented their professional organizations, participated. These experts, which included nurses, physicians, social workers, counselors, authors, and parents, worked together to create guidelines for care of women with a pregnancy loss in the ED. Recommendations for ED healthcare providers are included. Emergency department personnel agreed that improvements in care could be offered and were willing to endorse education for their staff. The guidelines delineate how to better provide physical, emotional, and bereavement support at any stage of gestational loss. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.
[Mh] Termos MeSH primário: Aborto Espontâneo/psicologia
Aborto Espontâneo/terapia
Guias como Assunto
Gestantes/psicologia
[Mh] Termos MeSH secundário: Adulto
Serviço Hospitalar de Emergência/organização & administração
Feminino
Pessoal de Saúde/educação
Seres Humanos
Comunicação Interdisciplinar
Gravidez
Inquéritos e Questionários
Texas
Revelação da Verdade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/NMC.0000000000000399


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[PMID]:28449628
[Au] Autor:Matovu JK; Buregyeya E; Arinaitwe J; Wanyenze RK
[Ad] Endereço:1 Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda.
[Ti] Título:'. . . if you bring the kit home, you [can] get time and test together with your partner': Pregnant women and male partners' perceptions regarding female partner-delivered HIV self-testing in Uganda - A qualitative study.
[So] Source:Int J STD AIDS;28(13):1341-1347, 2017 11.
[Is] ISSN:1758-1052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:In 2015, the World Health Organization reported that more than 60 million people were tested for HIV in 122 low- and middle-income countries between 2010 and 2014. Despite this level of progress, over 40% of people living with HIV remain unaware of their HIV status. This calls for innovative approaches to improve uptake of HIV testing services, including use of HIV self-test (HIVST) kits. We conducted a cross-sectional, qualitative study to assess pregnant women and their male partners' perceptions regarding female partner-delivered HIVST kits. This study was conducted at two health facilities in Central Uganda between November and December 2015. Data were collected on pregnant women's willingness to take HIVST kits to their male partners and other household members using eight focus group discussions and 30 in-depth interviews. Data were analyzed following a thematic framework approach. Overall, pregnant women were willing to take HIVST kits to their partners and other household members, with the exception of their cowives. Male partners were willing to use HIVST kits brought by their female partners. Our findings suggest that secondary distribution of HIVST kits through female partners is acceptable and has the potential to improve male partner and household-member HIV testing.
[Mh] Termos MeSH primário: Infecções por HIV/diagnóstico
Programas de Rastreamento/psicologia
Percepção
Gestantes/psicologia
Testes Sorológicos/métodos
Parceiros Sexuais
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
Grupos Focais
Seres Humanos
Masculino
Programas de Rastreamento/métodos
Gravidez
Pesquisa Qualitativa
Uganda
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1177/0956462417705800


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[PMID]:28451700
[Au] Autor:Giallo R; Pilkington P; McDonald E; Gartland D; Woolhouse H; Brown S
[Ad] Endereço:Healthy Mothers Healthy Families Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, 3052, Australia. rebecca.giallo@mcri.edu.au.
[Ti] Título:Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum.
[So] Source:Soc Psychiatry Psychiatr Epidemiol;52(7):815-828, 2017 Jul.
[Is] ISSN:1433-9285
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. METHOD: Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum. RESULTS: Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum. CONCLUSIONS: This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.
[Mh] Termos MeSH primário: Depressão Pós-Parto/epidemiologia
Mães/psicologia
Gestantes/psicologia
[Mh] Termos MeSH secundário: Adulto
Austrália/epidemiologia
Feminino
Seres Humanos
Mães/estatística & dados numéricos
Gravidez
Estudos Prospectivos
Fatores de Risco
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s00127-017-1387-8


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[PMID]:29419580
[Au] Autor:Shieh C; Draucker CB
[Ad] Endereço:Author Affiliations: Associate Professor (Dr Shieh) and Angela Barron McBride Endowed Professor of Mental Health Nursing (Dr Draucker), Department of Community Health Systems, Indiana University School of Nursing, Indianapolis.
[Ti] Título:Self-monitoring Lifestyle Behavior in Overweight and Obese Pregnant Women: Qualitative Findings.
[So] Source:Clin Nurse Spec;32(2):81-89, 2018 Mar/Apr.
[Is] ISSN:1538-9782
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Excessive maternal gestational weight gain increases pregnancy and infant complications. Self-monitoring has been shown to be an effective strategy in weight management. Literature, however, is limited in describing pregnant women's engagement in self-monitoring. AIM: This qualitative study explored the experiences of overweight and obese pregnant women who self-monitored their eating, walking, and weight as participants in an intervention for excessive gestational weight gain prevention. METHODS: Thirteen overweight and obese pregnant women participated in semistructured interviews. Reflexive iteration data analysis was conducted. FINDINGS: Five themes were identified: making self-monitoring a habit, strategies for self-monitoring, barriers to self-monitoring, benefits of self-monitoring, and drawbacks of self-monitoring. The women viewed self-monitoring as a "habit" that could foster a sense of self-control and mindfulness. Visual or tracing aids were used to maintain the self-monitoring habit. Forgetting, defective tracking aids, complexities of food monitoring, and life events could impede self-monitoring. Being unable to keep up with self-monitoring or to achieve goals created stress. CONCLUSIONS: Self-monitoring is a promising approach to weight management for overweight and obese pregnant women. However, healthcare providers should be aware that, although women may identify several benefits to self-monitoring, for some women, consistently trying to track their behaviors is stressful.
[Mh] Termos MeSH primário: Estilo de Vida
Obesidade/prevenção & controle
Sobrepeso/prevenção & controle
Gestantes/psicologia
Autogestão/psicologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Obesidade/psicologia
Sobrepeso/psicologia
Gravidez
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/NUR.0000000000000355


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[PMID]:28743251
[Au] Autor:Chadambuka A; Katirayi L; Muchedzi A; Tumbare E; Musarandega R; Mahomva AI; Woelk G
[Ad] Endereço:Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe. achadambuka1@yahoo.co.uk.
[Ti] Título:Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study.
[So] Source:BMC Public Health;18(1):57, 2017 07 25.
[Is] ISSN:1471-2458
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Zimbabwe's Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known. METHODS: A qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10. RESULTS: Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART. CONCLUSIONS: This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the importance of male partner and community support in satisfactory adherence to ART and enhancing counseling techniques. Strengthening community sensitization and male knowledge is critical to encourage women to disclose their HIV status and ensure successful adherence to ART. Targeting and engaging partners of women will remain key determinants to women's acceptance and adherence on ART under Option B+.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Aleitamento Materno/psicologia
Infecções por HIV/tratamento farmacológico
Aceitação pelo Paciente de Cuidados de Saúde/psicologia
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Complicações Infecciosas na Gravidez/tratamento farmacológico
Gestantes/psicologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Grupos Focais
Infecções por HIV/prevenção & controle
Seres Humanos
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Masculino
Gravidez
Pesquisa Qualitativa
População Rural/estatística & dados numéricos
População Urbana/estatística & dados numéricos
Zimbábue
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180210
[Lr] Data última revisão:
180210
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1186/s12889-017-4611-2


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[PMID]:27773474
[Au] Autor:Dvalishvili M; Mesxishvili D; Butsashvili M; Kamkamidze G; McFarland D; Bednarczyk RA
[Ad] Endereço:Emory University, Atlanta, GA, USA. Electronic address: mdvalis@emory.edu.
[Ti] Título:Knowledge, attitudes, and practices of healthcare providers in the country of Georgia regarding influenza vaccinations for pregnant women.
[So] Source:Vaccine;34(48):5907-5911, 2016 11 21.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To document knowledge, attitudes, and practices of Georgian obstetrician-gynecologists concerning influenza infection and vaccination during pregnancy. METHODS: We conducted a cross-sectional study of obstetrician-gynecologists in 8 cities in the country of Georgian, from June to July, 2015, using an anonymous, self-administered, written survey. Collected data included demographics; knowledge, attitudes, and practices related to influenza vaccination during pregnancy; perceptions of influenza infection in pregnancy; perceived barriers to influenza vaccination during pregnancy; and willingness to receive education about influenza infection and vaccination during pregnancy. RESULTS: A total of 278 obstetrician-gynecologists completed surveys. Most physicians perceived influenza to be a serious infectious disease (88%) and that pregnant women are more susceptible to it than the general population. Only 43% of physicians reported recommending influenza vaccination during pregnancy; 18% reported vaccinating any pregnant patients during the last influenza season. Most (75%) physicians reported a perception that there is insufficient evidence supporting influenza vaccination during pregnancy. Most (93%) were receptive to receiving additional education on maternal vaccination. CONCLUSIONS: Georgian physicians are hesitant to vaccinate pregnant women, but are receptive to education about maternal vaccination. Future educational outreach to Georgian physicians could reduce concerns about maternal vaccination, potentially increasing influenza vaccination among pregnant Georgian women.
[Mh] Termos MeSH primário: Conhecimentos, Atitudes e Prática em Saúde
Pessoal de Saúde/educação
Vacinas contra Influenza/administração & dosagem
Influenza Humana/prevenção & controle
Complicações Infecciosas na Gravidez/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
República da Geórgia
Pessoal de Saúde/psicologia
Seres Humanos
Vacinas contra Influenza/efeitos adversos
Meia-Idade
Obstetrícia
Médicos/psicologia
Padrões de Prática Médica
Gravidez
Gestantes
Inquéritos e Questionários
Vacinação/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28463877
[Au] Autor:Onoya D; Sineke T; Brennan AT; Long L; Fox MP
[Ad] Endereço:aHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa bDepartment of Global Health cDepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
[Ti] Título:Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women.
[So] Source:AIDS;31(11):1593-1602, 2017 Jul 17.
[Is] ISSN:1473-5571
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: We assessed the association between the timing of pregnancy with the risk of postpartum virologic failure and loss from HIV care in South Africa. DESIGN: This is a retrospective cohort study of 6306 HIV-positive women aged 15-49 at antiretroviral therapy (ART) initiation, initiated on ART between January 2004 and December 2013 in Johannesburg, South Africa. METHODS: The incidence of virologic failure (two consecutive viral load measurements of >1000 copies/ml) and loss to follow-up (>3 months late for a visit) during 24 months postpartum were assessed using Cox proportional hazards modelling. RESULTS: The rate of postpartum virologic failure was higher following an incident pregnancy on ART [adjusted hazard ratio 1.8, 95% confidence interval (CI): 1.1-2.7] than among women who initiated ART during pregnancy. This difference was sustained among women with CD4 cell count less than 350 cells/µl at delivery (adjusted hazard ratio 1.8, 95% CI: 1.1-3.0). Predictors of postpartum virologic failure were being viremic, longer time on ART, being 25 or less years old and low CD4 cell count and anaemia at delivery, as well as initiating ART on stavudine-containing or abacavir-containing regimen. There was no difference postpartum loss to follow-up rates between the incident pregnancies group (hazard ratio 0.9, 95% CI: 0.7-1.1) and those who initiated ART in pregnancy. CONCLUSION: The risk of virologic failure remains high among postpartum women, particularly those who conceive on ART. The results highlight the need to provide adequate support for HIV-positive women with fertility intention after ART initiation and to strengthen monitoring and retention efforts for postpartum women to sustain the benefits of ART.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Infecções por HIV/virologia
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Serviços de Saúde Materno-Infantil
Pacientes Desistentes do Tratamento
Complicações Infecciosas na Gravidez/virologia
Gestantes
[Mh] Termos MeSH secundário: Adolescente
Adulto
Terapia Antirretroviral de Alta Atividade
Contagem de Linfócito CD4
Esquema de Medicação
Feminino
Seguimentos
Infecções por HIV/complicações
Infecções por HIV/tratamento farmacológico
Seres Humanos
Adesão à Medicação/estatística & dados numéricos
Meia-Idade
Período Pós-Parto
Gravidez
Complicações Infecciosas na Gravidez/tratamento farmacológico
Resultado da Gravidez
Estudos Retrospectivos
África do Sul
Fatores de Tempo
Carga Viral/efeitos dos fármacos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/QAD.0000000000001517



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