Browsing by Author "Barros, Henrique"
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- Childhood circumstances and mode of deliveryPublication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueObjective To assess the influence of social circumstances at 12 yrs on c-section delivery. Methods Women (n¼6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents’ education was defined as low (#6 years, LPE) and high (HPE). The effect of participants’ financial socioeconomic conditions on csection risk was computed using logistic regression stratified by parents ‘education. Methods Women (n=6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents' education was defined as low (≤6 years, LPE) and high (HPE). The effect of participants' financial socioeconomic conditions on c-section risk was computed using logistic regression stratified by parents ‘education. Results Women with both high financial and educational childhood circumstances were significantly older, more educated and more frequently primiparous, with normal or underweight and reporting private antenatal care. The overall c-section rate was 35.6% varying from 32.2% (LF-LE) to 41.3% (HF-HE). After adjustment and considering women in LF-LPE as reference, we obtained OR=0.92; 95% CI 0.66 to 1.28 for LF-HPE group, OR=1.19; 95% CI 1.04 to 1.37 for HF-LPE group and OR=1.38; 95% CI 1.16 to 1.64) for HF-HPE group. Stratifying by parents' education and compared with women in LF group, those in HF group showed higher risk of c-section either in the LPE group (OR=1.19; 95% CI 1.04 to 1.37) or in the HPE group (OR=1.42; 95% CI 0.99 to 2.02). Conclusions Our results suggest that, independently of the parents' education and the current socio-demographic conditions, the childhood financial environment may influence the mode of delivery.
- Differences on risk of cesarean section after labour induction according different portuguese hospitalsPublication . Teixeira, Cristina; Rodrigues, Teresa; Correia, Sofia; Barros, HenriqueTo assess if the risk of caesarean section (CS) after labour induction (LI) differs between hospitals and which extent this association may explain differences in CS rates. Methods: Participants (6688 Portuguese women) were consecutively recruited in five public hospitals (level III) during the assembling of a birth-cohort. Personal interviews were used to obtain data on socio-demographic characteristics, gynecological history and obstetric events. The risk (computed as odds ratio (OR) and 95% confidence Interval (95%CI)) of CS were considered according to hospital and adjusted for socio-demographic and obstetric characteristics. An interaction term (hospital and LI) was considered in the final model. Results: The proportion of LI by hospital ranged from 15.8% to 53.5% (p<0.001) and the proportion of CS varied between 22.2% and 35.6% (p<0.001). Women with LI presented an higher adjusted rate of CS (OR=1.71; 95%CI:1.48-1.99). There was a statistically significant interaction between hospital and IL on the risk of CS (p=0.002). After stratification by hospital and adjustment to characteristics of mother, the risk of CS for women with LI in comparison with those without LI was higher for three hospitals (OR=3.15; 95%CI:1.98-5.04, OR=1.84; 95% CI:1.38-2.46 and OR=2.04; 95%CI:1.52-2.73) but no such effect was found in the remaining two. Conclusions: Different associations between LI and CS across hospitals probably result from different management of LI. These differences may partially explain discrepancies in CS rates across hospitals.
- Em torno do nascimentoPublication . Barros, Henrique; Rodrigues, Carina; Teixeira, CristinaA cada ano, quando iniciamos a preparação do Relatório de Primavera, confrontamo-nos com dois dilemas. Por um lado, como é conhecido, a maioria dos autores do Relatório são académicos, com forte experiência de investigação. Por isso, o nosso ímpeto inicial é sempre o de fazer um estudo aprofundado, precedido de uma extensa revisão da literatura, para fundamentar uma opinião sobre determinado tema. Estes estudos, no entanto, não cabem no objetivo de um relatório que deve ser realizado em poucos meses, focar os diversos temas relevantes do sistema de saúde e, sobretudo, tomar posição – o que é pouco habitual em cientistas habituados a questionar posicionamentos e ideologias. No entanto, a alternativa seria também para nós contranatura: redigir um panfleto político, baseado nos faits divers recentes, com pouco sustento de análise e muita política à mistura, para apoiar quem apreciamos ou atacar quem não gostamos – isto é, não ser mais do que uma versão escrita de alguns debates na Assembleia da República. O desafio com que nos deparamos a cada ano é encontrar um ponto intermédio entre estes dois mundos onde conseguirmos ser cientistas que opinam com base em análises fundamentadas, e não cientistas que “brincam aos políticos”, nem cientistas que nunca opinam porque “não se querem comprometer”. O nosso segundo dilema está relacionado com o tempo. Qual o espaço temporal sobre o qual devemos debruçar a nossa análise? Podemos optar pelo período mais recente, opinando sobre a capacidade resolutiva dos atuais dirigentes da saúde durante o último ano, ou na atual legislatura. O foco, nesta opção, recairia nos temas mais quentes do momento que talvez mais preocupem os cidadãos e decisores, como o acesso ao médico de família e aos cuidados continuados, a dívida dos hospitais, os tempos de espera, ou a melhor localização geográfica para o Infarmed. Outra opção seria analisar as grandes questões da saúde e dos cuidados de saúde dos portugueses, numa perspetiva longitudinal e, em última instância, observar como os atuais decisores têm lidado com as grandes problemáticas do envelhecimento, dos estilos de vida, ou da articulação entre os setores público e privado na saúde. Mais uma vez, a solução do dilema passa por encontrar um equilíbrio: escrever sobre o que acontece hoje, mas sem nunca esquecer a perspetiva a longo prazo, de onde viemos e para onde pretendemos ir, sabendo que a perspetiva longa diz respeito à saúde e bem-estar da população, que depende de muitos aspetos além do desempenho do Serviço Nacional de Saúde (SNS). Este Relatório reflete estes dilemas, por vezes mais opinativos, por vezes mais analíticos, por vezes falando do presente, e outras focando o que seria importante pensar para preparar o futuro.
- Equitable migrant-friendly perinatal healthcare access and quality in public maternity units in PortugalPublication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, HenriqueMigrant women are at higher risk to face access barriers to perinatal care services and to experience worse pregnancy outcomes compared to native. Assessing the perception of migrant women and health providers discloses a multifaceted view on migrant-friendly care, a multidimensional concept in itself. This study aims to compare self-perceived assessments of migrant women and directors of obstetrics and gynaecology (GYN/OBS) departments on equitable migrant-friendly perinatal healthcare quality and access during the intrapartum and postpartum period at public maternities in Portugal. Methods: In this cross-sectional study, two indicators on Healthcare access and Quality of care were developed to compare how adult migrant women who gave birth between April 2017 and March 2019 and GYN/OBS department directors assessed offered care. The one-sample Wilcoxon test was used to compare directors' with migrants' assessments and the Kruskal-Wallis one-way analysis of variance to test for country regional differences. A stratified analysis by sex, spoken language, and country of birth tested for potential effect modifiers. Results: Migrants rated Healthcare access significantly better (P<0.05), but perceived Quality of care worse (P<0.01) than GYN/OBS department directors. Migrants' and directors' perceptions differed significantly according to directors' gender (P<0.05). Migrants' and directors' assessments on Healthcare access (P<0.05) and Quality (P<0.01) changed significantly across regions. Conclusions: Migrants' and directors' self-perceived appraisal of Healthcare access and Quality of care significantly varied. Identifying these discordances allows to deliver insights into existing barriers in access and provision of care and raises awareness to improve quality assurance, essential to inform practice and policies.
- Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment toolPublication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, HenriqueMigration is seen as a common risk factor in obstetricmanagement. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019. This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units’ directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The OneSample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences. Significant differences between migrant woman and healthcare directors’ assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value <0.001) and healthcare quality (p-value < 0.05).
- Estimating child mortality from information on previous birth: data from a Portuguese birth cohortPublication . Paes, Neir; Teixeira, Cristina; Barros, HenriqueA whole range of techniques have been developed for estimating infant and child mortality from the information routinely recorded in maternity registers on age and reproductive history of delivering mothers. Among them, the best-known and most widely applied indirect technique was developed by William Brass. Using the baseline nformation from a birth cohort (Generation XXI assembled in the period 2005-2006 in the metropolitan area of Porto, North of Portugal, we addressed in this paper the following objectives: (1) to estimate the child mortality rates based on information about previous births and their survivorship among women recruited for this birth cohort; (2) to compare these indirect estimates with direct values retrieved from Portuguese vital statistics; (3) to analyse the potential of this birth cohort to generate plausible estimates of lifetable indicators. We retrieved data on mother’s age, previous live births prior to the current one, and number of surviving and deceased children from a group of multiparous women (n=3521). The data was divided into seven 5-year groups by maternal age and survival and death probabilities were computed for each group. Through the Brass method,we obtained estimates of probability of dying before attaining certain exact childhood ages, q(x), by using the multipliers k(i) as proposed by Palloni-Heligman. Then, a logit life-table system was used to derive lifetable indicators. Accordingly, probabilities of dying between birth and 2,3, 5 and 10 years were respectively: 4.0; 5.7; 7.3 and 9.6 per 1,000 children ever born, which were alocatted in time-period. These indirect estimates compared with the direct ones obtained from Portuguese vital statistics revealed that they were very similar. The life expectancy at birth was 77.6 years for both sexes, and the implied infant mortality was 4.0 per 1000 live births for Grand Porto during the period 2005-2006. The use of indirect method to analyze the potential of the Generation XXI cohort data in provide relevant information on reproductive issues, not available in the vital statistics, seems to be an important and effective tool, and promissory for analyzing the follow-up studies of this cohort held in 2009 and 2012.
- Estimating child mortality from information on previous birth: data from a Portuguese birth cohortPublication . Paes, Neir; Teixeira, Cristina; Barros, HenriqueA whole range of techniques have been developed for estimating infant and child mortality from the information routinely recorded in maternity registers on age and reproductive history of delivering mothers. Among them, the best-known and most widely applied indirect technique was developed by William Brass. Using the baseline information from a birth cohort (Generation XXI) assembled in the period 2005-2006 in the metropolitan area of Porto, North of Portugal, we addressed in this paper the following objectives: (1) to estimate the child mortality rates based on information about previous births and their survivorship among women recruited for this birth cohort; (2) tocompare these indirect estimates with direct values retrieved from Portuguese vital statistics; (3) to analyse the potential of this birth cohort to generate plausible estimates of life-table indicators. We retrieved data on mother’s age, previous live births prior to the current one, and number of surviving and deceased children from a group of multiparous women (n=3521). The data was divided into seven 5-year groups by maternal age and survival and death probabilities were computed for each group. Through the Brass method, we obtained estimates of probability of dying before attaining certain exact childhood ages, q(x), by using the multipliers k(i) as proposed by Trussel. Then, a logit life-table system was used to derive life-table indicators. Accordingly, probabilities of dying between birth and 2, 3, 5 and 10 years were respectively: 4.1; 6.7; 9.4 and 13.1 per 1,000 children ever born, which were alocatted in time-period. These indirect estimates compared with the direct ones obtained from Portuguese vital statistics revealed that they were very similar. The life expectancy at birth was 77.6 years for both sexes, and the implied infant mortality was 4.0 per 1000 live births for Grand Porto during the period 2005-2006. The use of indirect method to analyze the potential of the Generation XXI cohort data in provide relevant information on reproductive issues, not available in the vital statistics, seems to be an important and effective tool, and promissory for analyzing the follow-up studies of this cohort held in 2009 and 2012.
- Geographic origin and risk of cesarean section in PortugalPublication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueTo assess the influence of pregnant’s country of birth on the risk of cesarean-section (CS) in singleton deliveries in Portugal. Methods Participants (7435 women) were consecutively recruited during the procedure of assembling a birth-cohort. Clinical records were used for data on delivery and personal interviews were used to obtain a large set of data on social and demographic characteristics, gynecological history and current pregnancy events. Participants were classified according origin country as PT (Portuguese-born, 90%), ENA (from other European and North-American countries, 3.3%), AF (from African countries, 3.7%) and SA (from South-American countries, 3.0%) The risk of CS according the country of birth and adjusted for socio-demographic and obstetric characteristics was computed using logistic regression. Results When compared with PT, AF women were older (35.2 vs. 17.4, p<0.001), more frequently multiparous (61.9% vs. 51.3%, p<0.001) and showing higher prevalence of maternal pathology (61.9% vs. 51.3%, p<0.001). Both, ENA and AF used more frequently private antenatal care (52.5% vs. 36.8%, p<0.001 and 51.8 vs. 36.8, p<0.001, respectively) than PT women. All groups of foreign-born showed a higher proportion of more educated women than Portuguese-born. Compared with PT, SA had higher risk of CS (OR=1.63; 95%CI: 1.24-2.12), followed by the AF women (OR=1.26; 95%CI: 0.99-1.61). Higher risk remains among SA women after adjustment for socio-demographic and obstetric characteristics (OR=1.75; 95%CI: 1.29-2.39). Among foreign-born, when compared with ENA, SA women reveal higher risk, after adjustment for duration of stay (OR=1.93; 95%CI: 1.14 – 3.26). Conclusions After adjustment for known risk factors, the risk of CS was higher for SA women when compared with PT and ENA women. Our results suggest that origin country plays an important role on CS deliveries independently the duration of stay in Portugal.
- Marketing of breastmilk substitutes and early breastfeeding practices among native and migrant womenPublication . Lisi, Cosima; Teixeira, Cristina; Al Hamwi, Sousan; Rodrigues, Carina; Lopes, Sofia; Barros, HenriqueThere is a large body of evidence regarding the benefits of breastfeeding for mothers and their children. However, the influence of marketing of breastmilk substitutes on breastfeeding practices remains a big concern. The aim of this study is to examine the association between exposure to different breastmilk substitutes market factors and never breastfeeding or dropping exclusive breastfeeding within 1 month postpartum, comparing migrant with native women. Methods: This study is part of the project baMBINO, an ongoing research on perinatal health among migrant and native women in Portugal. Women with a live-birth and aged ≥ 18 years were recruited in 32 Portuguese public hospitals during admission for delivery. Data on breastfeeding practices and exposure to market factors were collected by telephone interviews at 1-3 months postpartum. According to their feeding practices within 1 month after delivery, women were classified into two categories: those who have never breastfed or have dropped exclusive breastfeeding, and those who have maintained exclusive breastfeeding. Five market factors were assessed: free samples, discounts, television, newspaper/magazine, and shop/ pharmacy advertisement. Logistic regression models were used to study the association between each market factor and early breastfeeding practices, adjusting for maternal age, education, parity, mode of delivery, and skin-to-skin contact in the first hour after birth. All analyses were stratified by women’s country of birth (native vs. migrant). Adjusted odds-ratio (aOR) and a respective 95% confidence interval (95%CI) were obtained. Results: Out of 539 natives and an equal number of migrant women, 43.4% and 36.7%, respectively, have either never breastfed or dropped exclusive breastfeeding within 1 month postpartum. After adjustment, natives exposed to free samples were more likely to never breastfeed or drop exclusive breastfeeding within 1 month after delivery (aOR = 1.90, 95%CI: 1.06-3.42), while those exposed to shop/pharmacy advertisement were less likely to (aOR = 0.62, 95%CI 0.43-0.89). Conversely, migrants exposed to newspaper/magazine advertisement were less likely to never breastfeed or drop exclusive breastfeeding within 1 month postpartum (aOR = 0.54, 95%CI 0.31-0.95). Conclusions/Recommendations: Our results revealed differences in the effect of market factors on breastfeeding practices between native and migrant women, which might be explained by cultural factors. Future research should investigate the mechanisms underlying the direction of association between specific market factors and early breastfeeding practices.
- Marketing of breastmilk substitutes and early breastfeeding practices among native and migrant womenPublication . Lisi, Cosima; Teixeira, Cristina; Al Hamwi, Sousan; Rodrigues, Carina; Lopes, Sofia; Barros, HenriqueThere is a large body of evidence regarding the benefits of breastfeeding for mothers and their children. However, the influence of marketing of breastmilk substitutes on breastfeeding practices remains a big concern. The aim of this study is to examine the association between exposure to different breastmilk substitutes market factors and never breastfeeding or dropping exclusive breastfeeding within 1 month postpartum, comparing migrant with native women. Methods: This study is part of the project baMBINO, an ongoing research on perinatal health among migrant and native women in Portugal. Women with a live-birth and aged ≥ 18 years were recruited in 32 Portuguese public hospitals during admission for delivery. Data on breastfeeding practices and exposure to market factors were collected by telephone interviews at 1-3 months postpartum. According to their feeding practices within 1 month after delivery, women were classified into two categories: those who have never breastfed or have dropped exclusive breastfeeding, and those who have maintained exclusive breastfeeding. Five market factors were assessed: free samples, discounts, television, newspaper/magazine, and shop/ pharmacy advertisement. Logistic regression models were used to study the association between each market factor and early breastfeeding practices, adjusting for maternal age, education, parity, mode of delivery, and skin-to-skin contact in the first hour after birth. All analyses were stratified by women’s country of birth (native vs. migrant). Adjusted odds-ratio (aOR) and a respective 95% confidence interval (95%CI) were obtained. Results: Out of 539 natives and an equal number of migrant women, 43.4% and 36.7%, respectively, have either never breastfed or dropped exclusive breastfeeding within 1 month postpartum. After adjustment, natives exposed to free samples were more likely to never breastfeed or drop exclusive breastfeeding within 1 month after delivery (aOR = 1.90, 95%CI: 1.06-3.42), while those exposed to shop/pharmacy advertisement were less likely to (aOR = 0.62, 95%CI 0.43-0.89). Conversely, migrants exposed to newspaper/magazine advertisement were less likely to never breastfeed or drop exclusive breastfeeding within 1 month postpartum (aOR = 0.54, 95%CI 0.31-0.95). Conclusions/Recommendations: Our results revealed differences in the effect of market factors on breastfeeding practices between native and migrant women, which might be explained by cultural factors. Future research should investigate the mechanisms underlying the direction of association between specific market factors and early breastfeeding practices.
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