Browsing by Author "Severo, Milton"
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- Obstetric interventions among native and migrant women: the (over)use of episiotomy in PortugalPublication . Lorthe, Elsa; Severo, Milton; Hamwi, Sousan; Rodrigues, Teresa; Teixeira, Cristina; Barros, HenriqueEpisiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association.Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy.Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics.Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
- Socioeconomic position early in adolescence and mode of delivery later in life: findings from a portuguese birth cohortPublication . Teixeira, Cristina; Silva, Susana; Severo, Milton; Barros, HenriqueObjective: This study assessed the influence of socioeconomic position at 12 years of age (SEP-12) on the variability in cesarean rates later in life. Methods: As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005–September/2006). Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women’s SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR) and respective 95% confidence interval (95% CI). Results: The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p=0.100) among primiparous women; 14.2%, 11.6% and 15.5% (p=0.04) among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p=0.08) among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR=1.12;95%CI:1.01-1.24 comparing high with low SEP-12 and RR=1.03:95%CI:0.94-1.14 comparing intermediate with low SEP-12) not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean. Conclusions: The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth.
- Testing an adaptation of the EPIC physical activity questionnaire in Portuguese adults: a validation study that assesses the seasonal bias of self-reportPublication . Camões, Miguel; Severo, Milton; Santos, Ana; Barros, Henrique; Lopes, CarlaBackground: No self-report method to measure different types and intensities of physical activity (PA) in adults has been tested in the Portuguese population. We assessed the validity, reproducibility and seasonal bias on past-year PA reporting. Subjects and methods: A sample of 953 Portuguese adults was evaluated between 2001 and 2003. A 4x7-day PA diary was used as a reference method to evaluate the validity of the EPIC questionnaire adapted for the Portuguese population (n = 114). Spearman’s correlation coefficients were calculated and agreement was tested using Bland–Altman plots. Trigonometric linear models were used to assess the seasonal variation. Results: Correlations between the questionnaire and the diaries were 0.56, 0.50, 0.88 and 0.78 for total, rest, occupational and leisure-time PA, respectively. The coefficients for reproducibility (2–3 months interval) ranged between 0.80 for leisure and 0.91 for occupational. Visualizing Bland–Altman plots, only rest PA revealed a tendency towards an increase in differences with increasing rest reported. Males interviewed in April and August reported the highest and lowest mean of leisure-time PA, respectively. For professional activities, the probability of amplitude being over one-half standard deviation was 33%. Conclusions: The questionnaire is a valid and reproducible instrument for the brief assessment of usual energy expenditure in adults, detailing different types of PA. In males, seasonal bias on reporting leisure-time and professional PA was found.