- Email: [email protected]
local health professionals’ collaborations for community health promotion and mortality among older adults in Japan: JAGES community intervention study
S368
European Congress of Epidemiology / Revue d’Épidémiologie et de Santé Publique 66S (2018) S277–S437
households were recruited for the study. Data was collected using a pre-tested questionnaire through door-to-door visits and face-to-face interviews. Interviewers assessed immunization status of selected children based on immunization cards or parent’s recall. Multilevel logistic regression analysis was performed to assess factors associated with incomplete immunization coverage. Results A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3% (95% confidence interval, 95% CI: [69.7–74.8%]) and 90.7% of the children were vaccinated against tuberculosis. Main barriers to children’s full immunization reported by parents or guardians were: long distance to the health center (32.2%), poor road conditions (13.3%), lack of means of transport (10.5%) and lack of time (9.0%). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33%, adjusted odds ratio (aOR) = 0.67, CI [0.47–0.94] less likely to have an incomplete immunization coverage compared to those with no education level. The likehood of incomplete immunization in children decreased with the increase household’s income (aOR = 0.73, 95% CI [0.58–0.93]). In addition, children who did not have an immunization card (aOR = 13.41, 95% CI [9.19–19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00–3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk a half hour and one hour to the health center were 57% more likely to have an incomplete immunization coverage (aOR = 1.57, 95% CI [1.15–2.13]) than those whose parents had to walk less than half an hour. Conclusion This study confirms that the goal of 90% coverage at the national level has not been achieved in 2017 and the factors associated with incomplete coverage of immunization were identified. Innovative strategies such as using electronic cards and the strengthening of sensitization must be initiated for a complete immunization coverage in Togo. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.355 P7-36
Individual and neighbourhood socioeconomic disparities and high blood pressure in France: Results from a cross-sectional analysis of the CONSTANCES cohort L. Neufcourt a,∗ , S. Bayat a , F. Paillard b , M. Goldberg c,d,e , M. Zins c,d,e , O. Grimaud a a Quantitative Methods in Public Health, French School of Public Health (EHESP), Rennes, France b Cardiovascular Prevention Center, University Hospital (CHU) of Rennes, Rennes, France c Paris-Descartes University, Paris-Descartes University, Paris, France d UMS 011, Cohortes épidémiologiques en population, Inserm, Villejuif, France e Paul-Brousse Hospital, Villejuif, France ∗ Corresponding author. E-mail address: [email protected] (L. Neufcourt) Introduction The influence of socioeconomic status (SES) on cardiovascular outcomes has already been well-established. Lower income, lower education or manual occupation are associated with a higher prevalence of cardiovascular risk factors such as high blood pressure (HBP) as well as with cardiovascular mortality. Neighborhood factors, such as the affluence of the area of residence have also been associated with cardiovascular diseases. However, few studies have been able to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP. We aimed to do so using a large sample of French adults. Methods Participants are randomly selected adults aged 18 to 69 recruited to the CONSTANCES cohort between 2012 and 2015. Information on lifestyle was collected by a self-administered questionnaire. Blood pressure (BP) was measured in 16 recruitment centers using a standardized protocol. HBP has been
defined as BP over 140/90 mmHg and/or taking antihypertensive medication as indicated by matched records from the national database or reimbursements from the French health insurance. SES has been defined at an individual-level using education and at a neighborhood-level through an indicator of socioeconomic deprivation of the area of residence (FDep), divided in quintiles in this study. Analyses were stratified by gender. We first calculated prevalence of HBP according to individual and neighborhood variables separately. We then performed three-level logistic regressions (recruitment center, neighborhood, individual) to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP, taking into account the specific structure of the data. Results A total of 63,627 individuals (53% women) recruited between 2012 and 2015 were included in the analyses. Mean age in men and women was 48.8 ± 13.3 years and 47.2 ± 13.5 years, respectively. In this sample, 19,383 individuals were classified hypertensive, so the crude prevalence of HBP was 30.5%. Using 2016 French population as reference, standardized prevalence of HBP was 27.5% [95% CI: 27.1–27.8], higher among men (33.8% [95% CI: 33.2–34.5%]) than women (21.3% [95% CI: 20.8–21.8%]). Prevalence increased with age, from 9.5% in 18–34 years to 63.5% in people aged 65 years and more. Prevalence of HBP strongly differed according to the education level in all age groups in both gender. For instance in women with no diploma, prevalence of HBP increased from 10% among 18–34 years to 65% among 65–70 years compared with 4% to 46% in women with highest diploma. The corresponding age-adjusted odds ratios (OR) for prevalence of HBP comparing the lowest versus highest level of education were 2.22 [95% CI: 2.00–2.50] in women and 1.82 [95% CI: 1.67–2.00] in men. Regarding neighborhood, living in more deprived areas was associated with a higher prevalence of HBP in women and men. Ageadjusted ORs for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.61 [95% CI: 1.47–1.75] in women and 1.69 [95% CI: 1.56–1.85] in men. In models including both individual and neighborhood indicators, OR comparing the lowest versus highest level of education were 2.09 [95% CI: 1.87–2.34] in women and 1.70 [95% CI: 1.53–1.88] in men. OR for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.25 [95% CI: 1.11–1.41] in women and 1.15 [95% CI: 1.03–1.30] in men. Conclusions In this cross-sectional analysis of a large sample of adults, we found marked socioeconomic gradients of HBP in all age groups and among both men and women. Individual and contextual indicators of SES were independently associated with the prevalence of HBP. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.356 P7-38
Researcher/local health professionals’ collaborations for community health promotion and mortality among older adults in Japan: JAGES community intervention study M. Haseda a,∗ , N. Kondo a,b , D. Takagi b , K. Kondo c,d a Health Education and Health Sociology, Tokyo, Japan b Health and Social Behavior, The University of Tokyo, Tokyo, Japan c Center for Preventive Medical Sciences, Chiba University, Chiba, Japan d Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan ∗ Corresponding author. E-mail address: [email protected] (M. Haseda) Introduction Health promoting interventions for long-term care prevention among older adults should target community social environment. However, in local government, many health sector staffs face challenges in essential activities including community diagnosis (risk and resource assessments) and intersectoral partnerships. Supporting municipality staffs for those actions, under the close researcher/municipality collaborations, may benefit them. However, the effectiveness of such support/collaborations has remained unclear. We evaluated that in terms of older residents’ community social participation and mortality risks.
European Congress of Epidemiology / Revue d’Épidémiologie et de Santé Publique 66S (2018) S277–S437 Methods In 2014, the half of the municipalities participating in the Japan Gerontological Evaluation Study (JAGES) received active supports from JAGES researchers for utilizing community diagnosis data and intersectoral collaborations with various organizations potentially contributing to health promotion for older adults. Participants were functionally independent community-dwelling older adults aged 65 years or more. First, we analyzed 107,292 older people in 25 municipalities participated in both 2013 and 2016 survey. Among them, 13 municipalities received active supports and community diagnosis data based on JAGES surveys (intervention) and remaining 12 municipalities obtained community diagnosis data only (control). We performed difference-in-difference (DID) analysis using multilevel Poisson regression to compare the changes in the prevalence of social participation among the older residents of the intervention and control group municipalities. Second, using the follow-up data (maximum 1267 days), we performed survival analyses applying Fine & Gray’s proportional hazard model for assessing the relative risk for death, considering competing risks of moving out. In both analyses, to control selection bias we calculated propensity of receiving active supports from demographic data and performed inverse probability of treatment weighting (IPTW) analysis. We stratified all analyses by gender and adjusted for age, education, income, living alone or not, marital status, comorbidity, depressive symptoms, Instrumental Activities of Daily Livings (IADL), and considered the clusters of residential areas in 2013. Results In total, 4591 people have died for 235,534 person-year observation period. Among men, the estimated local activity participation was 46.6% (95% confidence interval [CI]: 45.5%, 47.7%) in 2013 and 57.1% (95% CI: 56.0%, 58.1%) in 2016, among residents in intervention group. In contrast, the participations were 46.4% (95% CI: 45.4%, 47.5%) in 2013 and 54.6% (95% CI: 53.0%, 55.3%) in 2016, among residents in the control municipalities (DID = 0.028, P = 0.006). Among women, there was no significant difference between the two groups (P = 0.131). The adjusted hazard ratio for death among those who lived in the supported municipality was 0.90 (95% CI: 0.84, 0.96) in men and 0.99 (95% CI: 0.90, 1.09) in women, compared to the control group. Conclusion Supporting health sector staffs in municipalities were associated with improved health risks among men. Better partnerships with various organizations, based on strategic risk and resource assessments, might lead to enrich community environment that provides more opportunities for social participation for older men. Building similar collaborating framework may be beneficial for advancing health promotion in local settings. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.358 P7-39
Clinical practice and differential results in maternal and neonatal morbidity in pregnant women who are candidates for a normal birth A. Casteleiro a , M. Santiba˜nez b , P. Parás-Bravo b , A. Pellico López b , F. Amo Setién b , M. Paz-Zulueta b,∗ a Hospital Universitario Marqués de Valdecilla, Servicio Cantabro de Salud, Cantabria, Spain b Department of Nursing, University of Cantabria, Cantabria, Spain ∗ Corresponding author. E-mail address: [email protected] (M. Paz-Zulueta) Background In order to reduce maternal and neonatal morbidity at the time of childbirth, international organisms such as the World Health Organization and the National Institute for Health and Care Excellence, recommend that more humane care must be provided for childbirth, respecting its physiology and promoting the empowerment of pregnant women. Objective To determine the percentage of pregnant women who would potentially be candidates for normal childbirth in a region of northern Spain. To compare between the group of “pregnant women candidate for a normal birth” and non-candidate pregnant women, the main indicators of clinical practice and maternal and neonatal morbidity. Methodology Cross-sectional study. The study population was the total number of hospital deliveries attended at Hospital Universitario Marqués de Valdecilla from January 1, 2014 to December 31, 2014 (n = 3315). A “pregnant
S369
candidate for a normal birth” was defined as a pregnant woman with hospital delivery, without serious pathology (maternal, amniotic fluid or fetal), controlled gestation, simple fetus, spontaneous, term and neonatal state “newborn live” according to the National Clinical Practice Guide for Normal Delivery Care and international guidelines, being candidates for the implementation of the strategy of normal delivery care. Information was retrospectively obtained from secondary registers. Comparisons between groups were performed by using the Chi2 or Student t-tests for categorical and quantitative variables respectively. Results Among the deliveries, 1863 (56.20%) math the definition of “pregnant candidate for a normal birth”. In 50.86% of these candidate deliveries, a pregnancy episiotomy was performed against 60.96% in the non-candidate group (P < 0.001). Caesarean sections were performed at 19.32% of candidate deliveries, compared to 26.79% of non-candidate deliveries (P < 0.001). We also found statistically significant differences between groups depending on the type of delivery, need for delivery instrumentation, existence of perineal tears, Apgar test score, and the need for admission to ICU of the newborn. Conclusions Our results suggest a differential clinical practice according to the recommendations of the Clinical Practice Guide for Attention to Normal Childbirth. However, the percentages of episiotomies and caesarean sections remain high compared to standards and the results of other studies. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.359 P7-40
Health inequalities in vaccination: A challenge for measles elimination (the case of outbreak in Ecuador, 2011–2012) M. Rivadeneira a,∗ , S. Bassanesi b , S. Fuchs c Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador b Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil c Programa de Pós-gradua¸ cão em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ∗ Corresponding author. E-mail address: [email protected] (M. Rivadeneira) a
Introduction/background Low immunization coverage in specific population groups, together with high viral infectivity, has aggravated the measles outbreaks happening in the past decade. Ecuador, a country in northwestern South America, introduced routine measles vaccination more than three decades ago. As a result, the last cases of autochthonous measles happened in that country around 1996. However, a new measles outbreak occurred in 2011–12. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador in 2011 and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador, in whom at least one dose of measles-containing vaccine received was inquired. Variables included were: previous measles immunization, Unsatisfied basic needs (UBNI) of urban cantons, percentage of the 15–17 year-old population in the canton attending school, percentage of the population self-identifying as indigenous or African-Ecuadorian in the canton, and employment rate. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. Spatial autocorrelation was detected and conditional autoregressive analysis was performed for adjustment of variables. Principal components analysis was used to create a socioeconomic score. The slope index and relative index of inequality were calculated. Results Measles immunization coverage ranged from 54.1% to 98.5% in the cantons of Ecuador. Measles immunization coverage was inversely associated with unsatisfied basic needs (P = 0.0007) in urban areas and proportion of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. In cantons in the lower socioeconomic stratum, the rate of
European Congress of Epidemiology / Revue d’Épidémiologie et de Santé Publique 66S (2018) S277–S437
households were recruited for the study. Data was collected using a pre-tested questionnaire through door-to-door visits and face-to-face interviews. Interviewers assessed immunization status of selected children based on immunization cards or parent’s recall. Multilevel logistic regression analysis was performed to assess factors associated with incomplete immunization coverage. Results A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3% (95% confidence interval, 95% CI: [69.7–74.8%]) and 90.7% of the children were vaccinated against tuberculosis. Main barriers to children’s full immunization reported by parents or guardians were: long distance to the health center (32.2%), poor road conditions (13.3%), lack of means of transport (10.5%) and lack of time (9.0%). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33%, adjusted odds ratio (aOR) = 0.67, CI [0.47–0.94] less likely to have an incomplete immunization coverage compared to those with no education level. The likehood of incomplete immunization in children decreased with the increase household’s income (aOR = 0.73, 95% CI [0.58–0.93]). In addition, children who did not have an immunization card (aOR = 13.41, 95% CI [9.19–19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00–3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk a half hour and one hour to the health center were 57% more likely to have an incomplete immunization coverage (aOR = 1.57, 95% CI [1.15–2.13]) than those whose parents had to walk less than half an hour. Conclusion This study confirms that the goal of 90% coverage at the national level has not been achieved in 2017 and the factors associated with incomplete coverage of immunization were identified. Innovative strategies such as using electronic cards and the strengthening of sensitization must be initiated for a complete immunization coverage in Togo. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.355 P7-36
Individual and neighbourhood socioeconomic disparities and high blood pressure in France: Results from a cross-sectional analysis of the CONSTANCES cohort L. Neufcourt a,∗ , S. Bayat a , F. Paillard b , M. Goldberg c,d,e , M. Zins c,d,e , O. Grimaud a a Quantitative Methods in Public Health, French School of Public Health (EHESP), Rennes, France b Cardiovascular Prevention Center, University Hospital (CHU) of Rennes, Rennes, France c Paris-Descartes University, Paris-Descartes University, Paris, France d UMS 011, Cohortes épidémiologiques en population, Inserm, Villejuif, France e Paul-Brousse Hospital, Villejuif, France ∗ Corresponding author. E-mail address: [email protected] (L. Neufcourt) Introduction The influence of socioeconomic status (SES) on cardiovascular outcomes has already been well-established. Lower income, lower education or manual occupation are associated with a higher prevalence of cardiovascular risk factors such as high blood pressure (HBP) as well as with cardiovascular mortality. Neighborhood factors, such as the affluence of the area of residence have also been associated with cardiovascular diseases. However, few studies have been able to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP. We aimed to do so using a large sample of French adults. Methods Participants are randomly selected adults aged 18 to 69 recruited to the CONSTANCES cohort between 2012 and 2015. Information on lifestyle was collected by a self-administered questionnaire. Blood pressure (BP) was measured in 16 recruitment centers using a standardized protocol. HBP has been
defined as BP over 140/90 mmHg and/or taking antihypertensive medication as indicated by matched records from the national database or reimbursements from the French health insurance. SES has been defined at an individual-level using education and at a neighborhood-level through an indicator of socioeconomic deprivation of the area of residence (FDep), divided in quintiles in this study. Analyses were stratified by gender. We first calculated prevalence of HBP according to individual and neighborhood variables separately. We then performed three-level logistic regressions (recruitment center, neighborhood, individual) to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP, taking into account the specific structure of the data. Results A total of 63,627 individuals (53% women) recruited between 2012 and 2015 were included in the analyses. Mean age in men and women was 48.8 ± 13.3 years and 47.2 ± 13.5 years, respectively. In this sample, 19,383 individuals were classified hypertensive, so the crude prevalence of HBP was 30.5%. Using 2016 French population as reference, standardized prevalence of HBP was 27.5% [95% CI: 27.1–27.8], higher among men (33.8% [95% CI: 33.2–34.5%]) than women (21.3% [95% CI: 20.8–21.8%]). Prevalence increased with age, from 9.5% in 18–34 years to 63.5% in people aged 65 years and more. Prevalence of HBP strongly differed according to the education level in all age groups in both gender. For instance in women with no diploma, prevalence of HBP increased from 10% among 18–34 years to 65% among 65–70 years compared with 4% to 46% in women with highest diploma. The corresponding age-adjusted odds ratios (OR) for prevalence of HBP comparing the lowest versus highest level of education were 2.22 [95% CI: 2.00–2.50] in women and 1.82 [95% CI: 1.67–2.00] in men. Regarding neighborhood, living in more deprived areas was associated with a higher prevalence of HBP in women and men. Ageadjusted ORs for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.61 [95% CI: 1.47–1.75] in women and 1.69 [95% CI: 1.56–1.85] in men. In models including both individual and neighborhood indicators, OR comparing the lowest versus highest level of education were 2.09 [95% CI: 1.87–2.34] in women and 1.70 [95% CI: 1.53–1.88] in men. OR for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.25 [95% CI: 1.11–1.41] in women and 1.15 [95% CI: 1.03–1.30] in men. Conclusions In this cross-sectional analysis of a large sample of adults, we found marked socioeconomic gradients of HBP in all age groups and among both men and women. Individual and contextual indicators of SES were independently associated with the prevalence of HBP. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.356 P7-38
Researcher/local health professionals’ collaborations for community health promotion and mortality among older adults in Japan: JAGES community intervention study M. Haseda a,∗ , N. Kondo a,b , D. Takagi b , K. Kondo c,d a Health Education and Health Sociology, Tokyo, Japan b Health and Social Behavior, The University of Tokyo, Tokyo, Japan c Center for Preventive Medical Sciences, Chiba University, Chiba, Japan d Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan ∗ Corresponding author. E-mail address: [email protected] (M. Haseda) Introduction Health promoting interventions for long-term care prevention among older adults should target community social environment. However, in local government, many health sector staffs face challenges in essential activities including community diagnosis (risk and resource assessments) and intersectoral partnerships. Supporting municipality staffs for those actions, under the close researcher/municipality collaborations, may benefit them. However, the effectiveness of such support/collaborations has remained unclear. We evaluated that in terms of older residents’ community social participation and mortality risks.
European Congress of Epidemiology / Revue d’Épidémiologie et de Santé Publique 66S (2018) S277–S437 Methods In 2014, the half of the municipalities participating in the Japan Gerontological Evaluation Study (JAGES) received active supports from JAGES researchers for utilizing community diagnosis data and intersectoral collaborations with various organizations potentially contributing to health promotion for older adults. Participants were functionally independent community-dwelling older adults aged 65 years or more. First, we analyzed 107,292 older people in 25 municipalities participated in both 2013 and 2016 survey. Among them, 13 municipalities received active supports and community diagnosis data based on JAGES surveys (intervention) and remaining 12 municipalities obtained community diagnosis data only (control). We performed difference-in-difference (DID) analysis using multilevel Poisson regression to compare the changes in the prevalence of social participation among the older residents of the intervention and control group municipalities. Second, using the follow-up data (maximum 1267 days), we performed survival analyses applying Fine & Gray’s proportional hazard model for assessing the relative risk for death, considering competing risks of moving out. In both analyses, to control selection bias we calculated propensity of receiving active supports from demographic data and performed inverse probability of treatment weighting (IPTW) analysis. We stratified all analyses by gender and adjusted for age, education, income, living alone or not, marital status, comorbidity, depressive symptoms, Instrumental Activities of Daily Livings (IADL), and considered the clusters of residential areas in 2013. Results In total, 4591 people have died for 235,534 person-year observation period. Among men, the estimated local activity participation was 46.6% (95% confidence interval [CI]: 45.5%, 47.7%) in 2013 and 57.1% (95% CI: 56.0%, 58.1%) in 2016, among residents in intervention group. In contrast, the participations were 46.4% (95% CI: 45.4%, 47.5%) in 2013 and 54.6% (95% CI: 53.0%, 55.3%) in 2016, among residents in the control municipalities (DID = 0.028, P = 0.006). Among women, there was no significant difference between the two groups (P = 0.131). The adjusted hazard ratio for death among those who lived in the supported municipality was 0.90 (95% CI: 0.84, 0.96) in men and 0.99 (95% CI: 0.90, 1.09) in women, compared to the control group. Conclusion Supporting health sector staffs in municipalities were associated with improved health risks among men. Better partnerships with various organizations, based on strategic risk and resource assessments, might lead to enrich community environment that provides more opportunities for social participation for older men. Building similar collaborating framework may be beneficial for advancing health promotion in local settings. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.358 P7-39
Clinical practice and differential results in maternal and neonatal morbidity in pregnant women who are candidates for a normal birth A. Casteleiro a , M. Santiba˜nez b , P. Parás-Bravo b , A. Pellico López b , F. Amo Setién b , M. Paz-Zulueta b,∗ a Hospital Universitario Marqués de Valdecilla, Servicio Cantabro de Salud, Cantabria, Spain b Department of Nursing, University of Cantabria, Cantabria, Spain ∗ Corresponding author. E-mail address: [email protected] (M. Paz-Zulueta) Background In order to reduce maternal and neonatal morbidity at the time of childbirth, international organisms such as the World Health Organization and the National Institute for Health and Care Excellence, recommend that more humane care must be provided for childbirth, respecting its physiology and promoting the empowerment of pregnant women. Objective To determine the percentage of pregnant women who would potentially be candidates for normal childbirth in a region of northern Spain. To compare between the group of “pregnant women candidate for a normal birth” and non-candidate pregnant women, the main indicators of clinical practice and maternal and neonatal morbidity. Methodology Cross-sectional study. The study population was the total number of hospital deliveries attended at Hospital Universitario Marqués de Valdecilla from January 1, 2014 to December 31, 2014 (n = 3315). A “pregnant
S369
candidate for a normal birth” was defined as a pregnant woman with hospital delivery, without serious pathology (maternal, amniotic fluid or fetal), controlled gestation, simple fetus, spontaneous, term and neonatal state “newborn live” according to the National Clinical Practice Guide for Normal Delivery Care and international guidelines, being candidates for the implementation of the strategy of normal delivery care. Information was retrospectively obtained from secondary registers. Comparisons between groups were performed by using the Chi2 or Student t-tests for categorical and quantitative variables respectively. Results Among the deliveries, 1863 (56.20%) math the definition of “pregnant candidate for a normal birth”. In 50.86% of these candidate deliveries, a pregnancy episiotomy was performed against 60.96% in the non-candidate group (P < 0.001). Caesarean sections were performed at 19.32% of candidate deliveries, compared to 26.79% of non-candidate deliveries (P < 0.001). We also found statistically significant differences between groups depending on the type of delivery, need for delivery instrumentation, existence of perineal tears, Apgar test score, and the need for admission to ICU of the newborn. Conclusions Our results suggest a differential clinical practice according to the recommendations of the Clinical Practice Guide for Attention to Normal Childbirth. However, the percentages of episiotomies and caesarean sections remain high compared to standards and the results of other studies. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.359 P7-40
Health inequalities in vaccination: A challenge for measles elimination (the case of outbreak in Ecuador, 2011–2012) M. Rivadeneira a,∗ , S. Bassanesi b , S. Fuchs c Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador b Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil c Programa de Pós-gradua¸ cão em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ∗ Corresponding author. E-mail address: [email protected] (M. Rivadeneira) a
Introduction/background Low immunization coverage in specific population groups, together with high viral infectivity, has aggravated the measles outbreaks happening in the past decade. Ecuador, a country in northwestern South America, introduced routine measles vaccination more than three decades ago. As a result, the last cases of autochthonous measles happened in that country around 1996. However, a new measles outbreak occurred in 2011–12. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador in 2011 and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador, in whom at least one dose of measles-containing vaccine received was inquired. Variables included were: previous measles immunization, Unsatisfied basic needs (UBNI) of urban cantons, percentage of the 15–17 year-old population in the canton attending school, percentage of the population self-identifying as indigenous or African-Ecuadorian in the canton, and employment rate. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. Spatial autocorrelation was detected and conditional autoregressive analysis was performed for adjustment of variables. Principal components analysis was used to create a socioeconomic score. The slope index and relative index of inequality were calculated. Results Measles immunization coverage ranged from 54.1% to 98.5% in the cantons of Ecuador. Measles immunization coverage was inversely associated with unsatisfied basic needs (P = 0.0007) in urban areas and proportion of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. In cantons in the lower socioeconomic stratum, the rate of