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Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population.This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest.After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]).This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.

IntroductionGlobally, low birth weight (LBW) is prevalent in low-income countries. Although the economic assessment of interventions to reduce this burden is essential to guide health policies, research that illustrates the magnitude of LBW by country and region as a way to support the design of public policies is still relatively scarce.ObjectiveTo analyze the temporal trend of fetal growth of newborns in Brazil, in the period from 2010 to 2020.MethodsA time series study, whose data source was the Live Births Information System (SINASC), of the Department of Information and Informatics of the Unified Health System (DATASUS), linked to the Ministry of Health, Brazil. The Prais-Winsten linear model was applied to analyse the annual proportions of LBW. The annual percentage changes (APC) and its respective 95% confidence intervals (95%CI) were calculated. To visualize the dynamics of evolution in each Federation Unit (FU), prevalence rate averages of LBW were calculated and displayed on thematic maps.ResultsBetween 2010 and 2020, there was a trend toward stabilization of the increasing proportions of low birth weight in the North, Northeast and Centre-West regions. In Brazil and the other regions these tendencies remained stable.ConclusionTo improve the living conditions of the population, public policies and actions aimed at reducing social inequalities and inequity is health are necessary, such as strengthening the Unified Health System (SUS), income transfer programs, quota policies for vulnerable groups, and gender to improve access to education for women and the labour sector.WHAT IS ALREADY KNOWN ON THIS TOPICIn Brazil, health social inequalities have a historical explanation due to the socio-economic and political system that encourages a competitive economic development model.Improved access to education and health care has reduced the risk of low birth weight (LBW) in all Brazilian regions in recent years.Differences in trends in LBW rates and associated factors within and between regions of Brazil.WHAT THIS STUDY ADDSThe study provides relevant information on the trend of LBW rates in recent years and makes a comparison between regions and the country as a whole.There were differences in the trend of LBW between Brazilian regions, with an increasing trend in the North, Northeast and Central-West regions, but on the other hand, the South and Southeast regions remain stationary.Stationary trend in the prevalence of BPN in Brazil in recent years (2010-2020), findings that should be associated with the improvement in the living conditions of the population.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYIt can be taken into account when building public policies aimed at improving the living conditions of the population public policies and actions aimed at reducing health inequalities and inequities are needed.

Background: Alcohol consumption during pregnancy is a significant public health and pregnancy-related problem, such as spontaneous abortion, stillbirth or low birth weight. According to the WHO, there is no safe amount of alcohol consumption during pregnancy. Studies show high rates of alcohol consumption during pregnancy in sub-Saharan African countries with a prevalence range (2.2-87%). This research aimed to determine the prevalence and associated factors of alcohol consumption among pregnant women attending antenatal care in a rural district of Tete, Mozambique. Methods: A cross sectional survey was conducted between May and June 2022. The non-probability convenience method was applied for sample selection. Prevalence was determined using a 95% CI. binary logistic Regression was used to determine the factors associated with alcohol consumption. Data were analysed using statistical SPPS v26 and Stata. Results: The prevalence of alcohol consumption during pregnancy was 85.9% (152/177; 95% CI: 80.7-91.0), which was associated with increasing age (OR= 8.86; 95% CI: 2.646-29.687; p-value = 0.000 and OR= 9.81; 95% CI: 2.262-42.576; p-value = 0.002) respectively. In addition, another associated factor was following some religion (OR= 0.07; 95% CI: 0.020-0.246; p-value = 0.000). Conclusion: The survey significantly reveals a high prevalence of alcohol consumption among pregnant women attended in a antenatal care in Chitima. Maternal age and religion were the variables that have some significant association with alcohol consumption during pregnancy. Therefore, interventions for behavioural change to reduce alcohol consumption during pregnancy are needed, especially in all age groups.

IntroductionBirth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.DesignThis is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and municipal data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10th and 90th percentile), SGA (th percentile), LGA (>90th percentile), and low birth weight in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.ResultsWe analyzed 2,632,314 live births in Brazil in 2016. Following due adjustment, it was observed that women from municipalities in which there was a limited supply of in natura foods presented a higher chance of a SGA [OR2nd tertile:1.06 (1.05-1.07)] and LBW [OR2nd tertile: 1.11(1.09-1.12)] newborn. On the other hand, municipalities in which there was a greater supply of ultra-processed foods presented higher chances for a SGA [OR3rd tertile:1.04 (1.02-1.06)] and LBW [OR2nd tertile:1.13 (1.11-1.16)] newborn. Stratification showed that Black and Mixed/Brown women were associated with SGA [OR3rd tertile: 1.09 (1.01-1.18)] and [OR3rdtertile:1.06 (1.04-1.09)], respectively, and mixed-race women were also associated with LBW [OR3rd tertile:1.17 (1.14-1.20)], while indigenous women were associated with LGA [OR3rd tertile: 1.20(1.01-1.45)].ConclusionsLiving in areas with limited access to healthy foods was associated with an increased chance of SGA and low weight newborns, especially between Black and Mixed/Brown women. Initiatives focused on minimizing the effects of these food environments, and which aim to reduce social inequalities, are urgently required in the Brazilian context.

Introdução: a pandemia da COVID-19 marcou profundamente a estrutura da sociedade em todas as esferas. As peculiaridades dos serviços odontológicos, colocou estes no centro das atenções. Este artigo de revisão teve como objetivo levantar as principais evidências científicas que orientaram as práticas e a organização para a oferta dos serviços odontológicos. Metodologia: trata-se de estudo de revisão para a síntese de evidências, envolvendo estudos desenvolvidos desde janeiro de 2020 e outubro de 2022. Resultados: 102 artigos foram selecionados para análise, tendo evidenciado que a pandemia afetou profundamente os serviços de odontologia. Seus impactos consistiram na redução da oferta dos serviços, desafios de adoção de protocolos de biossegurança mais rígidos. Profissionais odontológicos foram demandados a se reinventar para uma nova realidade, nas suas práticas clínicas; lidar com o medo e ansiedade de se infectar e infectar suas famílias; e pelas incertezas da sustentabilidade financeira para manter os consultórios funcionais. Prescrições medicamentosas e a tele-odontologia foram a maior alternativa para a oferta dos serviços. Considerações finais: as lições da experiência com a pandemia, farão parte do futuro do pós-pandemia, bem como da prática clínica e gestão dos serviços odontológicos.

Introdução: A população de Sofala conta com de 2 457 828 habitantes em uma área de 68 081 km², e, portanto, uma densidade populacional de 36.1 habitantes por km². O Crescimento Populacional contínuo da Província de Sofala, demanda um acesso aos serviços de saúde mais abrangente. Objetivo: A pesquisa analisa a situação demográfica e o acesso aos serviços de saúde na província de Sofala. Metodologia: O estudo foi do tipo revisão bibliográfica, a busca dos documentos foi feita desde o período pós-independência nos sites governamentais nacionais e relatórios dos programas da Direção Provincial de Saúde de Sofala. Resultados: O rápido declínio da mortalidade de 1997 a 2020 não levou a uma mudança na distribuição etária da população. Ao se comparar a estrutura etária da população da província de Sofala nos anos censitários de 1997, 2007, 2017, observa-se uma distribuição muito semelhante as outras províncias. A cobertura da rede sanitária ao nível da província de Sofala ainda é limitada, pois o raio teórico de cobertura de cada unidade sanitária de nível primário é de 11.01 km, variando de 17.58 km em Cheringoma a 3.55 km na Cidade da Beira. Conclusão: A distribuição desigual dos recursos humanos, unidades sanitárias, oferta dos serviços de saúde especializados, beneficiando a população limita o acesso da população aos serviços, implicando a migração da população rural a zona urbana para acesso aos serviços especializados. Introduction: The population of Sofala is 2 457 828 inhabitants in an area of 68 081 km², and therefore has a population density of 36.1 inhabitants per km². The continuous population growth of Sofala Province demands more comprehensive access to health services. Objective: The research analyses the demographic situation and access to health services in Sofala Province. Methodology: The study was of the bibliographic review type, the search for the documents was carried out from the post-independence period in the national government websites and reports of the programmes of the Sofala Provincial Directorate of Health. Results: The rapid decline in mortality from 1997 to 2020 did not lead to a change in the age distribution of the population. When comparing the age structure of the population of Sofala province in the census years 1997, 2007, 2017, a very similar distribution to the other provinces is observed. The coverage of the health network in Sofala province is still limited as the theoretical radius of coverage of each primary health unit is 11.01 km, ranging from 17.58 km in Cheringoma to 3.55 km in Beira City. Conclusion: The unequal distribution of human resources, health units and specialized health services for the benefit of the population limits the population's access to services, implying the migration of the rural population to urban areas for access to specialized services. Introducción: La población de Sofala es de 2 457 828 habitantes en una superficie de 68 081 km², por lo que tiene una densidad de población de 36,1 habitantes por km². El continuo crecimiento demográfico de la provincia de Sofala exige un acceso más amplio a los servicios sanitarios. Objetivo: La investigación analiza la situación demográfica y el acceso a los servicios sanitarios en la provincia de Sofala. Metodología: El estudio fue del tipo revisión bibliográfica, la búsqueda de los documentos se realizó a partir del período posterior a la independencia en los sitios web del gobierno nacional y los informes de los programas de la Dirección Provincial de Salud de Sofala. Resultados: El rápido descenso de la mortalidad entre 1997 y 2020 no supuso un cambio en la distribución por edades de la población. Al comparar la estructura por edades de la población de la provincia de Sofala en los años censales 1997, 2007 y 2017, se observa una distribución muy similar a la de las demás provincias. La cobertura de la red sanitaria en la provincia de Sofala sigue siendo limitada, ya que el radio teórico de cobertura de cada unidad de salud primaria es de 11,01 km, y oscila entre 17,58 km en Cheringoma y 3,55 km en la ciudad de Beira. Conclusión: La distribución desigual de los recursos humanos, de las unidades sanitarias y de los servicios de salud especializados en beneficio de la población limita el acceso de la población a los servicios, lo que implica la migración de la población rural a las zonas urbanas para acceder a los servicios especializados.

Introdução: As doenças cardiovasculares (DCV) são consideradas a principal causa de morte no mundo, sendo considerada um problema de saúde pública, a preocupação aumenta à medida que atualmente o número de mortes em indivíduos mais jovens e em grupos vulneráveis. O objetivo do estudo foi determinar a associação entre o nível de escolaridade e a morte prematura por doenças cardiovasculares em adultos. Metodologia: Trata-se de um estudo transversal de caráter analítico, resultante de dados provenientes do Sistema de informação de mortalidade do Brasil em 2018. Para análise estatística realizou-se uma análise bivariada pelo de teste de Qui-quadrado e posteriormente foram submetidas a uma análise multivariada mediante modelo de regressão logística para o controle de fatores de confusão e modificação, ajustando-se os valores de razão de mortalidade proporcional (RMP). Resultado: foram analisados 452.282 óbitos; 16,7% dos quais foram atribuídos a doenças cardiovascular, em relação ao nível de escolaridade, observou-se uma maior prevalência de óbito por doenças DCV (17,3%) em analfabetos ou com ensino fundamental e do sexo masculino (62,8%). Após o ajuste completo para os possíveis fatores de confusão, o analfabetismo ou possuir apenas o ensino fundamental, permaneceu fortemente associada ao risco de morrer prematuramente por DCV (RMP =1,31; 95% IC 1,27-1,24, p

Introdução: A insegurança alimentar é um problema de saúde púbica, devido aos seus efeitos na saúde de pessoas infectadas pelo HIV, apesar dos benefícios indiscutíveis do tratamento antirretroviral. Objetivo: analisar a prevalência e fatores associados à insegurança alimentar em pessoas que vivem com HIV/AIDS. Metodologia: Trata-se de um estudo transversal, realizado com 206 pacientes atendidos, em maio-julho de 2022. Foram coletados dados socioeconômicos, demográficos, de estilo de vida e de segurança alimentar. Avaliou-se a insegurança alimentar por meio da Escala Brasileira de Insegurança Alimentar, e as suas associações através do teste qui-quadrado de Pearson/teste exato de Fisher e razão de prevalência. Resultados: A prevalência de insegurança alimentar (grave) foi mais elevada em homens (78,9%), com idade de 18-30 anos (88,9%), sem nenhum nível de escolaridade (82,4%), desempregados (72,3%), casados (73,1%), em agregados de 4 a 6 membros (77,3%) e morando em condições de habitação inadequada (70,2%), com estádio II da doença (78,4%), não fumantes (71,9%), consumidores regulares de bebidas alcoólicas (73,7%) e que praticavam atividade física (76,4%). Encontrou-se associações estatísticas entre insegurança alimentar e faixa etária (p = 0,001), escolaridade (p = 0,001), situação de emprego (p < 0,011), número de pessoas por domicílio (p < 0,028), ser fumante (p < 0,013) e estádio da doença (p < 0,017). Conclusão: estes resultados, sugerem a investimentos em políticas que visam a melhoria da produção agrícola, da renda, escolaridade, acesso a emprego e redução dos níveis de pobreza são necessárias para aumentar a disponibilidade, melhoria de acesso e utilização dos alimentos.

Background Antibiotics are synthetic or natural substances used to treat diseases of infectious origin. When used incorrectly, they can be a factor in the development of antimicrobial resistance, increased treatment time, costs, and mortality. The present study aimed to assess the pattern inappropriate use of antibiotics and their predictors in pediatric patients admitted to the Hospital Central de Nampula, Mozambique Methods A cross-sectional, retrospective study with a quantitative approach was conducted between January and July 2019. The population consisted of children aged 0 to 10 years hospitalized in the pediatric ward I. Binary logistic regression was used to determine risk factors for inappropriate use of antibiotics with 95% CI. Results The prevalence of antibiotic use among pediatric patients was 97.5%. Of the 464 antibiotics prescribed, 39.9% were for patients suffering from gastroenteritis, 21.8% and 9.1% Affected with pneumonia and malaria. Most antibiotics were for systemic use (95.9%, 445/464). Most (36.5%) of prescriptions had errors. Duration of treatment (74.6%) and dosage (25.4%) were the most frequent errors. Binary logistic regression analysis revealed that patients were prescribed with ≥ 3 antibiotics (OR = 2.920, 95% CI = 1.283–6.646, p–value = 0.011) and with a short hospitalization time (OR = 1.726, 95% CI = 1.040–2.864, p–value = 0.035) were more likely to experience some inappropriate use of antibiotics. Conclusion The study showed a higher prevalence of antibiotic use, however, a greater number of prescriptions contained errors. Errors related to dose and duration of treatment were the most common among pediatric patients. These results reveal a concern, since inappropriate and excessive use of antibiotics is a major factor for the development of antibiotic resistant microorganisms. Therefore, strategies concerning the use of antibiotics in order to reduce their inappropriate and excessive use are necessary.

Background Antibiotics are synthetic or natural substances used to treat bacterial infectious diseases. When used incorrectly, they can be a factor in the development of antimicrobial resistance, increased treatment time, costs, and mortality. The present study aimed to assess the pattern of inappropriate use of antibiotics and their predictors in pediatric patients admitted to the Central Hospital in Nampula, Mozambique. Methods A cross-sectional, retrospective study with a quantitative approach was conducted between January and July 2019. The population consisted of children ages 0–10 years hospitalized in the pediatric ward I. Binary logistic regression was used to determine risk factors for the inappropriate use of antibiotics with 95% confidence interval. Results The prevalence of antibiotic use among pediatric patients was 97.5%. Of the 464 antibiotics prescribed, 39.9% were for patients suffering from gastroenteritis, 21.8% and 9.1% for those affected with pneumonia and malaria, respectively. Most antibiotics were for parenteral use (95.9%, 445/464). Many (36.5%) of the prescriptions had errors, primarily in the duration of treatment (74.0%) or dosage (24.4%). Binary logistic regression analysis revealed that patients prescribed ≥ 3 antibiotics (OR = 2.83, 95% CI 1.245–6.462, p-value = 0.013) or hospitalized for a short time (OR = 1.88, 95% CI 1.133–2.3140, p-value = 0.015) were more likely to experience inappropriate use of antibiotics. Conclusion The study showed both a high prevalence of antibiotic use and a high error rate in prescriptions, especially among patients prescribed ≥ 3 antibiotics or hospitalized for a short time. These results are concerning, since inappropriate and excessive use of antibiotics is a major factor in the development of antibiotic-resistant microorganisms. Therefore, policies to reduce the inappropriate and excessive use of antibiotics are necessary.

The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.