Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey.

OBJECTIVE: We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors. STUDY DESIGN: This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19. RESULTS: Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes. CONCLUSIONS: Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use. IMPLICATIONS: Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.

Adherence to HIV post-exposure prophylaxis in a specialized service in São Paulo, Brazil.

INTRODUCTION: The effectiveness of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) depends on adherence to the protocol, which includes taking antiretrovirals (ARVs) and attending visits. We examined the adherence rate to antiretroviral agents and follow-up visits identifying the associated characteristics of adherence and the reasons for not attending HIV PEP consultations in a specialized service in São Paulo, Brazil. METHODOLOGY: This was a cross-sectional study with health service users who had an indication for PEP due to sexual exposure in an HIV/AIDS service from April to October 2019. The health service users were followed-up throughout the prophylaxis cycle. Adherence was determined through self-reports on antiretroviral agent use and attendance to follow-up consultations. RESULTS: Association measures were employed to identify adherence-related characteristics. The sample analyzed included 91 users. The mean age was 32.5 years old (SD = 9.8). The largest share was white-skinned (49.5%), men who have sex with other men (62.2%), male (86.8%), and undergraduate/graduate students (65.9%). Adherence totaled 56.7% and health insurance was the associated characteristic (p = 0.039). Work (55.9%), using a private service (15.2%), forgetfulness (11.8%) and considering follow-up unnecessary (11.8%) were the main reasons for not attending the follow-up appointments. CONCLUSIONS: Few users do attend HIV PEP consultations. The users without health insurance had the highest adherence percentage whereas work was mentioned as a reason for not attending HIV PEP consultations.

Sexual activity and satisfaction in older adults from a Brazilian cohort study.

Objectives: Although the majority of older adults experience sexual satisfaction regardless of their sexual activity, there are few studies that address sexuality in aging, especially in Latin America. The objective of this study was to assess the prevalence of sexual activity and satisfaction among older adults in two time-points, as well as their sociodemographic and health predictors.Method: We analyze data from 1,464 older adults aged 60 years or over from the Health, Well-Being, and Aging (SABE) cohort study conducted in Brazil. Multivariable regression models were used to determinate the factors associated with sexual activity and sexual satisfaction, stratified by gender. Results: Among older adults, the prevalence of sexual activity was 48%, while the vast majority reported feeling sexually satisfied (80%). Men had more sexual activity than women, while women presented greater sexual satisfaction than men. After the follow-up, older adults that were married were more likely to have sexual activity. In women, being older than 71 years was associated with lower sexual activity. In men, those with mobility problems and depression were less likely to have sexual activity. Regarding sexual satisfaction, having depression remained a leading factor for lower sexual satisfaction in men.Conclusion: Despite beliefs, a high percentage of older adults reported being sexually active and feeling sexually satisfied. Our results highlight the gender difference in the predictors of sexual activity and sexual satisfaction. Since sexuality is important for well-being throughout life, preventing factors that decrease sexual activity and sexual satisfaction in aging could help improve the quality of life of older adults.

Effectiveness of Remotely Delivered Parenting Programs on Caregiver-child Interaction and Child Development: a Systematic Review.

Remotely delivered parenting interventions are suitable to promote child well-being and development, in a context of social isolation, as our society faced due to COVID-19. The objective of this systematic review was to assess the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development. We carried out a systematic search to find studies from the inception of the database to September 2021 on six electronic databases: MEDLINE, CINAHL, Embase, Scopus, Web of Science Core Collection and Regional Portal Information and Knowledge for Health (BVS), and gray literature. Eligible study designs were experimental and quasi-experimental studies. We included parenting interventions as long as they were remotely delivered and focused on typically developing children. Two outcomes were considered: caregiver-child interaction and child development. Three randomized controlled trials (RCT) and one quasi-experimental study met the inclusion criteria. Results from two RCT revealed positive, small-to-medium effects on child development. One study showed that the new intervention had a not inferior effect compared to the results achieved by the traditional support. Children who participated in the quasi-experimental study showed significant elevations in language ability. One study reported positive caregiver-child interaction results. There is insufficient evidence to draw definitive conclusions regarding the effectiveness of remotely delivered parenting interventions on child development due to the heterogeneity of participant profiles, mode of delivery, and assessment tools. The results suggest the need to develop future methodologically rigorous studies assessing the effectiveness of remotely delivered parenting interventions for typically developing children on caregiver-child interaction and child development.

Effectiveness of different health delivery agents of parenting stimulation interventions on child development outcomes among children aged 0 to 36 months: a systematic review protocol.

OBJECTIVE: This review will evaluate the effectiveness of different health delivery agents of parenting stimulation interventions versus usual care, no intervention, or a different type of delivery agent on child development outcomes among children aged 0 to 36 months. INTRODUCTION: Stimulation interventions vary in terms of implementation. While some interventions are delivered by professionals, most are delivered by non-professionals. Several prior systematic reviews on this topic have been conducted; however, no known study has evaluated the effectiveness of stimulation interventions on child development by type of delivery agent. INCLUSION CRITERIA: This review will consider randomized controlled trials assessing parenting stimulation interventions delivered by different health delivery agents. These will be compared to usual care, no intervention, or a different delivery agent, targeted at caregiver-child dyads of children aged 0 to 36 months. The outcomes will include motor, language, cognitive, and socio-emotional development. The review will exclude studies including children with specific characteristics, interventions that do not focus on parenting, and protocols of randomized clinical trials. METHODS: The review will include both published and unpublished studies. The key information sources to be searched are: MEDLINE, APA (PsycNet), Embase, Scopus, Web of Science Core Collection, CINAHL, VHL Regional Portal, Google Scholar, Science Direct, Theses Canada Portal, and Library and Archives Canada. Studies in English, Spanish, and Portuguese will be included. Critical appraisal and data extraction will be conducted using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021245245.

Vulnerabilidade a vivenciar uma gravidez não intencional entre mulheres usuárias do Sistema Único de Saúde / Vulnerabilidad al vivenciar un embarazo no intencional entre mujeres usuarias del Sistema Único de Salud

Objetivo: Analisar a vulnerabilidade a vivenciar uma gravidez não intencional entre mulheres usuárias de Unidades Básicas de Saúde e os aspectos associados. Métodos: Estudo transversal com 470 mulheres usuárias de Unidades Básicas de Saúde da Coordenadoria Regional de Saúde Leste do município de São Paulo. Os dados foram coletados por meio de entrevistas e utilizou-se regressão logística múltipla para analisar os aspectos associados. Resultados: Aproximadamente metade das mulheres mostrou estar vulnerável a vivenciar uma gravidez não intencional (48,3%). Mulheres na faixa etária de 25 a 34 anos tiveram mais chance de estar vulneráveis à gravidez não intencional comparadas às mulheres na faixa etária de 18 a 24 anos (OR=2,0; IC95% 1,2-3,4), tendo sido o mesmo observado em relação às mulheres com 35 anos de idade ou mais (OR=9,7; IC95% 5,3-17,6). As mulheres em união estável tiveram menos chance de estar vulneráveis a uma gravidez não intencional comparadas às mulheres solteiras (OR=0,4; IC95% 0,3-0,7). As mulheres que não planejaram a gravidez anterior tinham mais chance de estar vulnerável a uma gravidez não intencional comparadas às mulheres que planejaram a gravidez anterior (OR=2,5; IC95% 1,2-5,1), diferentemente das mulheres que nunca engravidaram (OR=0,4; IC95% 0,2-0,7). Conclusão: Uma parcela significativa de mulheres estava vulnerável a vivenciar uma gravidez não intencional. Os aspectos associados a vivenciar uma gravidez não intencional foram a idade, não estar em união estável e não ter planejado a última gravidez.

Prácticas de las enfermeras brasileñas en el seguimiento de la salud infantil al inicio de la pandemia por COVID-19 / Practices of Brazilian nurses in child health monitoring at the beginning of the COVID-19 pandemic

Introducción: La COVID-19 ha afectado la rutina de los servicios de salud, y hay pocos estudios que aborden las prácticas de las enfermeras en el seguimiento de la salud infantil durante el período pandémico. Objetivo: Describir las prácticas de las enfermeras brasileñas en el seguimiento de la salud infantil al inicio de la pandemia por COVID-19. Métodos: Estudio transversal realizado con 115 enfermeras brasileñas de Atención Primaria de Salud. El cuestionario enviado por correo electrónico y WhatsApp, incluyó preguntas sobre las actividades para el seguimiento de la salud infantil, aspectos abordados en la atención de enfermería y la implementación de estrategias innovadoras. Para el análisis de los datos se utilizó estadística descriptiva a través del software Stata 15.1. Resultados: La mayoría de participantes pertenecía a la estrategia de salud de la familia (75,65 %) y era de la región sureste de Brasil (40,87 %). En la mayoría de las regiones brasileñas se suspendieron o disminuyeron las actividades de seguimiento de la salud infantil. La promoción de la actividad física, la orientación sobre jugar, la evaluación del consumo de alimentos y la orientación sobre la calidad del sueño fueron los aspectos menos abordados. En cuanto al uso de estrategias innovadoras, las llamadas telefónicas y los mensajes a través de WhatsApp fueron las más utilizadas. Conclusiones: Al inicio de la pandemia, las enfermeras adaptaron sus prácticas a estrategias innovadoras para mantener el seguimiento de la población infantil, sin embargo, acciones importantes de promoción de la salud para este período pandémico fueron poco abordadas. Palabras clave: Salud del niño; Enfermería de atención primaria; Atención primaria de salud; Infecciones por coronavirus; COVID-19.

Associação entre autopercepção de saúde, marcadores de alimentação e estado nutricional: inquérito Vigitel do estado de São Paulo / Association between self-rated health, markers of food and nutritional status: survey Vigitel do state of São Paulo

Objetivo: Avaliar a prevalência de autopercepção de saúde em adultos (18 a 59 anos) e pessoas idosas (≥60 anos) do estado de São Paulo e analisar a associação entre autopercepção negativa de saúde e marcadores de padrões de alimentação saudável e não saudável e estado nutricional. Métodos: Estudo transversal com 8.420 indivíduos (4.723 adultos e 3.697 pessoas idosas) do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) 2020 do estado de São Paulo. A autopercepção de saúde foi categorizada em positiva e negativa. Foram considerados marcadores de padrões saudáveis e não saudáveis de alimentação e estado nutricional segundo o Índice de Massa Corporal. Utilizou-se regressão logística, com nível de significância de 5%. Resultados: No total, 74,2% e 25,8% relataram autopercepção positiva e negativa, respectivamente. A autopercepção negativa foi superior entre pessoas idosas do que entre adultos (34,9% vs. 23,4%, p<0,001). Adultos que consumiram regularmente frutas e hortaliças (OR=0,5; IC 95%:0,3-0,7) e cinco ou mais grupos de alimentos minimamente processados (OR=0,7; IC 95%:0,5-0,9) tinham menor chance de autopercepção negativa, mas os que consumiram refrigerantes cinco ou mais dias da semana (OR=1,4; IC 95%:1,0-1,9) tinham maior chance de autopercepção negativa. Adultos obesos apresentaram maior chance de autopercepção negativa (OR=1,9; IC 95%:1,4-2,5). Entre as pessoas idosas, nenhuma variável permaneceu associada à autopercepção negativa. Conclusões: Considerável percentual de adultos e de pessoas idosas relatou autopercepção negativa, e os fatores associados foram distintos entre esses grupos populacionais. Recomenda-se a realização de análises estratificadas que considerem as particularidades das faixas etárias.

Sexual activity and satisfaction in older adults from a Brazilian cohort study

Objectives: Although the majority of older adults experience sexual satisfaction regardless of their sexual activity, there are few studies that address sexuality in aging, especially in Latin America. The objective of this study was to assess the prevalence of sexual activity and satisfaction among older adults in two time-points, as well as their sociodemographic and health predictors.Method: We analyze data from 1,464 older adults aged 60 years or over from the Health, Well-Being, and Aging (SABE) cohort study conducted in Brazil. Multivariable regression models were used to determinate the factors associated with sexual activity and sexual satisfaction, stratified by gender. Results: Among older adults, the prevalence of sexual activity was 48%, while the vast majority reported feeling sexually satisfied (80%). Men had more sexual activity than women, while women presented greater sexual satisfaction than men. After the follow-up, older adults that were married were more likely to have sexual activity. In women, being older than 71 years was associated with lower sexual activity. In men, those with mobility problems and depression were less likely to have sexual activity. Regarding sexual satisfaction, having depression remained a leading factor for lower sexual satisfaction in men.Conclusion: Despite beliefs, a high percentage of older adults reported being sexually active and feeling sexually satisfied. Our results highlight the gender difference in the predictors of sexual activity and sexual satisfaction. Since sexuality is important for well-being throughout life, preventing factors that decrease sexual activity and sexual satisfaction in aging could help improve the quality of life of older adults.

Vulnerabilidade a vivenciar uma gravidez não intencional entre mulheres usuárias do Sistema Único de Saúde / Vulnerabilidad al vivenciar un embarazo no intencional entre mujeres usuarias del Sistema Único de Salud / Vulnerability to experiencing an unintentional pregnancy among women who use the Unified Health System

Resumo Objetivo Analisar a vulnerabilidade a vivenciar uma gravidez não intencional entre mulheres usuárias de Unidades Básicas de Saúde e os aspectos associados. Métodos Estudo transversal com 470 mulheres usuárias de Unidades Básicas de Saúde da Coordenadoria Regional de Saúde Leste do município de São Paulo. Os dados foram coletados por meio de entrevistas e utilizou-se regressão logística múltipla para analisar os aspectos associados. Resultados Aproximadamente metade das mulheres mostrou estar vulnerável a vivenciar uma gravidez não intencional (48,3%). Mulheres na faixa etária de 25 a 34 anos tiveram mais chance de estar vulneráveis à gravidez não intencional comparadas às mulheres na faixa etária de 18 a 24 anos (OR=2,0; IC95% 1,2-3,4), tendo sido o mesmo observado em relação às mulheres com 35 anos de idade ou mais (OR=9,7; IC95% 5,3-17,6). As mulheres em união estável tiveram menos chance de estar vulneráveis a uma gravidez não intencional comparadas às mulheres solteiras (OR=0,4; IC95% 0,3-0,7). As mulheres que não planejaram a gravidez anterior tinham mais chance de estar vulnerável a uma gravidez não intencional comparadas às mulheres que planejaram a gravidez anterior (OR=2,5; IC95% 1,2-5,1), diferentemente das mulheres que nunca engravidaram (OR=0,4; IC95% 0,2-0,7). Conclusão Uma parcela significativa de mulheres estava vulnerável a vivenciar uma gravidez não intencional. Os aspectos associados a vivenciar uma gravidez não intencional foram a idade, não estar em união estável e não ter planejado a última gravidez.

Resumen Objetivo Analizar la vulnerabilidad al vivenciar un embarazo no intencional entre mujeres usuarias de Unidades Básicas de Salud y los aspectos asociados. Métodos Estudio transversal con 470 mujeres usuarias de Unidades Básicas de Salud de la Coordinación Regional de Salud Este del municipio de São Paulo. Los datos se recopilaron a través de entrevistas y se utilizó la regresión logística múltiple para el análisis de los aspectos asociados. Resultados Aproximadamente la mitad de las mujeres se mostró vulnerable a vivir un embarazo no intencional (48,3 %). Mujeres en el grupo de edad de los 25 a los 34 años tuvieron más posibilidades de vulnerabilidad a un embarazo no intencional cuando comparadas con las mujeres en el grupo de edad de los 18 a los 24 años (OR=2,0; IC95 % 1,2-3,4). Lo mismo se ha observado en relación con las mujeres de 35 años o más (OR=9,7; IC95 % 5,3-17,6). Las mujeres en unión de hecho tuvieron menos posibilidades de vulnerabilidad a un embarazo no intencional en comparación con las mujeres solteras (OR=0,4; IC95 % 0,3-0,7). Las mujeres que no planificaron el embarazo anterior tuvieron más posibilidades de estar vulnerables a un embarazo no intencional cuando comparadas con las mujeres que planificaron el embarazo anterior (OR=2,5; IC95 % 1,2-5,1), a diferencia de las mujeres que nunca habían quedado embarazadas (OR=0,4; IC95 % 0,2-0,7). Conclusión Una parte significativa de las mujeres estaba vulnerable a vivir un embarazo no intencional. Los aspectos asociados a la vivencia de un embarazo no intencional fueron la edad, no tener una unión de hecho y no haber planificado el último embarazo.

Abstract Objective To analyze the vulnerability to experience an unintentional pregnancy among women users of Primary Care Centers and the associated aspects. Methods A cross-sectional study with a total of 470 women users of Primary Care Centers of the East Health Supervision Department from the city of Sao Paulo. Data were collected through interviews and multiple logistic regression was used to analyze the associated aspects. Results Approximately half of the women were found to be vulnerable to experiencing an unintentional pregnancy (48.3%). Women aged 25 to 34 years old were more likely to be vulnerable to unintentional pregnancy compared to women aged 18 to 24 years old (OR=2.0; 95%CI 1.2-3.4), the same observed for women aged 35 years old or older (OR=9.7; 95%CI 5.3-17.6). Women in a stable relationship were less likely to be vulnerable to an unintentional pregnancy compared to single women (OR=0.4; 95%CI 0.3-0.7). Women who did not plan a previous pregnancy were more likely to be vulnerable to an unintentional pregnancy compared to women who planned a previous pregnancy (OR=2.5; 95%CI 1.2-5.1), unlike women who never got pregnant (OR=0.4; 95%CI 0.2-0.7). Conclusion A significant portion of women was vulnerable to experiencing an unintentional pregnancy. The aspects associated with experiencing this pregnancy were age, not being in a stable relationship and not having planned the last pregnancy.

Food commercialization in schools: analysis of the regulatory process in Brazil / Comercialização de alimentos em escolas: análise do processo de regulamentação no Brasil

ABSTRACT Objective To identify and to describe the legal provisions that regulate the sale of food in Brazilian schools. Method Documentary analysis carried out in 2019, on the websites of the State, capital and Federal District Legislative Assemblies, via e-mail and/or telephone contact and publications on the subject review. The data were grouped by geographic region and a descriptive analysis was carried out. Results Data were obtained from 96% of the federative units (25 States and the Federal District). 62 legal provisions were found: 60% current, 11% revoked and 29% draft bills. Current legislation was found in 67% of States: 100% of the States in the South, Southeast and Center-West regions, 56% in the Northeast and 43% in the North. Most of the legal provisions prohibit the sale of ultra-processed foods and encourage the sale of fruits and fresh foods in the public and private school network. Conclusion Progress is observed in the school food regulatory process in this country, considering its coverage in the States and in the public and private school network, but still restricted to the South, Southeast and Midwest regions.

RESUMO Objetivo Identificar e descrever os dispositivos legais que regulamentam a comercialização de alimentos em escolas brasileiras. Método Análise documental realizada em 2019, nos sites das Assembleias Legislativas dos Estados, Capitais e Distrito Federal, via e-mail e/ou contato telefônico e publicações sobre o tema. Os dados foram agrupados por região geográfica e procedeu-se análise descritiva. Resultados Obteve-se dados de 96% das unidades federativas (25 Estados/Capitais e Distrito Federal). Foram encontrados 62 dispositivos legais: 60% vigentes, 11% revogados e 29% projetos de lei. Regulamentação vigente foi encontrada em 67% dos Estados brasileiros: 100% dos Estados das Regiões Sul, Sudeste e Centro-Oeste, 56% no Nordeste e 43% no Norte. A maioria dos dispositivos legais proíbe a comercialização de alimentos ultraprocessados e incentiva a venda de frutas e alimentos in natura, na rede pública e privada. Conclusão Constata-se avanço no processo de regulamentação no país, considerando abrangência nos estados/capitais e na rede pública e privada, porém ainda restrito às Regiões Sul, Sudeste e Centro-Oeste.

Male condom and dual protection use by adolescent men in Brazil.

OBJECTIVE: To assess the use of male condoms and dual protection by Brazilian adolescent men, as well as their associated aspects. METHODS: A database from the Study of Cardiovascular Risks in Adolescents (ERICA) was used for this national cross-sectiotabelnal school-based research. The sample included adolescents of both sexes, aged between 12 and 17 years old, selected through cluster sampling in 2014 (n = 75,060). This study analyzed information from adolescent men who reported having had sexual intercourse (n = 12,215). The dependent variables were the use of male condoms and the use of dual protection (simultaneous use of male condoms and oral hormonal contraceptives) in the last sexual intercourse. Data were analyzed using univariate and multiple logistic regression. RESULTS: Most adolescents used a male condom in the last sexual intercourse, while the use of double protection was quite low. The use of male condoms, reported by 71% (95%CI 68.7-73.1), was positively associated with age, living with both parents, and having used alcohol in the previous 30 days. The use of double protection, reported by 3.6% (95%CI 2.8-4.5) was positively associated with age and studying in a private school, as well as negatively associated with tobacco use in the previous 30 days. CONCLUSIONS: The wide difference shown in the proportion of condom or dual protection use in the last sexual intercourse draws attention to the different logics that govern juvenile sexual relations. The low proportion of dual protection use may be a reflection of men's lack of knowledge about a function that has historically been attributed to women, which is contraception. Thus, one must deconstruct such dichotomy that the sphere of sexuality is of the domain/interest of men, while that of reproduction concerns only women.

Continuidade da atenção às doenças crônicas no estado de São Paulo durante a pandemia de Covid-19 / Continuity of health care for chronic diseases in the state of São Paulo during the COVID-19 pandemic

RESUMO As Doenças Crônicas Não Transmissíveis (DCNT) representam as principais causas de morte e de invalidez em todo o mundo. Em acréscimo a esse cenário, desponta, em 2020, a pandemia causada pelo novo Coronavírus 2019 (Sars-CoV-2), causador da Covid-19. Este estudo avaliou a continuidade da atenção às DCNT pelos serviços de saúde dos municípios do estado de São Paulo durante a primeira fase da pandemia de Covid-19. Trata-se de estudo transversal, realizado em 171 municípios do estado de São Paulo, com aplicação de formulário aos gestores municipais. Foi utilizado peso de pós-estratificação para correção da baixa taxa de resposta. A maioria dos municípios (89,6%) definiu um conjunto de serviços de saúde que deveria ser mantido, e 95,7% relataram alguma descontinuidade da atenção. Os serviços com descontinuidade (interrupção total e interrupção parcial) foram os seguintes: cirurgias eletivas (54,1% e 38,1%), reabilitação (10,0% e 62,1%), diagnóstico/tratamento das DCNT (1,0% e 42,1%), tratamento de transtornos mentais (2,4% e 38,4%), diagnóstico/tratamento de câncer (interrupção parcial 15,9%) e cuidados paliativos (4,4% e 22,6%). Baixa demanda da população e diminuição da oferta interferiram na continuidade da assistência. Destaca-se a implantação da Telessaúde. A interrupção total ou parcial expõe os indivíduos a complicações agudas e crônicas.

ABSTRACT Chronic Noncommunicable Diseases (NCDs) represent the leading causes of death and disability worldwide. Added to this scenario, in 2020, the pandemic by the Coronavirus disease 2019 (SARS-CoV-2), causing COVID-19, emerges. This study evaluated the continuity of care for NCDs by health services in the municipalities of the state of São Paulo during the first phase of the COVID-19 pandemic. This is a crosssectional study, carried out in 171 municipalities in the state of São Paulo, and with application of a form to municipal managers. Post-stratification weight was used to correct the low response rate. Most municipalities (89.6%) defined a set of health services that should be maintained, and 95.7% reported some discontinuity of care. The services with discontinuity (total and partial interruption) were as follows: elective surgeries (54.1% and 38.1%), rehabilitation (10.0% and 62.1%), diagnosis/treatment of NCDs (1.0% and 42.1%), treatment of mental disorders (2.4% and 38.4%), diagnosis/treatment of cancer (partial interruption 15.9%) and palliative care (4.4% and 22.6%). Low demand from the population and reduced supply interfered with the continuity of care. The implementation of Telehealth stands out. The total or partial interruption exposes individuals to acute and chronic complications.

Antenatal care in Mozambique: Number of visits and gestational age at the beginning of antenatal care.

OBJECTIVE: 1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique. METHOD: cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously. RESULTS: all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits. CONCLUSION: the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.

Pregnancy planning does not interfere with child development in children aged from 11 to 23 months old.

OBJECTIVE: to analyze the correlation between child development and pregnancy planning and other associated aspects. METHOD: a cross-sectional study conducted with 125 mother-child dyads, the children aged from 11 to 23 months old and attending daycare centers located in socially disadvantaged areas. Child development according to domains was assessed using the Ages & Stages Questionnaire-BR and pregnancy planning was evaluated through the London Measure of Unplanned Pregnancy. The mothers were interviewed at their homes and non-parametric tests were used for data analysis. RESULTS: 17.6% of the pregnancies were unplanned, 24.8% were planned and 57.6% were ambivalent. Inadequate development in the different domains ranged from 21% to 40% and was not associated with pregnancy planning. However, the "communication" domain was associated with Bolsa Família and the "personal/social" and "communication" domains, with gender; while "personal/social", "broad motor coordination" and "fine motor coordination" were domains related to the child's age. CONCLUSION: no correlation between pregnancy planning and child development was observed; however, the low frequency of planned pregnancies and the high percentages of inadequate child development show the need to invest in the training of health professionals, both for contraceptive care and preconception health and for the promotion of child development, especially in socioeconomically disadvantaged contexts.