Organization of Food and Nutritional Surveillance within the Brazilian National Health System : history and current challenges

A Política Nacional de Alimentação e Nutrição ressalta a importância do Sistema de Vigilância Alimentar e Nutricional - SISVAN, que se destina à identificação do diagnóstico descritivo e analítico da situação alimentar e nutricional da população brasileira, contribuindo para que se conheça a natureza e a magnitude dos problemas nutricionais do país. Este artigo visa apresentar o histórico das ações da Vigilância Alimentar e Nutricional no Brasil, desde sua idealização até a prática atual, destacando a superação das limitações encontradas ao longo dos anos, o fortalecimento obtido por meio dos marcos legais e os desafios enfrentados neste momento. Entende-se hoje que o SISVAN só pode ser conduzido utilizando-se uma combinação de estratégias, sendo as principais: o sistema informatizado do SISVAN, os inquéritos populacionais, as Chamadas Nutricionais, a análise das bases de dados nacionais da saúde, o acesso à produção científica e o financiamento de pesquisas sobre o tema.The National Food and Nutrition Policy emphasizes the importance of the Food and Nutritional Surveillance System (SISVAN), which has the purpose of determining descriptive and analytical diagnoses of the food and nutritional status of the Brazilian population. It thus contributes towards providing knowledge on the nature and magnitude of the country's nutritional problems. The present paper aimed to present the history of food and nutritional surveillance actions in Brazil, from the time of concept design to current practice. The surmounting limitations encountered over the years, strengthening obtained through legal milestones and challenges currently faced are highlighted. The view taken is that SISVAN can only be managed today through a combination of strategies. Of these, the main ones are the SISVAN information technology system, population-based surveys, Nutrition Days, and analysis of national healthcare databases, along with access to scientific production and funding for research on the topic

Desafios e Avanços no Manejo da Hemorragia Pós-Parto: Estratégias Emergentes e Melhores Práticas

This article presents a literature review on the management of postpartum hemorrhage (PPH), focusing on emerging strategies and best practices. PPH is a significant obstetric complication that continues to pose a challenge for healthcare professionals. The review encompasses guidelines and recommendations from organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO), as well as highlighting studies on arterial embolization and other innovative interventions. The results emphasize the importance of a multidisciplinary approach and early identification of PPH to prevent serious complications. It is concluded that arterial embolization emerges as a valuable option in the management of refractory PPH, but its use should be carefully considered in conjunction with other therapeutic and preventive approaches.Este artigo apresenta uma revisão da literatura sobre o manejo da hemorragia pós-parto (HPP), com foco em estratégias emergentes e melhores práticas. A HPP é uma complicação obstétrica significativa que continua a representar um desafio para os profissionais de saúde. A revisão abrange diretrizes e recomendações de organizações como o Colégio Americano de Obstetras e Ginecologistas (ACOG) e a Organização Mundial da Saúde (OMS), além de destacar estudos sobre embolização arterial e outras intervenções inovadoras. Os resultados destacam a importância da abordagem multidisciplinar e da identificação precoce da HPP para prevenir complicações graves. Conclui-se que a embolização arterial surge como uma opção valiosa no manejo da HPP refratária, mas que seu uso deve ser cuidadosamente considerado em conjunto com outras abordagens terapêuticas e preventivas

A organização da Vigilância Alimentar e Nutricional no Sistema Único de Saúde: histórico e desafios atuais

A Política Nacional de Alimentação e Nutrição ressalta a importância do Sistema de Vigilância Alimentar e Nutricional - SISVAN, que se destina à identificação do diagnóstico descritivo e analítico da situação alimentar e nutricional da população brasileira, contribuindo para que se conheça a natureza e a magnitude dos problemas nutricionais do país. Este artigo visa apresentar o histórico das ações da Vigilância Alimentar e Nutricional no Brasil, desde sua idealização até a prática atual, destacando a superação das limitações encontradas ao longo dos anos, o fortalecimento obtido por meio dos marcos legais e os desafios enfrentados neste momento. Entende-se hoje que o SISVAN só pode ser conduzido utilizando-se uma combinação de estratégias, sendo as principais: o sistema informatizado do SISVAN, os inquéritos populacionais, as Chamadas Nutricionais, a análise das bases de dados nacionais da saúde, o acesso à produção científica e o financiamento de pesquisas sobre o tema

Characteristics of women diagnosed with mpox infection compared to men: A case series from Brazil

Background: Cisgender men were mostly affected during the 2022 mpox multinational outbreak, with few cases reported in women. This study compares the characteristics of individuals diagnosed with mpox infection according to gender in Rio de Janeiro. Methods: We obtained surveillance data of mpox cases notified to Rio de Janeiro State Health Department (June 12 to December 15, 2022). We compared women (cisgender or transgender) to men (cisgender or transgender) using chi-squared, Fisher's exact, and Mood's median tests. Results: A total of 1306 mpox cases were reported; 1188 (91.0%) men (99.8% cisgender, 0.2% transgender), 108 (8.3%) women (87.0% cisgender, 13.0% transgender), and 10 (0.8%) non-binary persons. Compared to men, women were more frequently older (40+years: 34.3% vs. 25.1%; p < 0.001), reported more frequent non-sexual contact with a potential mpox case (21.4% vs. 9.8%; p = 0.004), fewer sexual partnerships (10.9 vs. 54.8%; p < 0.001), less sexual contact with a potential mpox case (18.5% vs. 43.0%; p < 0.001), fewer genital lesions (31.8% vs. 57.9%; p < 0.001), fewer systemic mpox signs/symptoms (38.0% vs. 50.1%; p = 0.015) and had a lower HIV prevalence (8.3% vs. 46.3%; p < 0.001), with all cases among transgender women. Eight women were hospitalized; no deaths occurred. The highest number of cases among women were notified in epidemiological week 34, when the number of cases among men started to decrease. Conclusions: Women diagnosed with mpox presented differences in epidemiological, behavioral, and clinical characteristics compared to men. Health services should provide a comprehensive assessment that accounts for gender diversity

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians

ABSTRACT: Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation