Validation of clinical simulation scenarios for the teaching of soft skills in child-centered care.

Consultations with children and their families are complex and require soft skills. However, there is a gap in the medical curriculum concerning these skills, especially as encounter training is often adult-centered. We developed, validated, and applied simulation scenarios that prioritize active participation of children to train soft skills in child-centered care for undergraduate medical students. This is a methodological study to develop three scenarios and a checklist of what is expected. The content was validated by 18 experts. A pre-test was carried out for adjustments. Then, the simulations were applied and evaluated by 18 medical undergraduate students. They included the participation of 6 pediatric simulated patients aged 9-12 years trained by a drama teacher. According to the results, the scenarios and checklist proved to be valid instruments in content terms (ICV-I > 0.8). The scripts were followed by the simulated pediatric patients, but they had difficulty mimicking a hypoactive state. Some were anxious, but everyone enjoyed participating in the feedback. The simulated parents had difficulty participating and giving space to the child's speech. Participants assessed that the simulations performed as they were proposed and, after experimenting them, felt more prepared. The simulations provided an opportunity for students to practice soft skills by interacting with children in a safe environment. Using children as simulated patients is feasible but presents some challenges. Our study has expanded the ways in which children's health content can be taught. We are investigating whether this training leads to better patient outcomes in real clinical settings.

Educational Strategies to Reduce Physician Shortages in Underserved Areas: A Systematic Review.

The shortage of physicians in rural and underserved areas is an obstacle to the implementation of Universal Health Coverage (UHC). We carried out a systematic review to analyze the effectiveness of initiatives in medical education aimed to increase the supply of physicians in rural or underserved areas. We searched for studies published between 1999 and 2019 in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Interventional or observational controlled studies were defined as inclusion criteria. A total of 955 relevant unique records were selected for inclusion, which resulted in the identification of 17 articles for analysis. The admission of students from rural areas associated with a rural curriculum represented 52.95% of the interventions. Medical practice after graduation in rural or underserved areas was the most evaluated outcome, representing 12 publications (70.59%). Participants of these educational initiatives were more likely to work in rural or underserved areas or to choose family medicine, with significant differences between the groups in 82.35% of the studies. Educational strategies in undergraduate and medical residencies are effective. However, it is necessary to expand these interventions to ensure the supply of physicians in rural or urban underserved areas.

Impact of educational policies on access to health care in Brazil: A cross-sectional study.

INTRODUCTION: Various initiatives to improve access to health care have been implemented internationally. In Brazil, this has included policies intended to expand access to higher education for underrepresented socio-economic groups. These measures have reduced inequalities in access to medical education, but it is not known whether they influence career choices. We examine the effect of these educational policies on physician practice patterns in primary care and/or in medically underserved areas. METHODS: This is a cross-sectional study that analysed the association between affirmative educational policies and the career choices of physicians who graduated between 2010 and 2015. Multivariate binary regression analysis was used to evaluate the impact of affirmative educational policies on physician career choices, including primary care practice, practice in cities with ≤20 000 inhabitants, and practice in less developed municipalities 4 years after graduation. RESULTS: We identified the practice patterns of 65 304 (82.8%) physicians 4 years after their graduation. Most physicians included in our analysis were female (54.5%), aged ≤27 years (72.4%), born in developed cities and studied in private medical schools. Physicians admitted to medical school based on racial or social access policies were more likely to practice in municipalities with fewer than 20 000 inhabitants (odds ratio [OR]: 1.64; 1.36-1.98) and in primary care (OR: 1.55; 1.35-1.53). Physicians who benefited from scholarships for under-represented socio-economic groups were more likely to practice in small cities (OR: 1.24; 1.07-1.43) and primary care (OR: 1.23; 1.11-1.37). The provision of financial aid also improved the likelihood of practice in primary care and underserved areas. Graduation from medical schools located in smaller cities was associated with practice in municipalities ≤20 000 inhabitants and primary care. CONCLUSIONS: Our results demonstrated that educational policies implemented in the Brazilian context are effective in reducing inequities in physician distribution and led to an increase in the number of physicians practicing in primary care.

Políticas de ampliação do acesso ao ensino superior e mudança no perfil de egressos de medicina no Brasil: um estudo transversal / Policies for expanding access to higher education and changing the profile of medical graduates in Brazil: a cross-sectional study

Resumo Este estudo avalia o impacto de políticas de ampliação do acesso ao ensino superior na redução de iniquidades no perfil dos egressos de cursos médicos no Brasil. Estudo transversal que utiliza dados do Censo da Educação Superior de 2018. Foram realizadas análises para identificar associação entre ser beneficiário da Lei de Cotas, do Programa Universidade para Todos ou do Fundo de Financiamento Estudantil e três marcadores: nascimento em município de pequeno porte, ser não-branco ou ter cursado ensino médio em escola pública. Realizamos análises utilizando teste de qui-quadrado de Pearson e análise multivariada através de regressão de Poisson. Houve associação significativa entre ser beneficiário destas políticas e ser egresso não branco, ter nascido em município de pequeno porte e ser egresso de escola pública no ensino médio. Todas as políticas apresentaram resultados de Razões de Prevalências (RP) ajustadas superiores a um e com significância estatística. A Lei de Cotas foi a política mais efetiva com RP=1,92 para ser egresso não-branco, RP=6,66 para ter estudado ensino médio em escola pública e RP=1,08 para ter nascido em município de pequeno porte. Apesar destes resultados, estes grupos continuam sub-representados nos cursos médicos e na composição da força de trabalho.

Abstract This study assesses the effectiveness of policies to expand access to higher education in reducing inequities in the profile of graduates from medical courses in Brazil. This work consists of a cross-sectional study using data from the 2018 Higher Education Census. Analyses were carried out to identify the association between being a beneficiary of the Quota Law, the University for All Program, or the Student Financing Fund and three markers: born in a small-sized municipality, being non-white, or having attended high school in a public school. Analyses were performed using Pearson's chi-square test, and multivariate analysis was conducted using Poisson regression. A significant association was found between being a beneficiary of these policies and being a non-white graduate, who was born in a small town and who had studied in a public high school. All policies presented adjusted Prevalence Ratio (PR), which demonstrated an association with statistical significance. The Quota Law was the most effective policy, with RP=1.92 for non-white graduates, RP=6.66 for having studied in a public high school, and RP=1.08 for being born in a small town. Despite these results, these groups remain underrepresented in medical courses and in the workforce.

Policies for expanding access to higher education and changing the profile of medical graduates in Brazil: a cross-sectional study. / Políticas de ampliação do acesso ao ensino superior e mudança no perfil de egressos de medicina no Brasil: um estudo transversal.

This study assesses the effectiveness of policies to expand access to higher education in reducing inequities in the profile of graduates from medical courses in Brazil. This work consists of a cross-sectional study using data from the 2018 Higher Education Census. Analyses were carried out to identify the association between being a beneficiary of the Quota Law, the University for All Program, or the Student Financing Fund and three markers: born in a small-sized municipality, being non-white, or having attended high school in a public school. Analyses were performed using Pearson's chi-square test, and multivariate analysis was conducted using Poisson regression. A significant association was found between being a beneficiary of these policies and being a non-white graduate, who was born in a small town and who had studied in a public high school. All policies presented adjusted Prevalence Ratio (PR), which demonstrated an association with statistical significance. The Quota Law was the most effective policy, with RP=1.92 for non-white graduates, RP=6.66 for having studied in a public high school, and RP=1.08 for being born in a small town. Despite these results, these groups remain underrepresented in medical courses and in the workforce.

Este estudo avalia o impacto de políticas de ampliação do acesso ao ensino superior na redução de iniquidades no perfil dos egressos de cursos médicos no Brasil. Estudo transversal que utiliza dados do Censo da Educação Superior de 2018. Foram realizadas análises para identificar associação entre ser beneficiário da Lei de Cotas, do Programa Universidade para Todos ou do Fundo de Financiamento Estudantil e três marcadores: nascimento em município de pequeno porte, ser não-branco ou ter cursado ensino médio em escola pública. Realizamos análises utilizando teste de qui-quadrado de Pearson e análise multivariada através de regressão de Poisson. Houve associação significativa entre ser beneficiário destas políticas e ser egresso não branco, ter nascido em município de pequeno porte e ser egresso de escola pública no ensino médio. Todas as políticas apresentaram resultados de Razões de Prevalências (RP) ajustadas superiores a um e com significância estatística. A Lei de Cotas foi a política mais efetiva com RP=1,92 para ser egresso não-branco, RP=6,66 para ter estudado ensino médio em escola pública e RP=1,08 para ter nascido em município de pequeno porte. Apesar destes resultados, estes grupos continuam sub-representados nos cursos médicos e na composição da força de trabalho.

Evaluating medical education regulation changes in Brazil: workforce impact.

BACKGROUND: Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians' distribution. METHODS: This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare. RESULTS: From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013-2015 period. Increase in physician supply improved access to antenatal care. CONCLUSIONS: There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

Education in the Mais Médicos program: the gap between proposals and implementation / A dimensão da formação no Programa Mais Médicos: hiato entre propostas e implementação

Abstract: Introduction: The scarcity and inequalities in the geographical distribution of physicians challenge the consolidation of the right to health and create migratory flows that increase health inequities. Due to their complex and multidimensional characteristics, they demand multisectoral political approaches, considering several factors related to the availability and area of ​​practice of medical doctors, as well as the social vulnerability of local populations. Objective: This study aimed at analysing results of the "Mais Médicos" (More Doctors) Program Educational Axis in Brazil. Methodology: A documental research was conducted, highlighting the location and the public or private nature of new undergraduate medical school vacancies between the years 2013 until 2017, which were then compared to the goals and strategies outlined in the official Program documents. Results: The Educational Axis reached important milestones despite the resistance of some institutional actors. The Program extended its undergraduate vacancies by 7696 places, 22.48% of that in public institutions and 77.52% in private ones. Vacancy distribution prioritized cities in rural areas of Brazil, at the same instance bringing forward significant regulatory changes for undergraduate medical courses. However, political disputes with representatives of medical societies and stakeholders interested in favouring the private educational and healthcare sectors surface in the official discourses and documents. These factors weakened the program normative body, creating a hiatus between its core objectives and respective implementation. Evidence related to the concentration of vacancies in the Southeast regions allow the maintenance of a known unequal workforce distribution, despite a proportionally bigger increase in the Midwest, North and Northeast regions. Conclusion: The predominance of vacancies in private institutions and the weakening of the new undergraduate courses monitoring instruments can compromise changes in the graduate students' profiles, which are necessary for the fixation of physicians in strategic geographic areas to promote Primary Healthcare.

Resumo: Introdução: A carência e as desigualdades na distribuição geográfica de médicos desafiam a consolidação do direito à saúde e criam fluxos migratórios que acirram iniquidades em saúde. Devido ao seu caráter complexo e multidimensional, demandam abordagens políticas multissetoriais, considerando vários fatores relativos à disponibilidade e à área de atuação de médicos, bem como à vulnerabilidade social das populações consideradas. Objetivo: Este estudo teve como objetivo analisar os resultados do eixo Formação do Programa Mais Médicos no Brasil. Métodos: Realizou-se uma pesquisa documental, especificamente relativa à localização e à natureza pública ou privada das novas vagas de graduação em Medicina, no período de 2013 a 2017, em que se confrontaram os resultados obtidos com as metas e estratégias pactuadas nos documentos oficiais do programa. Resultados: O eixo Formação alcançou resultados importantes, apesar da resistência de alguns atores institucionais. O programa expandiu em 7.696 vagas de graduação, sendo 22,48% em instituições públicas e 77,52% em instituições privadas. A distribuição das novas vagas priorizou cidades do interior do Brasil e aprovou mudanças regulatórias importantes para os cursos de Medicina. No entanto, as disputas políticas com atores sociais representativos da classe médica e aqueles interessados no favorecimento do setor privado na educação e assistência à saúde ficaram expressas nos discursos e documentos oficiais. Tais aspectos fragilizaram o corpo normativo do programa e criaram um hiato entre os seus objetivos e a implementação. Evidências referentes à concentração de vagas no Sudeste do país favorecem a manutenção das desigualdades, a despeito de um crescimento proporcionalmente maior nas Regiões Centro-Oeste, Nordeste e Norte. Conclusão: A prevalência de vagas em instituições privadas e a fragilização de instrumentos de monitoramento dos novos cursos podem comprometer a mudança no perfil dos egressos, necessária para a fixação de médicos em áreas estratégicas e na atenção primária à saúde.

Inclusion of health care for people with disabilities in Brazilian undergraduate medical education / Inclusão do cuidado com a saúde das pessoas com deficiência nos currículos de medicina do Brasil

Abstract: Introduction: In Brazil, official data estimate there are 45.6 million people with some type of disability and legislation establishes that medical schools should prepare future professionals for the essential care for people with disabilities (PWD). Health disparities faced by PWD are due, among other factors, to inadequate access to healthcare and poor training of professionals to deal with these situations. Objective: To identify the presence of aspects related to PWD healthcare in the curricula of medical courses in Brazil. Method: A documentary analysis of curricula and syllabuses was performed and included research in websites of 328 medical courses (42% public and 58% private) authorized by the Brazilian Ministry of Education. The Brazilian National Curricular Guidelines (NCG) were adopted as a theoretical framework (Brazil, 2014). The classification considered was: Class I - minimum attendance of the pedagogical project to the recommendations on care for PWD, due to the strict transcription of the NCG text and Class II - inclusion in the syllabus and programmatic content of the reference curricular components to the development of specifically related clinical skills to the health care of the PWD, including communication, clinical examination skills and ethical aspects. Results: Documents from 171 courses were available for analysis and the inclusion of aspects related to PWD healthcare was identified in 89 courses (52%). This inclusion was more prevalent in public courses (n=56; 62,9%) than in private ones. The inclusion of the teaching of the Brazilian Sign Language (Libras) was observed In 50 courses (29.2%). The curricular contents were predominantly focused on the Class I (n=80;89,9%) with an absolute lack of description of the procedural strategies to promote the development of clinical competencies related to PWD care. Conclusion: Our study reinforces the need to improve this approach in medical school curricula since providers can play an essential role in mitigating health disparities faced by PWD through competent care. In the Brazilian context, our data point out to a dramatic situation consistent with the invisibility of PWD issues; a need for the development and implementation of PWD-specific educational curricula.

Resumo: Introdução: No Brasil, estima-se que haja 45,6 milhões de pessoas com alguma deficiência. As disparidades de saúde enfrentadas pelas pessoas com deficiência (PCD) decorrem, entre outros fatores, do acesso inadequado aos cuidados de saúde e da formação deficiente dos profissionais para lidar com essas situações. Objetivo: Este estudo teve como objetivo identificar a presença de aspectos relacionados com a atenção à saúde das PCD nos currículos dos cursos de Medicina do Brasil. Método: Foi realizada análise documental dos projetos pedagógicos dos cursos, dos currículos, das ementas de componentes curriculares e dos conteúdos programáticos, incluindo pesquisas em sites de 328 cursos de Medicina (42% públicos e 58% privados) autorizados pelo Ministério da Educação. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina foram adotadas como referencial teórico. A classificação considerada foi: classe I - atendimento mínimo do projeto pedagógico às recomendações sobre o cuidado para PCD, pela estrita transcrição do texto das DCN, e classe II - inclusão nas ementas e nos conteúdos programáticos dos componentes curriculares de atividades voltadas ao desenvolvimento de competências clínicas especificamente relacionadas ao cuidado destinado à saúde das PCD, incluindo comunicação, exame clínico e aspectos éticos. Resultado: Documentos de 171 cursos estavam disponíveis para análise adequada. Desse total, em 89 cursos (52%) foi identificada a inclusão de aspectos relacionados ao cuidado com PCD, sendo mais prevalente nos cursos públicos (n = 56; 62,9%). Em 50 (29,2%) cursos, observou-se a inclusão do ensino da Língua Brasileira de Sinais (Libras). Os conteúdos curriculares identificados foram predominantemente focados na classe I (n = 80; 89,9%), com absoluta falta de descrição das estratégias processuais para promover o desenvolvimento de competências clínicas relacionadas ao cuidado para PCD. Conclusão: No contexto brasileiro, os dados apontam para uma situação dramática no que se refere à invisibilidade das questões relativas às PCD na formação médica e para a necessidade de desenvolvimento e implementação de estratégias educacionais especificamente voltadas para o cuidado com as PCD nos currículos médicos. O estudo reforça o papel essencial do cuidado competente destinado à saúde das PCD como estratégia que visa à mitigação das iniquidades de saúde enfrentadas por essas pessoas.

Factors associated with medical students' quality of life in a Brazilian northeast countryside university / Fatores associados à qualidade de vida dos estudantes de medicina no interior do Nordeste brasileiro

Abstract: Introduction: The current policy of interiorization of medical education worldwide and the application of active methods, as well as the lack of consensus regarding the factors associated with medical students' quality of life are topics of discussion in the medical literature. Objective: In view of the scarcity of analyses on the subject, this study aimed to evaluate the topictopic at a medical school in a Brazilian northeast countryside university. Method: Cross-sectional study, developed from March to May of 2018. The questionnaire WHOQOL-bref was used to evaluate the quality of life and the data were related to: sociodemographic characteristics, anthropometric data and lifestyle. Data analysis was performed using descriptive statistics; then, a bivariate analysis was performed with a test for comparison of mean scores aimed to identify possible variables associated with the investigated domains. Binary logistic regression was performed to identify possible factors associated with poor quality of life in the investigated domains. The statistical analysis estimated 95% CI and p-value <0.05. Results: The present study characterized the students' quality of life and identified the following factors as being associated with poor quality of life: female gender, attending preclinical years, being a smoker, having normal weight classified according to the body mass index, having a negative assessment of their own health and quality of life. The results also showed that most students had a negative evaluation regarding the physical, psychological and environmental domains; in contrast to the social relationships domain, in which most reported a positive assessment. Conclusion: The findings allow discussions about measures aimed at dealing with factors that affect the quality of life of medical students attending medical schools located in remote and rural regions.

Resumo: Introdução: A atual política de interiorização da educação médica mundial e a aplicação de métodos ativos, bem como a falta de consenso sobre os fatores associados à qualidade de vida dos estudantes de Medicina, são conhecidos temas de discussão na literatura médica. Objetivo: Tendo em vista a escassez de análise sobre o assunto, este estudo teve como objetivo avaliar a qualidade de vida entre os estudantes de Medicina de uma universidade do interior do Nordeste brasileiro. Método: Trata-se de um estudo transversal, desenvolvido de março a maio de 2018. Utilizou-se o questionário WHOQOL-bref para avaliar a qualidade de vida, e os dados foram relacionados a características sociodemográficas, dados antropométricos e estilo de vida. Analisaram-se os dados por meio de estatística descritiva, e, em seguida, fez-se a análise bivariada com teste para comparação das médias dos escores, a fim de identificar possíveis variáveis associadas aos domínios investigados. Realizou-se regressão logística binária para identificar possíveis fatores associados à pior qualidade de vida nos domínios investigados. A análise estatística estimou IC 95% e valor de p < 0,05. Resultado: O presente estudo caracterizou a qualidade de vida dos estudantes de Medicina e identificou como principais fatores associados à má qualidade de vida: ser do sexo feminino, cursar anos pré-clínicos, ser fumante, ter peso normal classificado pelo índice de massa corporal e apresentar uma avaliação negativa da própria saúde e da qualidade de vida. Os resultados também evidenciaram que a maioria dos estudantes apresentou uma avaliação negativa nos domínios físico, psicológico e meio ambiente, em contraste com o domínio relações sociais, ao qual a maioria atribuiu uma avaliação positiva. Conclusão: Os achados permitem discutir acerca de medidas voltadas a lidar com fatores que prejudicam a qualidade de vida de alunos de escolas de Medicina em regiões remotas e rurais.

Educational Predictors for the Retention of Physicians in Remote and Unassisted Areas: a Narrative Review / Preditores Educacionais para Fixação de Médicos em Áreas Remotas e Desassistidas: uma Revisão Narrativa

Abstract: This is an international narrative review study, which had the objectives of identifying and understanding the determining educational aspects for the retention of physicians in remote and unassisted areas. Through search on databases, we selected ten articles about medical education institutions and programs that increased the recruitment and retention levels for their alumni in areas where there was shortage of professionals, which clarified the educational aspects associated to such results, and which were considered as predictors for the retention of physicians. The main predictors found were: selection processes that prioritized the admission of students who were previously linked to places where there was a shortage of physicians; the creation of curricular frameworks based on problem-based methodologies focused on local health issues, with an emphasis in primary care and Family and Community Medicine approaches; and the quality of the educational experiences, especially in the primary care environment in rural or remote areas, which, in turn, involve the educational trajectory and experience of professors, as well as the infrastructure and localization of the medical schools in strategic areas. The placement of school is such areas allow close proximity between the professors to the reality of the vulnerable communities. The results of the review still point out that the retention of physicians in unassisted areas demands the confrontation of social, cultural, economic and political factors, which frequently transcend the governability of educational institutions. They also reiterate the need for a wider conceptual uniformity among research studies in order to ensure more solid scientific evidence about the subject, and the importance of conducting studies that contemplate the Latin-American context, specifically Brazil, where the literature on the topic is still scarce.

Resumo: O estudo é uma revisão narrativa da literatura internacional cujos objetivos foram identificar e compreender aspectos educacionais determinantes para fixação de médicos em áreas remotas e desassistidas. A partir de buscas nas bases de dados, foram selecionados dez artigos de revisão sobre instituições e programas de ensino médico que aumentaram a atração e a permanência de seus egressos em regiões de escassez profissional e que explicitaram os aspectos educacionais associados a tais resultados, os quais foram considerados preditores educacionais para fixação de médicos. Os principais preditores encontrados foram: a realização de processos seletivos que priorizaram o ingresso de estudantes previamente vinculados aos locais com escassez de médicos; a construção de estruturas curriculares com metodologias de problematização com foco em questões locais de saúde e com ênfase na abordagem clínica da atenção primária à saúde e da Medicina de Família e Comunidade; e a qualidade das experiências formativas, sobretudo nos cenários de atenção primária, em áreas rurais ou remotas, a qual, por sua vez, envolve a formação e a experiência docente, assim como a infraestrutura e a localização das escolas médicas em áreas estratégicas que permitam a aproximação dos discentes com a realidade das comunidades vulneráveis. Os resultados da revisão apontam ainda que a fixação de médicos em áreas desassistidas demanda o enfrentamento de fatores socioculturais, econômicos e políticos que, frequentemente, transcendem a governabilidade das instituições formadoras. E reiteram a necessidade de uma maior uniformidade conceitual entre as pesquisas, com o intuito de assegurar evidências científicas mais sólidas sobre o assunto e a importância da realização de estudos que contemplem o contexto latino-americano e, de forma específica, o Brasil, onde ainda é escassa a literatura sobre o tema.

Medical school expansion policies: educational access and physician distribution.

INTRODUCTION: Many countries are employing strategies intended to reduce maldistribution of health workers and inequities. The purpose of this study was to analyse the impact of expansion policies of medical schools on regional inequalities in the distribution of undergraduate class sizes, and the capacity to attract and retain doctors and to expand health facilities. METHODS: We conducted a descriptive analysis to compare the distribution of undergraduate places in 2007 and 2016 to determine the impact of targeted expansion policies on inequalities in access to medical education in Brazil. A group of municipalities with new medical schools (n = 54) and a control group without medical schools (n = 408) were compared to analyse impacts of expansion in the health sector. We compared the increase in the number of physicians per 1000 inhabitants and health establishments per inhabitants between 2007 and 2016 based on these two groups. We also analysed the relationship between geographic distance from the state capital and capacity to attract physicians. RESULTS: There was a decrease in the regional inequalities of undergraduate places in medical schools; the greatest increase in the places per 1000 inhabitants was in municipalities of between 50 000 and 100 000 inhabitants. Municipalities with new medical schools showed an increase in physicians per 1000 inhabitants and in health establishments per inhabitant ratio, demonstrating the potential to attract and retain doctors, as well as strengthening the health infrastructure. Municipalities more distant from state capitals showed a greater increase in physician : inhabitant ratio. DISCUSSION: Countries with health workforce shortages and inequalities in their distribution might consider public financing and regulation policies for expansion of medical schools as a strategy to attract and retain professionals. Early results in Brazil showed that such strategies could strengthen service networks in deprived areas, supporting implementation of Universal Healthcare Coverage.

Aspectos institucionais para a adoção da Educação Interprofissional na formação em enfermagem e medicina / Institutional aspects for the adoption of Interprofessional Education in nursing and medical training

RESUMO Os marcos teórico-conceituais e metodológicos da Educação Interprofissional (EIP) em saúde vêm sendo amplamente reconhecidos em todo o mundo como úteis para o desenvolvimento de competências colaborativas para o efetivo trabalho em equipe. O artigo teve como objetivo explorar as percepções de estudantes de enfermagem e medicina sobre os fatores institucionais que interferem na adoção de iniciativas de EIP em seus contextos de formação. Trata-se de um estudo de caso, que adotou a abordagem qualitativa e a perspectiva exploratória. Os participantes da pesquisa foram estudantes de enfermagem e medicina de duas universidades públicas de um estado do Nordeste - uma estadual e outra federal. O grupo focal foi escolhido para coleta de dados, e foi utilizada a técnica de análise de conteúdo categorial, observando as fases de pré-análise, exploração do material e tratamento dos resultados. Três categorias temáticas foram construídas a posteriori: a importância do trabalho em equipe, contextos institucionais para adoção da EIP e desafios para a adoção da EIP. Embora as realidades pesquisadas apresentem avanços nas mudanças curriculares, como a aproximação do ensino com a realidade dos serviços, a adoção de métodos mais ativos para a formação de sujeitos críticos e reflexivos, ainda são notórias as lacunas no desenvolvimento de competências colaborativas.

ABSTRACT The theoretical-conceptual and methodological frameworks of Interprofessional Education in Health (IPE) have been widely recognized throughout the world as useful for the development of collaborative competences for effective teamwork. This article aims to explore the perceptions of nursing and medical students regarding the institutional factors that interfere in the adoption of IPE initiatives in their training contexts. It is a case study, which adopted the qualitative approach and the exploratory perspective. The research participants were nursing and medical students from two public universities from a Brazilian Northeastern state - one state and one federal. The focus group was chosen for data collection, and the categorical content analysis technique was used, observing the phases of pre-analysis, material exploration and treatment of results. Three thematic categories were built a posteriori: the importance of teamwork, the institutional contexts for the adoption of the IPE and challenges for the adoption of the IPE. Although the realities researched present advances in curricular changes, such as the approximation of teaching with the reality of services, the adoption of more active methods for the formation of critical and reflexive subjects, the gaps in the development of collaborative competences are still notorious.

An innovative educational strategy to addressing cultural competence in healthcare for quilombola women.

BACKGROUND: The Quilombola community is made up of descendants of enslaved Africans. These people represent an ethnic minority group within the Brazilian Black population with worse health indicators including higher rates of maternal mortality. CONTEXT: The Brazilian National Guidelines for education of health professionals state that cultural competence and education of ethnic-racial relations need to be reinforced. ACTIVITIES: An action research initiative was developed with the main goal of contributing to the development of cultural competence, interprofessional education, and collaborative work as well as improving the maternal and child indicators of the Quilombola community. An elective module for undergraduate health courses with the subject "Cultural Competence in Health Care for Quilombola Women" was implemented. Data on health-related needs identification, students' perceptions about interactions with the community, and competencies necessary to work with the Quilombola community were considered. OUTCOMES: Our educational strategy reinforces the importance of considering the processes that influence the health care of this population. The reflective capacity and communication skills emerged as the most important attitudinal and psychomotor components, respectively. FUTURE DIRECTIONS: Sustainability comes from partnerships established between the Quilombola community and the university to institutionalize educational and research strategies. This project contributes to reducing health inequities and deconstructing racism in the training of future health professionals. CONCLUSIONS: The creation of links, the building of trust between users and health staff, and the ability to reflect, with emphasis on communication, were shown as the main components of culturally competent behavior in maternal health care in the studied Quilombola population.

Incorporando a Competência Cultural para Atenção à Saúde Materna em População Quilombola na Educação das Profissões da Saúde / Incorporating Cultural Competence for Maternal Healthcare in the Quilombola Population into Health Profession Training

RESUMO INTRODUÇÃO: A educação das relações étnico-raciais e a história da cultura afro-brasileira, previstas nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina como temas transversais, representam um desafio para o desenvolvimento curricular no contexto da social accountability, das metodologias de ensino e dos cenários de prática e integração à rede de serviços de saúde. OBJETIVOS: Identificar as necessidades relacionadas à saúde materna em população quilombola, valorizando os valores, conhecimentos, saberes e cultura local. Estabelecer uma estratégia de cuidado, com participação discente, que contemple as necessidades identificadas na comunidade quilombola. Descrever os conhecimentos, habilidades e atitudes necessários ao desenvolvimento de competências culturais relacionadas à saúde materna das mulheres quilombolas. MÉTODOS: Pesquisa-ação para implantação de serviço de atenção interprofissional no pré-natal, com participação discente, tendo por base as necessidades da comunidade quilombola Capoeiras, em Macaíba (RN). Os dados foram analisados qualitativamente, pela técnica de análise de conteúdo temática categorial, com categorias definidas a priori. RESULTADOS: A criação de vínculos (a)efetivos entre usuárias e equipe de saúde e a habilidade de reflexão com ênfase na comunicação se mostraram como principais necessidades para o comportamento culturalmente competente no cuidado à saúde materna quilombola. As oportunidades de o estudante de Medicina conhecer a situação de saúde da população quilombola e vivenciar o trabalho interprofissional se mostraram estratégias efetivas para potencializar o desenvolvimento de competências culturais na formação médica. CONCLUSÕES: A formação de profissionais da saúde hábeis em interagir eficazmente com populações etnicamente diversas requer que estes conheçam os processos que influenciam a saúde e cuidados de saúde das minorias populacionais, além de vivências relacionadas à diversidade cultural, inseridas nos currículos médicos.

ABSTRACT INTRODUCTION: Training in ethnic and race relations and the history of Afro-Brazilian culture, established in the National Curricular Directives for Undergraduate Medical Courses as a transversal theme, represents a challenge for developing curricula in terms of social accountability, teaching methodologies and work experience in practical settings with integration into the health service network. OBJECTIVE: To identify the maternal health care needs among the quilombola population, appreciating the local culture, values and knowledge. To set a care strategy with student participation which contemplates the identified needs in the quilombola community. To describe the knowledge, skills and attitudes required for the development of cultural competencies related to maternal health care of quilombola women. METHODS: Action research for the implantation of interprofessional prenatal care services with student participation, based on the needs of the quilombola community of Capoeiras, in Macaiba (RN). The information gathered was analyzed qualitatively by means of content analysis, with a priori definition of the thematic categories. RESULTS: The formation of affective bonds between users and the health team, and communication skills that help enable reflection were found as the main needs for culturally competent behavior in maternal care of the quilombola community. The medical students' opportunity to learn about the health of the quilombola people and to have an interprofessional work experience proved to be effective strategies to leverage the development of cultural skills in medical training. CONCLUSIONS: The training of health professionals capable of interacting effectively with ethnically diverse populations requires their understanding the processes that influence the health and healthcare of ethnic minorities, as well as experiences related to cultural diversity, included in medical curricula.

Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome.

PURPOSE: To investigate the effects of a supervised aerobic exercise training intervention on health-related quality of life (HRQL), cardiorespiratory fitness, cardiometabolic profile, and affective response in overweight/obese women with polycystic ovary syndrome (PCOS). METHODS: Twenty-seven overweight/obese inactive women with PCOS (body mass index, ≥ 25 kg·m; age 18 to 34 yr) were allocated into an exercise group (n = 14) and a control group (n = 13). Progressive aerobic exercise training was performed three times per week (~150 min·wk) over 16 wk. Cardiorespiratory fitness, HRQL, and cardiometabolic profile were evaluated before and after the intervention. Affective response (i.e., feeling of pleasure/displeasure) was evaluated during the exercise sessions. RESULTS: The exercise group improved 21% ± 12% of cardiorespiratory fitness (P < 0.001) and HRQL in the following domains: physical functioning, general health, and mental health (P < 0.05). Moreover, the exercise group decreased body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol level (P < 0.05). The affective response varied from "good" to "fairly good" (i.e., positive affective response) in an exercise intensity-dependent manner during the exercise training sessions. CONCLUSIONS: Progressive aerobic exercise training improved HRQL, cardiorespiratory fitness, and cardiometabolic profile of overweight/obese women with PCOS. Moreover, the participants reported the exercise training sessions as pleasant over the intervention. These results reinforce the importance of supervised exercise training as a therapeutic approach for overweight/obese women with PCOS.

Prevalence of Maternal Morbidity and Its Association with Socioeconomic Factors: A Population-based Survey of a City in Northeastern Brazil / Prevalência da morbidade materna e sua associação com fatores socioeconômicos: estudo de base populacional em uma capital do nordeste brasileiro

Abstract Purpose To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil. Methods A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors. Results The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model. Conclusion Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.

Resumo Objetivo Identificar a prevalência da morbidade materna e os fatores socioeconômicos, demográficos e de assistência à saúde associados a ela em uma capital do Nordeste brasileiro. Métodos Estudo seccional, de base populacional, com desenho de amostras complexas. Aplicou-se umquestionário validado paramorbidade materna em848 mulheres com idade entre 15 e 49 anos selecionadas em 8.227 domicílios distribuídos em 60 setores censitários de Natal, capital do Rio Grande do Norte, Brasil. O desfecho principal foi a morbidade materna. A análise multivariada foi feita por meio da regressão de Poisson, com 5% de significância. Resultados A prevalência de morbidade materna foi de 21,2%. A análise bivariada encontrou associação entre o maior número de complicações obstétricas com: mulheres da raça preta/parda (razão de prevalência [RP] = 1,23; intervalo de confiança de 95% [IC95%]: 1,04-1,46); pior condição socioeconômica (RP = 1,33; IC95%: 1,12-1,58); pré-natal na rede pública (RP = 1,42; IC95%: 1,16 -1,72); mulheres que não foram informadas sobre o lugar da realização do parto durante o pré-natal (RP = 1,24; IC95%: 1,05-1,46); mulheres que realizaram o parto na rede pública (RP = 1,63; IC95%: 1,30-2,03); pacientes que percorreram mais de um hospital para realizar o parto (RP = 1,22; IC95%: 1,03-1,45); e aquelas que não tiveram acompanhante em todos os momentos da assistência ao parto - antes, durante e depois do parto (RP = 1,25; IC95% = 1,05-1,48). No modelo final da regressão, tanto o local do parto quanto a condição socioeconômica mantiveram a associação. Conclusões A maior prevalência da morbidade materna esteve associada às piores condições socioeconômicas e à realização do parto na rede pública. Isso reforça a necessidade de fortalecimento de políticas públicas que reduzam as desigualdades em saúde.

Prevalence of Maternal Morbidity and Its Association with Socioeconomic Factors: A Population-based Survey of a City in Northeastern Brazil.

Purpose To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil. Methods A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors. Results The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model. Conclusion Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.

Objetivo Identificar a prevalência da morbidade materna e os fatores socioeconômicos, demográficos e de assistência à saúde associados a ela em uma capital do Nordeste brasileiro. Métodos Estudo seccional, de base populacional, com desenho de amostras complexas. Aplicou-se um questionário validado para morbidade materna em 848 mulheres com idade entre 15 e 49 anos selecionadas em 8.227 domicílios distribuídos em 60 setores censitários de Natal, capital do Rio Grande do Norte, Brasil. O desfecho principal foi a morbidade materna. A análise multivariada foi feita por meio da regressão de Poisson, com 5% de significância. Resultados A prevalência de morbidade materna foi de 21,2%. A análise bivariada encontrou associação entre o maior número de complicações obstétricas com: mulheres da raça preta/parda (razão de prevalência [RP] = 1,23; intervalo de confiança de 95% [IC95%]: 1,04­1,46); pior condição socioeconômica (RP = 1,33; IC95%: 1,12­1,58); pré-natal na rede pública (RP = 1,42; IC95%: 1,16 -1,72); mulheres que não foram informadas sobre o lugar da realização do parto durante o pré-natal (RP = 1,24; IC95%: 1,05­1,46); mulheres que realizaram o parto na rede pública (RP = 1,63; IC95%: 1,30­2,03); pacientes que percorreram mais de um hospital para realizar o parto (RP = 1,22; IC95%: 1,03­1,45); e aquelas que não tiveram acompanhante em todos os momentos da assistência ao parto ­ antes, durante e depois do parto (RP = 1,25; IC95% = 1,05­1,48). No modelo final da regressão, tanto o local do parto quanto a condição socioeconômica mantiveram a associação. Conclusões A maior prevalência da morbidade materna esteve associada às piores condições socioeconômicas e à realização do parto na rede pública. Isso reforça a necessidade de fortalecimento de políticas públicas que reduzam as desigualdades em saúde.

A Escola Multicampi de Ciências Médicas da Universidade Federal do Rio Grande do Norte, Brasil, no contexto do Programa Mais Médicos: desafios e potencialidades / The Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte, Brazil, in the context of the More Doctors Program: challenges and potentialities / La Escuela Multicampi de Ciencias Médicas de La Universidad Federal de Riop Grande do Norte, Brasil, en el contexto del Programa Más Médicos: desafíos e potencialidades

A proposta deste artigo é relatar criticamente a experiência institucional e curricular de implantação do curso de Medicina da Escola Multicampi de Ciências Médicas do Rio Grande do Norte, da Universidade Federal do Rio Grande do Norte (UFRN). Este relato se coloca como forma de documentar, monitorar e refletir sobre o desenvolvimento das ações de expansão de vagas e criação de novos cursos de Medicina em universidades federais, no âmbito do Programa Mais Médicos. Para tanto, foram descritas de maneira crítica as ações de ensino, pesquisa e extensão já desenvolvidas, além de apresentar uma visão geral do curso e da integração ensino-serviço-comunidade, destacando os êxitos logrados e os desafios no desenvolvimento das ações de ensino, pesquisa e extensão. Por fim, são apresentadas as dificuldades inerentes à implantação de novos cursos fora dos centros urbanos no Brasil.

This paper reports on the institutional and curricular experience of launching the Medical Course of the Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte (UFRN). This report is a way of documenting, monitoring and reflecting on the development of actions of expansion of seats and creation of new medical courses in federal universities, within the framework of the More Doctors Program. To that end, the teaching, research and extension actions already developed are critically described, as well as it is presented an overview of the course and the teaching-service-community integration, highlighting the achievements and challenges in the development of teaching, research and extension. Finally, we describe the difficulties inherent in the implantation of new courses outside urban centers in Brazil.

El objetivo de este artículo es relatar la experiencia institucional y curricular de implantación del curso de Medicina de la Escuela Multicampi de Ciencias Médicas de la Universidad Federal de Rio Grande do Norte, de la Universidad Federal de Rio Grande do Norte (UFRN). Se presenta como una forma de comentar, monitorear y reflexionar sobre el desarrollo de las acciones de expansión de plazas y creación de nuevos cursos de Medicina en universidades federales, en el ámbito del Programa Más Médicos. Para ello, se describen de manera crítica las acciones de enseñanza, investigación y extensión ya desarrolladas, además de presentar una visión general del curso y de la integración enseñanza-servicio-comunidad, destacando los éxitos conseguidos y los desafíos en el desarrollo de las acciones de enseñanza, investigación y extensión. Finalmente se presentan las dificultades inherentes a la implantación de nuevos cursos fuera de los centros urbanos en Brasil.

Vivência integrada na comunidade: inserção longitudinal no Sistema de Saúde como estratégia de formação médica / Integrated experience in the community: longitudinal health care insertion as medical education strategy / Vivencia integrada en la comunidad: inserción longitudinal en el Sistema de Salud como estrategia de formación médica

Propostas inovadoras para o processo ensino-aprendizagem nos cursos de Medicina vêm sendo desenvolvidas em busca de uma formação profissional generalista, humanista e crítica. A partir da aprovação do Programa Mais Médicos (PMM), novas escolas foram criadas adotando metodologias de ensino ativas e promovendo maior integração ensinoserviço-comunidade. Este artigo é um relato de experiência sobre o desenvolvimento do módulo Vivência Integrada na Comunidade no curso de Medicina da Escola Multicampi de Ciências Médicas do Rio Grande do Norte, que oportuniza ao estudante uma inserção longitudinal no sistema de Saúde em municípios do interior do Nordeste. Essa proposta vem promovendo maior integração entre a universidade, os gestores e os trabalhadores da Saúde. A aposta é a de que este módulo poderá contribuir com a fixação do médico na região e fortalecer o sistema de Saúde no interior do Brasil.

Innovative teaching-learning process proposals for medical courses have been developed for generalist, humanistic, critical professional education. Beginning with approval of the More Doctors Program, new schools were created, adopting active teaching methodologies and promoting further community-service-teaching integration. This paper is an experience report on the development of the Integrated Experience in the Community module in the medical course at the Medical Sciences Multi-campuses College of Rio Grande do Norte, which provides students with longitudinal insertion opportunities in the healthcare system of the hinterland towns of the Northeast region. This proposed module has been promoting further integration between the university managers, and healthcare workers. The goal of this module is to contribute to securing physicians for in the region and strengthening the healthcare system in the Brazilian hinterland.

Se han desarrollado propuestas innovadoras para el proceso enseñanza-aprendizaje en los cursos de medicina a la búsqueda de una formación profesional generalista, humanista y crítica. A partir de la aprobación del Programa Más Médicos se crearon nuevas escuelas, adoptando metodologías de enseñanza activas y promoviendo una mayor integración enseñanza-serviciocomunidad. Este artículo es un relato de experiencia sobre el desarrollo del módulo "Vivencia integrada en la comunidad" en el curso de medicina de la Escuela Multicampi de Ciencias Médicas de Rio Grande do Norte que proporciona al estudiante una inserción longitudinal en el sistema de salud en municipios del interior del Nordeste de Brasil. Esta propuesta ha promovido una mayor integración entre la Universidad, los gestores y los trabajadores de la salud. La apuesta es que este módulo podrá contribuir con la fijación del médico en la región y fortalecer el sistema de salud en el interior de Brasil.

Prevalência da síndrome metabólica nos estágios pubertários de escolares do sexo feminino / Prevalence of metabolic syndrome in pubertal stages of female students / Prevalencia del síndrome metabólico en etapas de la pubertad de las estudiantes do sexo femenino

Objetivo Analisar a prevalência da síndrome metabólica (SM) nos estágios pubertários de escolares do sexo feminino. Métodos Estudo transversal com 449 escolares, entre oito e 18 anos, estratificadas nos estágios pubertário, índice de massa corporal (IMC) e percentual de gordura (%G). A SM foi classificada pela International Diabetes Federation. A análise feita pela distribuição de frequências, intervalos de confiança (95 %), Qui-quadrado e razão de chance para associações. Resultados A prevalência de SM foi 3,3 % (IC:2 %-5 %), sendo 2,5 % (IC:0,1 %-5%) no púbere e 7,9 % (IC:3,2 %-12,6 %) no pós-púberes, com associação significante destes com a SM (X²=5,2 [p<0,02]). A razão de chance aponta meninas pós-púberes (3,3 [IC:1,2-5]) e obesas (2,1 [CI:2-2,2]) mais propensas à SM, indicando associação linear significante do IMC com o desfecho (X²=29,4 [p<0,001]). Púberes menos de 10 anos com SM apresentaram maiores %G. Os componentes prevalentes foram: circunferência da cintura alterada (27,2 % [IC23 %-31 %]) e colesterol HDL baixo (39,6 % [IC35 %-44 %]) e prevalência da hipertensão sistêmica nas pós-púberes. Conclusões A SM inicia-se no estágio púbere, com prevalência no pós-púbere, sendo o excesso de gordura o desencadeador nas menores de 10 anos. Estratégias de prevenção são necessárias à população de crianças e adolescentes.(AU)

Objective To analyze the prevalence of metabolic syndrome (MS) in pubertal stages of female students. Methods Cross-sectional study of 449 school children between eight and 18 years, stratified by pubertal stage, body mass index (BMI) and body fat percentage (BF %). The MS was classified according to the International Diabetes Federation. The analysis by frequency distribution, confidence intervals (95 %), Chi-square and odds ratio for associations was performed. Results The prevalence of MS was 3.3 % (CI:2 %-5 %) and 2.5 % (CI: 0.1 - 5 %) in pubertal and 7.9% (CI:3.2 % - 12.6 %) in the post-pubescent, with a significant association of this group with MS (X² = 5.2 [p <0.02]). The odds ratio shows that post-pubescent girls (3.3 [CI: 1.2 to 5]) and obese girls (2.1 [CI: 2 - 2.2]) are more likely to have MS, indicating significant linear association between BMI and the outcome (X²=29.4 [p<0.001]). Pubescent children under 10 years of age with MS had higher %G. The prevalent components were altered waist circumference (27.2 % [CI23 %-31 %]) and low HDL cholesterol (39.6 % [CI 35 % - 44 %]), as well as prevalence of systemic hypertension in post-pubertal girls. Conclusions MS begins in the pubertal stage, with prevalence in the post-pubertal stage. Excess fat is a trigger in children under 10 years of age. Prevention strategies are needed for the population of children and adolescents.(AU)

Objetivo Analizar la prevalencia del síndrome metabólico (SM) en el estadio puberal de estudiantes de sexo femenino. Métodos Estudio transversal con 449 niños en edad escolar entre ocho y 18 años, estratificado en la etapa de la pubertad, el índice de masa corporal (IMC) y el porcentaje de grasa corporal (% GC). El SM fue clasificado por la Federación Internacional de Diabetes. El análisis se adelantó por medio de la distri study bución de frecuencias, intervalos de confianza (95 %), Chi-cuadrado y Odds ratio para las asociaciones. Resultados La prevalencia de SM fue del 3,3 % (IC:2 %-5 %) y 2,5 % (IC:0,1 %-5 %) en la pubertad y el 7,9 % (IC:3,2 %-12,6 %) en el post-pubescente, con estas asociación significativa con SM (X²=5,2 [p <0,02]). El Odds ratio señala niñas post-púberes (3,3 [IC: 1.2 a 5]) y obesidad (2,1 [IC: 2-2,2]) más probabilidades de SM, lo que indica la asociación lineal significativa entre el IMC y la resultado (X²=29,4 [p<0,001]). Pubescentes menos de 10 años con EM tenía mayor %G. Los componentes predominantes fueron alterados circunferencia de la cintura (27,2 % [IC del 23 %-31 %]) y colesterol HDL bajo (39,6 % [IC del 35 %-44 %]) y la prevalencia de la hipertensión arterial sistémica en la post-puberal. Conclusiones SM comienza en la etapa puberal, con una prevalencia en el post-puberal, y el exceso de grasa es el desencadenante en niños menores de 10 años. Se necesitan estrategias de prevención para la población de niños y adolescentes.(AU)