Nursing students admitted through the affirmative action system display similar performance in professional and academic trajectories to those from the regular path in a public school in Brazil.

OBJECTIVES: Affirmative action providing higher education access for socially vulnerable students has been implemented in several countries. However, these policies remain controversial. This study compares the performance of students admitted through the regular path and social quota systems, during and after completion of nursing education, in a public nursing school in Brazil. METHODS: This retrospective cohort study included all students admitted to nursing school at the School of Health Sciences (ESCS), Brazil, between 2009 and 2014, who were followed until May 2020. The first phase involved document analysis from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey was conducted among the alumni. The social quota system criterion was public school attendance across all primary and secondary education levels. RESULTS: Of the 448 students included in the study, 178 (39.7%) were from the affirmative action and 270 (60.3%) from the regular path systems. Affirmative action students were older at the time of nursing school admission (p < 0.001) and took longer to be admitted to the nursing school (p < 0.001) after completing high school. There were no significant differences in the dropout rates and years to complete nursing school. In the second phase, 108 alumni answered the survey. No significant differences were found in their participation in the undergraduate scientific research program and university extension projects, attending residency programs, getting a master's degree and doctoral degree, monthly income, teaching activity, joining public service through a government job competition process, participation in management activities in the private and public health sector, and degree of job satisfaction. CONCLUSION: Our results revealed that affirmative action is a policy that contributes to the reduction of inequalities and guarantees the training of nursing professionals with a similar professional qualification received through affirmative action and regular path systems.

Comparison Between Students Admitted Through Regular Path and Affirmative Action Systems in a Brazilian Public Medical School.

Purpose: Affirmative action policies to provide access to higher education for socially vulnerable students have been implemented in several countries and have faced many questions nowadays. The aim of the study was to compare the socioeconomic background and performance during and after completing the undergraduate course of students admitted through the regular path and social quota systems in a public medical school in Brazil. Methods: A retrospective cohort study including students admitted to a medical school within the School of Health Sciences (ESCS), in Brazil, between 2005 and 2012, and followed until May 2020. In the first phase, data collection was performed by analyzing documents from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey with 12 questions was sent to the medical school alumni. The social quota system criteria were the public school attendance in all primary and secondary education levels. Results: Among 707 students, 204 (28.9%) were from the social quota and 503 (78.5%) from the regular path system. The place of residence of social quota students had a lower Human Development Index (p < 0.001) and per capita income (p < 0.001) when compared to regular path students. Regular path students were associated with the highest dropout from medical school (OR: 50.552, 95% CI: 12.438-205.453, p < 0.001). There was no difference between regular path and social quota students attending medical residency programs (OR: 1.780, 95% CI: 0.957-3.309, p = 0.069). Out of the 308 alumni who completed the survey, regular path students had more family members who were health professionals than social quota students (p < 0.001). There were no significant differences regarding monthly income, job satisfaction, employment, or management activities. Conclusion: Affirmative action targeted students with a disadvantaged socioeconomic background. Regular path students had a higher dropout rate than social quota students.

Active health Ombudsman service: evaluation of the quality of delivery and birth care.

OBJECTIVE: To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS: This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS: Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS: The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.

Investigation of newborns with abnormal results in a newborn screening program for four lysosomal storage diseases in Brazil.

Lysosomal storage diseases (LSDs) are genetic disorders, clinically heterogeneous, mainly caused by defects in genes encoding lysosomal enzymes that degrade macromolecules. Several LSDs already have specific therapies that may improve clinical outcomes, especially if introduced early in life. With this aim, screening methods have been established and newborn screening (NBS) for some LSDs has been developed. Such programs should include additional procedures for the confirmation (or not) of the cases that had an abnormal result in the initial screening. We present here the methods and results of the additional investigation performed in four babies with positive initial screening results in a program of NBS for LSDs performed by a private laboratory in over 10,000 newborns in Brazil. The suspicion in these cases was of Mucopolysaccharidosis I - MPS I (in two babies), Pompe disease and Gaucher disease (one baby each). One case of pseudodeficiency for MPS I, 1 carrier for MPS I, 1 case of pseudodeficiency for Pompe disease and 1 carrier for Gaucher disease were identified. This report illustrates the challenges that may be encountered by NBS programs for LSDs, and the need of a comprehensive protocol for the rapid and precise investigation of the babies who have an abnormal screening result.

Citologia oncótica cervicovaginal na população lésbica e transgêneros / Cervicovaginal oncotic cytology in the lesbian and transgender population

O câncer de colo uterino causa a morte de milhares de mulheres no mundo. Entre essas mulheres, há grupos como o de lésbicas e transgêneros que têm dificuldade no rastreio devido à discriminação e ao desconhecimento. As lésbicas e transgêneros masculinos que não fizeram histerectomia total devem se manter no rastreio da mesma forma que as mulheres cisgêneros. Transgêneros femininos devem ser seguidas, porém ainda não há protocolos definidos.(AU)

Cervical cancer causes the death of thousands of women worldwide. Among these women, there are groups, like lesbians and transgenders that present difficulty in screening due to discrimination and lack of knowledge. The lesbians and transgenders men who didn´t have total hysterectomy, must keeping in screening the same way as cisgenders. Transgender woman must be followed, but there aren't definitive guidelines.(AU)

Active health Ombudsman service: evaluation of the quality of delivery and birth care / Ouvidoria ativa em saúde: avaliação da qualidade da atenção ao parto e nascimento

ABSTRACT OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.

RESUMO OBJETIVO Avaliar a ouvidoria ativa em saúde como ferramenta de avaliação da qualidade da atenção ao parto e nascimento da Rede Cegonha do Distrito Federal. MÉTODOS Estudo transversal, do tipo inquérito por via telefônica, em 1.007 puérperas com partos realizados entre 15/10/2013 e 19/11/2013, nas 12 maternidades públicas que compõem a Rede Cegonha no Distrito Federal. O instrumento continha 25 questões de múltipla escolha ou do tipo escala Likert, que incluiu dados sociodemográficos e avaliação da aceitabilidade em cinco domínios: acessibilidade, relacionamento entre o paciente e os profissionais de saúde, condições da estrutura do serviço, informação ao paciente, e equidade e opinião do paciente. Variáveis qualitativas ou categóricas foram estudadas de acordo com a frequência e distribuição de proporções. Utilizou-se o escore transformado para uma escala de zero a 100 para análise das questões do tipo escala Likert. Resultados foram expressos em média e desvio-padrão. RESULTADOS O acesso às consultas de pré-natal foi avaliado como bom ou ótimo por 86,1% das participantes e os exames laboratoriais como bom ou ótimo por 85,2%. O acesso aos exames de imagem teve 45,7% avaliações boas ou ótimas; 79,5% das entrevistadas realizaram o parto na maternidade onde buscaram atendimento inicial e 18,3% receberam visita domiciliar por agente comunitário de saúde após a alta. A maioria relatou que os recém-nascidos foram colocados em seus colos ou peitos imediatamente após o nascimento, 48,9% tiveram presença de acompanhante no momento do parto, 76,3% foram orientadas em relação à primeira consulta dos recém-nascidos e 94,8% sobre aleitamento materno na maternidade. Quanto à avaliação dos profissionais de saúde, 85,9% das mulheres consideraram o acolhimento e a cordialidade recebidos como bons ou ótimos no pré-natal e 94,8%, como bons ou ótimos na maternidade. CONCLUSÕES A ouvidoria ativa em saúde contribuiu para a avaliação da qualidade da gestão pública, possibilitando a incorporação da perspectiva das usuárias do serviço de saúde na avaliação da aceitabilidade da Rede Cegonha no Distrito Federal.

Concepção de gestantes sobre o parto cesariano / Pregnant women's conceptions regarding caesarean birth / Concepción de gestantes sobre la operación cesárea

A gestação e o parto são acontecimentos biossociais permeados por valores culturais, familiares e emocionais e envolvem crenças e mitos que influenciam na escolha da via de parto. Este estudo objetivou identificar os motivos que levam gestantes a optar pela cesariana, pesquisar a influência cultural e familiar na escolha da via de parto e investigar as orientações recebidas. Caracteriza-se como pesquisa descritiva de abordagem qualitativa; os dados foram coletados em 2012 por meio de entrevista semiestruturada com 20 gestantes de duas clínicas privadas e duas Unidades Básicas de Saúde. Os resultados apontaram a dor e a influência familiar e cultural como interferentes na escolha da via do parto. Para reverter o crescente número de cesáreas é necessário destacar a importância da ação educativa durante o pré-natal para que a gestante possa ser ouvida e esclarecida em suas dúvidas e temores.

Pregnancy and birth are bio-social happenings permeated with cultural, family and emotional values, and involve beliefs and myths which influence the choice of means of birth. This study aimed to identify the reasons which lead pregnant women to opt for caesarean births, to research the cultural and family influence on the choice of the means of birth, and to investigate the advice received. It is characterized as descriptive research with a qualitative approach; the data was collected in 2012 through semi-structured interviews with 20 pregnant women in two private clinics and two Primary Health Care Centers. The results indicated pain and the family and cultural influences as influencing the choice as to the means of birth. To roll back the growing number of caesareans, it is necessary to emphasize the importance of educational action during the pre-natal consultations so that the pregnant woman may be heard and have her doubts and fears clarified.

La gestación y el parto son acontecimientos biosociales permeados por valores culturales, familiares y emocionales e involucran creencias y mitos que influencian en la elección de la vía de parto. Este estudio tuvo la finalidad de identificar los motivos de las gestantes para optar por la cesárea, investigar la influencia cultural y familiar en la elección de la vía de parto e investigar las orientaciones que estas mujeres tuvieron. Se caracteriza como investigación descriptiva de abordaje cualitativo; los datos fueron obtenidos en 2012 por medio de entrevista semiestructurada con 20 gestantes de dos clínicas particulares y dos Unidades Básicas de Salud. Los resultados apuntaron el dolor y la influencia familiar y cultural como factores que se interponen en la elección de la vía del parto. Para reverter el creciente número de cesáreas, es necesario destacar la importancia de la acción educativa durante el prenatal para que la gestante pueda ser comprendida y para que sus dudas y miedos sean aclarados.

Ouvidoria ativa em saúde na Rede Cegonha do Distrito Federal

Introdução: A Rede Cegonha (RC) é composta por um conjunto de medidas que visa garantir às mulheres usuárias do SUS atendimento adequado, seguro e humanizado, desde a confirmação da gravidez, atenção ao pré-natal, parto, puerpério, incluindo a saúde da criança até dois anos de idade. Foi criada pela portaria 1.459/2011, do Ministério da Saúde. Em 2011, na Secretaria de Estado de Saúde do Distrito Federal (SES/DF), formou-se o Grupo Condutor que elaborou um Plano de Ação para implementação da RC no DF. A Ouvidoria Ativa em Saúde (OAS) é um conceito inovador que objetiva defender os direitos do usuário do Sistema Único de Saúde (SUS) e atuar como um instrumento de avaliação da gestão pública, mediante a promoção do exercício da democracia direta e de pesquisas sobre a satisfação do usuário. Objetivos: Avaliar a qualidade dos serviços prestados pela RC, sob a perspectiva da mulher usuária cujo parto ocorreu em maternidades públicas do DF. Metodologia: Estudo transversal, tipo inquérito, realizado por via telefônica, pela equipe da Ouvidoria da SES/DF. No período estudado (15/10/2013 a 19/11/2013), foram realizados 3.750 partos nas 12 maternidades da SES/DF. Foram entrevistadas 1007 puérperas (26,8%). O questionário, constituído de 26 questões fechadas, do tipo múltipla escolha ou Likert, incluiu os seguintes itens: 1. Dados sociodemográficos; 2. Assistência materno-infantil; 3. Acesso aos serviços; 4. Relação com os profissionais de saúde; e, 5. Infraestrutura. Resultados: A faixa etária mais frequente foi 25-29 anos (26,3%, N=265/1007). O local de residência era o DF em 69,7% (N=702/1007). 74,2% fizeram acompanhamento pré-natal exclusivo no DF (N=748/1007) e 22,4% totalmente fora do DF (N= 226/1007). Apenas 0,2% não realizaram acompanhamento pré-natal (N=2/1007) e 67,8% realizaram 6 ou mais consultas de pré-natal (N=683/1007). Entre as que realizaram acompanhamento pré-natal exclusivo no DF, o acesso a consultas foi avaliado como bom/ótimo em 86,1% (N=644/748) e a exames laboratoriais como bom/ótimo em 85,2% (N=637/748). Acesso aos exames de imagem teve pior desempenho com 45,7% (N= 342/748) de avaliações boas/ótimas. 79,5% das entrevistadas realizaram o parto na maternidade onde buscaram atendimento inicial (N=801/1007). Somente 18,3% haviam recebido visita domiciliar por agente comunitário de saúde após a alta (N=184/1007). A maioria relatou que os recém-nascidos foram colocados em seus colos ou peitos imediatamente após o nascimento (69,0%, N=695/1007). Porém, somente 48,9% tiveram presença de acompanhante no momento do parto (N=492/1007). 76,3% foram informadas pela equipe de saúde em relação a data e Centro de Saúde no qual deveriam levar o recém-nascido para a 1a consulta (N=768/1007) e 94,8% receberam orientação para prática do aleitamento materno ainda na maternidade (N=955/1007). Quanto a avaliação do relacionamento com os profissionais de saúde, 85,9% (N= 865/1007) consideraram acolhimento e cordialidade recebidos durante o pré-natal como bom/ótimo e 94,8% (N=955/1007) classificaram a qualidade do atendimento recebido na maternidade como bom/ótimo. Conclusão: Este trabalho de OAS funcionou como um dispositivo inovador para avaliação da qualidade da gestão pública, pois viabilizou a incorporação da perspectiva da mulher usuária nos processos decisórios para a melhoria dos serviços de saúde da Rede Cegonha no DF.