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Objective: To investigate women's perspectives on the quality of maternal and new-born care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods: Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards- based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results: 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a signifi-cantly lower QMNC index for 2020 compared with 2021 (P < 0.001).Conclusion: This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate health-care strategies to improve health care for women and newborns in Latvia are required.

Objective To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. Methods Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. Results Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. Conclusion Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

Objective: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. Methods: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. Results: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n= 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 4 87, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. Conclusion: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic.Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured question- naire with 40 key WHO standards- based quality measures. Four domains of QMNC were assessed: (1) provision of care ; (2) experience of care ; (3) availability of human and physical resources ; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region.Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high- quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%) ; adequate staff profession-alism (94.6%) ; adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center ; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstru- mental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1% ; 19.5% in Lisbon to 28.2% in Algarve).Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

Objective: To investigate potential associations between individual and country- level factors and medicalization of birth in 15 European countries during the COVID- 19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020– 2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P

Objective To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. Methods Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. Results Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. Conclusion Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.

Introdução: As doenças crônicas não transmissíveis (DCNTs), são as principais causas de mortalidade no mundo, correspondendo 71% das mortes globais. Dentre as DCNTs, destacam- se o Diabetes Mellitus (DM) e a Hipertensão Arterial Sistêmica (HAS), como causas diretas e, ou indiretas para o desenvolvimento de doenças cardiovasculares (DCV) e doença renal crônica (DRC), gerando impactos sociais e econômicos substanciais aos indivíduos, famílias, à sociedade e os sistemas públicos de saúde. O DM e o pré-diabetes vêm aumentando globalmente e destaca-se como outro importante problema de saúde pública a alta prevalência de DM não diagnosticado, inclusive no Brasil. Por serem condições sensíveis à Atenção Primária à Saúde (APS), é importante o investimento dos gestores (municipal, estadual e federal), profissionais de saúde e comunidades, em políticas e ações de manejo e gerenciamento destas morbidades, no sentido de combater às suas causas e prevenção de agravos e complicações. Objetivos: Este estudo teve duplo objetivo. O primeiro visa determinar a prevalência de pré-diabetes e DM não diagnosticado e os fatores associados em indivíduos com diagnóstico de HAS; e o segundo, identificar a prevalência de função renal diminuída pela taxa de filtração glomerular (TFG) e albuminúria entre os indivíduos com pré-diabetes, DM não diagnosticado e DM diagnosticado previamente. Métodos: Estudo do tipo transversal, realizado no período de agosto de 2017 a abril de 2018, com indivíduos com diagnóstico de HAS e, ou DM cadastrados na APS de Viçosa- MG. Foram coletados dados sociodemográficos, hábitos e estilo de vida, antropométricos, exames bioquímicos e realizada a aferição da pressão arterial. Foram estimadas as prevalências de pré-diabetes, DM diagnosticado previamente e DM não diagnosticado, assim como a prevalência de TFG diminuída e albuminúria pela classificação do estado de diabetes. Para verificar as associações entre as variáveis categóricas foi utilizado o teste qui-quadrado de Pearson. Nas variáveis contínuas foi testada a normalidade, utilizando-se o teste Komogorov Smirnov e utilizada ANOVA ou teste de Kruskal-Wallis de acordo com o resultado do teste. Para todos os testes foram fixados o nível de confiança de 95%. Regressão logística bivariada e multivariada foi utilizada para estimar a força de associação entre as variáveis dependentes (Taxa de filtração glomerular diminuída ealbuminúria) e explicativas (Glicemia normal, pré-diabetes, DM não diagnosticado, hemoglobina glicada e glicemia de jejum). Resultados: Entre os indivíduos com HAS, 58,6% apresentaram alteração no metabolismo da glicose, destes 47,5% tinham de pré-diabetes e 11,1% DM não diagnosticado, ou seja, tinham a doença e desconheciam esta condição. Os fatores associados a alteração da glicose entre os hipertensos na análise multivariada foram a glicose alterada, a idade, triglicerídeos e IMC elevados. Na amostra com 841 individuos, 227 (27%), 53 (6,3%) e 363 (43,2%) tinham pré-diabetes, DM não diagnosticado e DM diagnóstico previamente respectivamente. A prevalência de TFG diminuída geral foi de 8% sendo superior nos indivíduos com DM não diagnosticado (15,1%). A prevalência de albuminúria alterada foi de 9,4% sendo mais prevalente entre os indivíduos com DM diagnosticado previamente (15,4%). TFG diminuída foi associada a DM não diagnosticado; e a albuminúria alterada associou-se ao DM diagnosticado, DM não diagnosticado, hemoglobina glicolisada (HbA1c) e glicemia plasmática de jejum elevados. Conclusões: Encontrou-se uma alta prevalência de função renal diminuída entre indivíduos com DM não diagnosticado e DM prévio, assim como pré-diabetes e DM não diagnosticado entre os indivíduos com HAS. Esses indivíduos podem se beneficiar de intervenções como diagnóstico preceoce e tratamento oportuno e assim impedir o desenvolvimento de complicações do DM e da DRC, destacando-se o papel estratégico da APS no rastreamento e monitoramento das principais doenças crônicas (HAS e DM), traçando estratégias e ações para a reduzir o desenvolvimento destas doenças, suas complicações e mortes prematuras, bem como, os custos financeiros evitáveis, conforme recomendado pelos órgãos internacionais e nacionais: Organização Mundial de Saúde (OMS) e Associação Americana de Diabetes (ADA) e Sociedade Brasileira de Diabetes (SBD) e Sociedade barsileira de Cardiologia (SBC). Palavras-Chave: Prevalência. Diabetes Mellitus. Diabetes Mellitus não diagnosticado. Pré- diabetes. Hipertensão Arterial. Doença Renal Crônica. Atenção Primária à Saúde. Introduction: Chronic non-communicable diseases (NCDs) are the main causes of mortality worldwide, accounting for 71% of deaths globally. Among NCDs, Diabetes Mellitus (DM) and Systemic Arterial Hypertension (SAH) stand out as direct and / or indirect causes for the development of cardiovascular diseases (CVD) and chronic kidney disease (CKD), generating social and substantial economic costs to individuals, families, society and public health systems. DM and prediabetes have been increasing globally and the high prevalence of undiagnosed DM stands out as another important public health problem, Brazil included. Since those conditions are germane to Primary Health Care (PHC), it is important for politicians in all levels of government, along with health professionals and communities, to commit to policies and actions that deal and manage those morbidities, in order to combat their causes and prevent possible worsening and complications of the situation. Objectives: The goal of this study is twofold. First, it aims to determine the prevalence of prediabetes and undiagnosed DM and the associated factors in individuals diagnosed with SAH; second, it aims to identify the prevalence of kidney function decreased by the glomerular filtration rate (GFR) and albuminuria among individuals with pre-diabetes, undiagnosed DM and previously diagnosed DM. Method: Cross- sectional study carried out from August 2017 to April 2018 with individuals diagnosed with SAH and / or DM admitted to the PHC of Viçosa, MG. Sociodemographic data, habits and lifestyle, anthropometric data and biochemical tests were collected, as well as blood pressure was measured. The prevalence of prediabetes, previously diagnosed DM and undiagnosed DM were estimated, as well as the prevalence of decreased GFR and albuminuria by the classification of the diabetes status. Pearson's chi-squared test was applied to check associations between categorical variables. For continuous variables, normality was tested using the Komogorov-Smirnov test and ANOVA or Kruskal-Wallis test was used according to the test result. For all tests, a 95% confidence level was set. Bivariate and multivariate logistic regression was applied to estimate the strength of association between the dependent variables (decreased glomerular filtration rate and albuminuria) and explanatory variables (normal glycemia, prediabetes, undiagnosed DM, glycated hemoglobin and fasting glycemia). Results:Among individuals with SAH 58.6% had altered glucose metabolism and 47.5% of these had pre-diabetes, 11.1% had undiagnosed DM, i.e., they had the disease and were unaware of it. Among hypertensive individuals, the factors associated with glucose alteration in the multivariate analysis were altered glucose, age, triglycerides and elevated BMI. In the sample with 841 individuals, 227 (27%), 53 (6.3%) and 363 (43.2%) had, respectively, pre-diabetes, undiagnosed DM and previously diagnosed DM. The overall decreased GFR prevalence was 8%, being higher in individuals with undiagnosed DM (15.1%). The prevalence of altered albuminuria was 9.4%, being more prevalent among individuals with previously diagnosed DM (15.4%). Decreased GFR was associated with undiagnosed DM; altered albuminuria was associated with diagnosed DM, undiagnosed DM, glycated hemoglobin (HbA1c) and elevated fasting plasma glucose. Conclusion: A high prevalence of decreased kidney function was found among individuals with undiagnosed diabetes and previous DM, as well as prediabetes and undiagnosed DM among individuals with SAH. Those individuals can benefit from interventions such as early diagnosis and timely treatment and thus prevent the development of complications of DM and CKD, highlighting the strategic role of PHC in the tracking and monitoring of the main chronic diseases (SAH and DM), outlining strategies and actions to reduce the development of these diseases, their complications and premature deaths, as well as avoidable financial costs, as recommended by international and national bodies: World Health Organization (WHO) and American Diabetes Association (ADA) and Brazilian Society Diabetes (SBD) and Brazilian Society of Cardiology (SBC). Keywords: Prevalence. Diabetes Mellitus. Undiagnosed Diabetes Mellitus. Prediabetes. Arterial Hypertension. Chronic Kidney Disease. Primary Health Care.

INTRODUÇÃO: Este estudo busca conhecer a percepção de preceptores e residentes egressos acerca da Residência Multiprofissional em Saúde ocorrida no Hospital das Clínicas da Universidade Federal de Goiás no período de 2010 a 2012. OBJETIVOS: Conhecer a percepção de assistentes sociais (preceptoras e egressas) em relação à sua atuação, bem como compreender o processo de implantação e implementação do Programa de Residência Multiprofissional em Saúde (PRMS); identificar as competências necessárias quanto ao preparo para o trabalho no SUS e descrever as dificuldades encontradas no campo de atuação. MÉTODOS: Estudo descritivo, exploratório, com abordagem qualitativa. O instrumental utilizado foi entrevista semiestruturada com perguntas abertas, a cinco preceptoras e a doze assistentes sociais egressas. As entrevistas transcritas foram submetidas à análise de conteúdo proposta por Bardin utilizando o software ATLAS TI. As análises foram feitas levando em consideração a formação e a atuação profissional na residência e apresentados os fatores que interferem no campo de atuação. RESULTADOS: Há necessidade de aquisição de novos conhecimentos para o trabalho em equipe multiprofissional; desenvolver competências específicas de preceptoria e para o trabalho no SUS e aprimorar as relações interprofissionais, multiprofissionais e interpessoais. CONCLUSÃO: A análise das entrevistas demonstrou que os objetivos da residência multiprofissional em saúde no Serviço Social foram alcançados, embora, seja necessário pensar em ações específicas para o aprimoramento de competências que contribuam para o exercício da função de preceptor e para o trabalho no SUS focado na interdisciplinaridade e integralidade da atenção em saúde. INTRODUCTION: This study is about knowing the perception of former students and preceptors relative to the Multidisciplinary Residency in Health at the Federal University of Goiás Public Hospital during the period of 2010 to 2012. OBJECTIVES: To analyze the perception of social workers (preceptors and former students) with respect to their performance, as well as understand the deployment and implementation process of the Multidisciplinary Residency in Health Program (PRMS as the portuguese acronym); identify the necessary skills to labor in the SUS and describe the difficulties encountered in the field of action. METHODS: A descriptive and exploratory study with qualitative approach. The instrument was a semi-structured interview with open questions recorded from five preceptors and twelve former social workers students. The transcribed interviews were submitted to content analysis proposed by Bardin and using the software ATLAS TI. The analyzes were performed taking into account the formation and the professional performance in residence and presented the factors that affect the field of action. RESULTS: It’s necessary to: acquire new knowledges to work in multidisciplinary teams; to develop specific competencies for preceptorship and for work in the SUS; to enhance inter-branch, multi-professional and interpersonal relationships. CONCLUSION: The analysis of the content of the interviews showed that the goals of the health multi-professional residence, specifically in Social Work, have been achieved, though, it is necessary to consider specific actions to improve skills that contribute to the exercise of the preceptor role and to work in the SUS focused on interdisciplinarity and integrality of health care.