Identificação de elementos estratégicos para implantação e engajamento de serviços de teleconsultoria para atenção primária à saúde: uma revisão de literatura / Identification of strategic elements for the implementation and engagement of teleconsulting services for primary health care: a literature review

A construção deste artigo é uma iniciativa gerada a partir de necessidades percebidas no Projeto Regula + Brasil Colaborativo / PROADI-SUS, relacionadas à dificuldade de uso espontâneo de teleconsultoria pelos profissionais da APS. O objetivo deste artigo foi apoiar o uso amplo e apropriado de teleconsultorias, maximizando resultados de investimentos em projeto e programas com esse foco. Foi realizado por meio de revisão simples de literatura, mediante busca no Google Acadêmico com o termo “teleconsultoria” em português, incluindo 19 artigos e 2 documentos do Ministério da Saúde, com estudos publicados a partir de 2007 até o ano de 2021. A síntese dos resultados, apontou para uma série de elementos que podem ser considerados estratégicos na implantação e engajamento dos serviços de teleconsultoria: plataforma de TICs com boa usabilidade, teleconsultores adequados às necessidades locais da APS, existência de equipamentos, insumos e redes apropriados; participação dos profissionais-alvo da APS no desenho dos processos; circulação de opiniões favoráveis por profissionais líderes para seu uso; incentivo continuado por parte dos gestores; treinamento apropriado; mapeamento de dificuldades; e monitoramento do processo de implantação e uso. A conclusão da pesquisa indica que mesmo que esses elementos não possam ser considerados como protocolo a ser seguido, uma vez que o contexto local deva ser considerado, a utilização ampla de estratégias pode potencializar o uso da teleconsultoria em larga escala

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Evaluation of the consequences of primary health care expansion in municipal districts in full management of the São Paulo State Health System

Este projeto de pesquisa tem como: Objetivo geral: Avaliar as repercussões da expansão da Atenção Básica em municípios em Gestão Plena do Sistema Único de Saúde, selecionados no Estado de São Paulo e objetivos específicos: a) Identificar as diretrizes políticas no nível municipal que impulsionaram a expansão da Atenção Básica e dos outros níveis de complexidade da atenção do sistema municipal; b) Analisar a demanda por procedimentos ambulatoriais especializados e de alta complexidade, gerada pela expansão da Atenção Básica. A metodologia utilizada foi Estudo de Caso, pois possibilita conhecer o fenômeno, adequadamente, a partir da exploração intensa de um único caso. Utiliza-se de abordagens quantitativas e qualitativas. Para interpretação dos dados qualitativos, a técnica empregada foi Análise de Conteúdo. Este projeto de pesquisa apresentou os seguintes resultados: A expansão da Atenção Básica, por meio da Estratégia Saúde da Família, é motivada pelo desejo de mudança na Atenção Básica e tem como objetivo a reorganização do Sistema de Saúde Local; A expansão da Atenção Básica trouxe repercussões para o sistema, que não foram contempladas no \"planejamento\" inicial, tais como: O despreparo dos profissionais e a alta rotatividade, colocando em risco a sustentabilidade da Estratégia Saúde da Família e reorganização da rede de serviços de Saúde; maior demanda por serviços de média e alta complexidade.This research project aims to evaluate the consequences of the increasing implementation of the basic health program in municipal districts, selected, in full management of the single system of health of the state of Sao Paulo as a general goal and as specific goals: a) identify the political variables - at the municipal district\'s level - which influence upon the growth of the process of implementation of the basic health program and other levels of complexity as well; b) Evaluate the demand for policlinical procedures of high complexity and specialized, generated by the expansion of the basic health program. The methodology used was that of a case study because it makes possible to know the phenomenon, in an adequate way, from the intense exploration of a single case. Quantitative and qualitative approaches are employed. In order to interpret the qualitative data, the technique of content analysis was employed. This research project generated the following results: The expansion of the basic health program, through the family health strategy, is motivated by the desire of a change in the basic health program and aims to reshape the local health system. The expansion of the basic health program brought consequences to the system, which weren\'t anticipated at the beggining of the process, such as: the lack of capacity and competence of the profesionals involved and the high alternation of these same people, endangering the subsistence of the family health strategy and the reorganization of the health services network; higher demand for medium and high complexity services

A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections

Introduction: Physiotherapy may play a role in the recovery of signs, symptoms and function of patients with lower respiratory tract infections (LRTI) but its effectiveness is still controversial. Objectives: To assess the effects of respiratory physiotherapy compared with standard pharmacological care on symptoms and function in outpatients with LRTI. Design: Single-blind, randomised controlled trial. Setting: Outpatients were recruited from the casualties of a central hospital. Participants: Outpatients with LRTI were recruited and randomly allocated to the control (pharmacological) or experimental (pharmacological and respiratory physiotherapy) group. Intervention: The intervention consisted of conventional pharmacological treatment and conventional pharmacological treatment plus respiratory physiotherapy. Respiratory physiotherapy included breathing and airway clearance techniques, exercise training and education during 3-weeks, 3 times per week. Main outcome measure: Primary outcome measures - occupation rate of wheezes Wh%; Secondary outcome measures - number of crackles, peripheral oxygen saturation (SpO2) modified Borg scale (mBorg), modified Medical Research Council scale (mMRC), 6-min walk test (6MWT), forced expiratory volume in 1 s and forced vital capacity, and volume and density of the lung and bronchial tree volume. Results: Ninety-seven patients (53 controls and 44 experimental) completed the intervention. After the intervention, both groups improved significantly in all variables (0.0001 < p < 0.04; 0.001<ƞ2<0.092), with the exception of the mBorg. The magnitude of improvement of the experimental group exceeded the control group in the number of crackles, SpO2 levels, mMRC and 6MWT (0.002 < p < 0.032; 0.002<ƞ2<0.092). Conclusion: Adding respiratory physiotherapy to the pharmacological treatment of outpatients with LRTI results in greater recovery of symptoms and function parameters. Trial registration: NCT02053870.publishe

Evaluation Model for developing effective indicators for health surveillance actions in Brazil

Abstract Objective: to present an evaluation model for developing effective indicators for the Vigilância Sanitária (VISA) (Sanitary and Health Surveillance) actions in Brazil. Methods: an exploratory, evaluative study from primary sources data - electronic form by key informants and reports on national, international and secondary benchmarking visits - documental analysis. Results: the diversity of VISA management practices made it possible to define the evaluation object: Health Surveillance Actions - as an organized action system. The components: management; regulation; sanitary and health control; sanitary and health risk monitoring and information, communication and health education were derived from the aims of the intervention and composes a central structure of the Theoretical Model and the Logical Model Actions of VISA in the Sistema Nacional de Vigilância Sanitária (SNVS) (National Sanitary and Health Surveillance System) . Conclusions: The Vigilância Sanitária (VISA) (Sanitary and Health Surveillance) accumulates experience with the process indicators for monitoring actions, being incipient are capable of evaluating its impact. The theoretical resources in the evaluation area support the information management in the VISA field and besides contributing for studies on social determinants and the incorporation of analyses in historic series

Characterization of a large cluster of HIV-1 A1 infections detected in Portugal and connected to several Western European countries

HIV-1 subtypes associate with differences in transmission and disease progression. Thus, the existence of geographic hotspots of subtype diversity deepens the complexity of HIV-1/AIDS control. The already high subtype diversity in Portugal seems to be increasing due to infections with sub-subtype A1 virus. We performed phylogenetic analysis of 65 A1 sequences newly obtained from 14 Portuguese hospitals and 425 closely related database sequences. 80% of the A1 Portuguese isolates gathered in a main phylogenetic clade (MA1). Six transmission clusters were identified in MA1, encompassing isolates from Portugal, Spain, France, and United Kingdom. The most common transmission route identified was men who have sex with men. The origin of the MA1 was linked to Greece, with the first introduction to Portugal dating back to 1996 (95% HPD: 1993.6-1999.2). Individuals infected with MA1 virus revealed lower viral loads and higher CD4+ T-cell counts in comparison with those infected by subtype B. The expanding A1 clusters in Portugal are connected to other European countries and share a recent common ancestor with the Greek A1 outbreak. The recent expansion of this HIV-1 subtype might be related to a slower disease progression leading to a population level delay in its diagnostic.Supported by FEDER, COMPETE, and FCT by the projects NORTE-01-0145-FEDER-000013, POCI-01-0145-FEDER-007038 and IF/00474/2014; FCT PhD scholarship PDE/BDE/113599/2015; FCT contract FCT IF/00474/2014; European Funds through grant BEST HOPE (project funded through HIVERA, grant 249697) and by FCT PTDC/DTP-EPI/7066/2014. Global Health and Tropical Medicine Center are funded through FCT (UID/Multi/04413/2013). We would like to acknowledge all the patients and health care professionals from the Portuguese hospitals that contributed in some way to this study

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Núcleos de Ensino da Unesp: artigos 2010: volume 2: formação de professores

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data