A Review of the Effectiveness of Audio-Only Telemedicine for Chronic Disease Management.

Background: The clinical effectiveness of audio-only telemedicine has not been fully quantified. The pandemic afforded a unique situation to retrospectively observe clinical outcomes of care for three disease cohorts within three care models, including audio-only telemedicine. Methods: Patients were classified into three care models: audio-only telemedicine, in-person, and hybrid. Each model was compared with an aggregate group before the onset of the pandemic and within each group during the pandemic. Each disease cohort was evaluated in cross-sectional and paired analyses. Results: Patients (n = 52,720) were grouped within one of three care models. A majority (n = 48,335) of patients qualified for the "pre" group comparison. The audio-only telemedicine care model showed similar control of renal disease, hypertension control, and diabetes management than in-person and hybrid care models. Conclusions: Audio-only telemedicine appears to be noninferior to in-person or hybrid models for chronic disease management for the diseases studied. In all instances, it had similar control compared with the in-person care model. We acknowledge the limitations of this study, including convenience sampling and a limited observation timeframe. Audio-only telemedicine should be considered a viable care model modality that can be integrated into options for patient care. Further study and investment are warranted, as it provides efficacy and convenience to health systems (Clinical Registration Number # 32449).

Avaliação de atributos da Atenção Primária à Saúde: a perspectiva dos profissionais / Evaluación de atributos de la Atención Primaria de Salud: perspectiva de los profesionales / Assessment of primary health care features: the professionals' perspective

Resumo Objetivo: Avaliar os atributos da Atenção Primária à Saúde, na perspectiva dos profissionais, em município com 100% de cobertura da Estratégia de Saúde da Família. Métodos: Estudo observacional analítico, delineamento transversal, com 83 profissionais da Atenção Primária à Saúde. Utilizou-se o Primary Care Assessment Tool , versão profissionais, que avalia numa escala de zero a dez, a orientação da atenção primária para atributos essenciais e derivados. Resultados: O escore geral, considerado de alto desempenho, foi de 7,23. Quando comparados os grupos de profissionais com percepção de baixo e alto desempenho, observa-se diferença nas médias dos Atributos Essenciais (p=0,042), reforçando fragilidade no atributo acesso de primeiro contato, com baixo desempenho (3,70). O Escore de Atributos Derivados teve maior desempenho (8,27), destacando a orientação familiar e comunitária. Conclusão: A avaliação indica percepção positiva da Atenção Primária à Saúde, com possibilidade de melhorias em todos os atributos, em especial o acesso, atendendo aos objetivos de qualidade das políticas públicas em saúde.

Resumen Objetivo: Evaluar los atributos de la Atención Primaria de Salud, bajo la perspectiva de los profesionales, en un municipio con el 100 % de cobertura de la Estrategia Salud de la Familia. Métodos: Estudio observacional analítico, de diseño transversal, con 83 profesionales de la Atención Primaria de Salud. Se utilizó la Primary Care Assessment Tool , versión profesionales, que evalúa en una escala de cero a diez la orientación de la atención primaria en atributos esenciales y derivados. Resultados: La puntuación general, considerada de alto desempeño, fue de 7,23. Al comparar los grupos de profesionales con percepción de bajo y alto desempeño, se observa una diferencia en los promedios de los Atributos Esenciales (p=0,042), lo que refuerza la debilidad del atributo acceso de primer contacto, con bajo desempeño (3,70). La puntuación de Atributos Derivados tuvo un mayor desempeño (8,27), donde se destacó la orientación familiar y comunitaria. Conclusión: La evaluación indica una percepción positiva de la Atención Primaria de Salud, con posibilidad de mejora en todos los atributos, en especial el acceso, y de este modo se cumplen los objetivos de calidad de las políticas públicas de salud.

Abstract Objective: To assess primary health care features from the perspective of professionals in a Brazilian municipality with 100% of Family Health Strategy coverage. Methods: Analytical observational study, with a cross-sectional design, involving 83 primary healthcare professionals. It applied the Primary Care Assessment Tool , professional version, which assesses the orientation of primary health care to essential and derivative features in a scale from 0 to 10. Results: The overall score was 7.23, which was considered a perception of high performance. Comparison of groups of professionals with perception of low and high performance showed a difference in the averages obtained for essential features (p=0.042), reinforcing the fragility in first-contact accessibility, which had a low performance (3.70). The score for derivative features showed better performance (8.27), with an emphasis on family centeredness and community orientation. Conclusion: The assessment indicated a positive perception regarding primary health care, with the possibility of improving all features, especially accessibility, to meet the quality objectives of public health policies.

Modelo de vulnerabilidade em saúde: esclarecimento conceitual na perspectiva do sujeito-social / Modelo de vulnerabilidad en salud: esclarecimiento conceptual en la perspectiva del sujeto social / Health vulnerability model: conceptual clarification from social subjects' perspective

Resumo Objetivo: Esclarecer a vulnerabilidade em saúde a partir da proposição de um modelo conceitual. Método: Aplicou-se o esclarecimento de conceito segundo proposta de Meleis, subsidiado por revisão e por reflexão crítica. Selecionaram-se 101 artigos em cinco base de dados por meio da equação de busca " vulnerability " AND " health ", cujos achados foram submetidos à análise categorial e de similitude. Essa foi processada no software Iramuteq para identificação do elemento essencial, conceitos e subconceitos da vulnerabilidade em saúde - e posterior construção de um modelo. Resultados: A partir da revisão e etapas posteriores, a vulnerabilidade em saúde foi redefinida, e foi construído um modelo com base na relação de três componentes: 1) O sujeito-social, com seus conceitos e subconceitos; 2) A condição de precariedade e agenciamento; 3) Processos de potencialização ou fragilização da vulnerabilidade em saúde. O fenômeno foi descrito, identificando-se o sujeito-social como elemento essencial, e foram conhecidos os principais atributos com as definições constitutivas e operacionais, tornando possível identificar a presença da vulnerabilidade em saúde. Conclusão: O conceito foi esclarecido por meio da construção de um modelo, fornecendo subsídios à elaboração de pesquisas na área da saúde e ao futuro desenvolvimento de teorias de médio ou longo alcance do fenômeno de interesse.

Resumen Objetivo: Esclarecer la vulnerabilidad en salud a partir de la proposición de un modelo conceptual. Métodos: Se aplicó el esclarecimiento de concepto según la propuesta de Meleis, respaldado con revisión y reflexión crítica. Se seleccionaron 101 artículos en cinco bases de datos por medio de la ecuación de búsqueda " vulnerability " AND " health ", cuyos resultados fueron sometidos al análisis categorial y de similitud. Este fue procesado con el software Iramuteq para la identificación del elemento esencial, conceptos y subconceptos de la vulnerabilidad en salud y la posterior construcción de un modelo. Resultados: A partir de la revisión y etapas posteriores, la vulnerabilidad en salud fue redefinida y se construyó un modelo basado en la relación de tres componentes: 1) El sujeto social, con sus conceptos y subconceptos, 2) La condición de precariedad y gestión, 3) Procesos de potencialización o debilitamiento de la vulnerabilidad en salud. El fenómeno se describió con la identificación del sujeto social como elemento esencial y se conocieron los principales atributos con las definiciones constitutivas y operativas, lo que permitió identificar la presencia de la vulnerabilidad en salud. Conclusión: El concepto fue esclarecido mediante la construcción de un modelo y respalda la elaboración de estudios en el área de la salud y el desarrollo futuro de teorías de medio o largo alcance del fenómeno de interés.

Abstract Objective: To clarify health vulnerability from the proposition of a conceptual model. Method: Concept clarification was applied according to Meleis' proposal, supported by review and critical reflection. 101 articles were selected in five databases using the search equation "vulnerability" AND "health", whose findings were submitted to category and similar analysis. This was processed in the software Iramuteq to identify the essential element, concepts and subconcepts of vulnerability in health - and later construction of a model. Results: From the review and later stages, health vulnerability was redefined and a model was constructed based on the relationship of three components: 1) The social subject, with its concepts and subconcepts; 2) The condition of precariousness and agency; 3) Processes of potentiation or weakening of vulnerability in health. The phenomenon was described, the social subject was identified as an essential element, and the main attributes were known with constitutive and operational definitions, making it possible to identify the presence of vulnerability in health. Conclusion: The concept was clarified through the construction of a model, providing support for the elaboration of research in the health area and future development of medium or long-range theories of the phenomenon of interest.

Syria Profile of the Epidemiology and Management of Early Childhood Caries Before and During the Time of Crisis.

Syria has witnessed the greatest humanitarian crisis of forcibly displaced population since World War II. The present review aimed to outline Syria's profile of the epidemiology and management of early childhood caries (ECC). Before the crisis, the burden of ECC amongst Syrian pre-schoolers had been growing in prevalence and severity. Comparable data showed an increase in the burden of ECC amongst Syrian children aged five years, rising from 74% in 1991 to 81% in 2011, with a dmft value of 8.6. A similar increase was observed in the burden of ECC amongst Syrian children aged three years, rising from 50% in 1991 to 56% in 2011, with a dmft value of 6.1. Whilst there are no data on the burden of ECC during the current crisis, estimates could be extrapolated from data on the current burden of dental caries amongst Syrian primary school children living inside Syria or in informal settlements outside Syria. Such data suggested that the burden of ECC might have further increased amongst Syrian pre-schoolers during the crisis time. This is due to the crisis exacerbating effect on ECC risk factors, in terms of increasing the existing high sugar intake amongst Syrian pre-schoolers as well as increasing different barriers Syrian families face to fresh foods, sugar-free medicines, oral hygiene and fluoride products and accessing essential preventative dental care. Tackling the growing burden of ECC amongst Syrian pre-schoolers should not be postponed till post-crisis time. The seed work for relevant public health interventions could start and be embedded in different health and social initiatives taking place during the time of crisis. A number of public health interventions informed by relevant international and local (Syrian) studies conducted during the time of crisis have been suggested to tackle the burden of ECC amongst Syrian young children. They include a mix of upstream, midstream, and downstream interventions that aim to reduce sugar intake, improve feeding and oral hygiene practices, increase access to an appropriate source of fluoride and build the capacity of the Syrian dental and wider workforce to tackle the growing burden of ECC in Syrian pre-schoolers.

A new cross-platform architecture for epi-info software suite.

BACKGROUND: The Epi-Info software suite, built and maintained by the Centers for Disease Control and Prevention (CDC), is widely used by epidemiologists and public health researchers to collect and analyze public health data, especially in the event of outbreaks such as Ebola and Zika. As it exists today, Epi-Info Desktop runs only on the Windows platform, and the larger Epi-Info Suite of products consists of separate codebases for several different devices and use-cases. Software portability has become increasingly important over the past few years as it offers a number of obvious benefits. These include reduced development time, reduced cost, and simplified system architecture. Thus, there is a blatant need for continued research. Specifically, it is critical to fully understand any underlying negative performance issues which arise from platform-agnostic systems. Such understanding should allow for improved design, and thus result in substantial mitigation of reduced performance. In this paper, we present a viable cross-platform architecture for Epi-Info which solves many of these problems. RESULTS: We have successfully generated executables for Linux, Mac, and Windows from a single code-base, and we have shown that performance need not be completely sacrificed when building a cross-platform application. This has been accomplished by using Electron as a wrapper for an AngularJS app, a Python analytics module, and a local, browser-based NoSQL database. CONCLUSIONS: Promising results warrant future research. Specifically, the design allows for cross-platform form-design, data-collection, offline/online modes, scalable storage, automatic local-to-remote data sync, and fast analytics which rival more traditional approaches.

Potential use cases for the development of an electronic health facility registry in Nigeria: Key informant's perspectives.

BACKGROUND: Master facility lists (MFL) maintain an important standard (unique identifier) in country health information systems that will aid integration and interoperability of multiple health facility based data sources. However, this standard is not readily available in several low and middle income countries where reliable data is most needed for efficient planning. The World Health Organization in 2012 drew up guidelines for the creation of MFLs in countries but this guideline still requires domestication and process modeling for each country adopting it. Nigeria in 2013 published a paper-based MFL directory which it hopes to migrate to an electronic MFL registry for use across the country. OBJECTIVE: To identify the use cases of importance in the development of an electronic health facility registry to manage the MFL compiled in Nigeria. METHODS: Potential use cases for the health facility registry were identified through consultations with key informants at the Federal Ministry of Health. These will serve as input into an electronic MFL registry development effort. RESULTS: The use cases identified include: new health facility is created, update of status of health facility, close-out, relocation, new information available, delete and management of multi-branch health facility. CONCLUSION: Development of an application for the management of MFLs requires proper architectural analysis of the manifestations that can befall a health facility through its lifecycle. A MFL electronic registry will be invaluable to manage health facility data and will aid the integration and interoperability of health facility information systems.

Is tree loss associated with cardiovascular-disease risk in the Women's Health Initiative? A natural experiment.

Data from the Women's Health Initiative were used to quantify the relationship between the loss of trees to an invasive forest pest-the emerald ash borer-and cardiovascular disease. We estimated a semi-parametric Cox proportional hazards model of time to cardiovascular disease, adjusting for confounders. We defined the incidence of cardiovascular disease as acute myocardial infarction requiring overnight hospitalization, silent MI determined from serial electrocardiograms, ischemic or hemorrhagic stroke, or death from coronary heart disease. Women living in a county infested with emerald ash borer had an increased risk of cardiovascular disease (HR=1.25, 95% CI: 1.20-1.31).

Estratégias para distribuição e fixação de médicos em sistemas nacionais de saúde: o caso brasileiro / Strategies for distribution and fixation of physicians in national health systems: the Brazilian case

INTRODUÇÃO: A distribuição geográfica de médicos é um problema com que se defrontam os sistemas nacionais de saúde e, no Brasil, tem se tornado um dos desafios para a consolidação do Sistema único de Saúde (SUS). A análise dos determinantes dessa distribuição está fundamentado em abordagens sobre o mercado de trabalho em saúde e no médico sua formação ou oferta inserido no contexto histórico, político, social e institucional em que são construídos. O referencial de análise proposto neste estudo tem como objetivo evidenciar os fatores e condicionantes que interferem na distribuição e fixação de médicos identificar possíveis estratégias de intervenção que podem ser aplicadas à realidade brasileira, no contexto das políticas públicas.OBJETIVO: O mote para essa discussão é a compreensão de que a forte concentração geográfica dos profissionais e dos serviços impede a concretização dos princípios que regem o Sistema Único de Saúde, particularmente no que se refere à universalização, à integralidade e à própria descentralização. As estratégias tentadas pelo governo brasileiro também são abordadas, mais especificamente, o Projeto Rondon, o Programa de Interiorização das Ações de Saúde e Saneamento (PIASS) e o Programa de Interiorização do SUS (PISUS). MATERIAL E MÉTODO: Essa análise é complementada com um estudo de caso sobre a experiência recente no campo da política pública em saúde destinada a minimizar a má distribuição de médicos no território nacional: o Programa de Interiorização do Trabalho em Saúde (PITS), implementado pelo Ministério da Saúde em 2001. RESULTADOS: Sua condição de estratégia inédita na política de recursos humanos em saúde em nosso país permitiu identificar aspectos relevantes para qualquer iniciativa que pretenda fortalecer a distribuição de profissionais de saúde, para além dos grandes centros urbanos. CONCLUSÃO: Por fim, o estudo oferece um referencial de análise para a distribuição e a fixação de médicos, construído a partir dos elementos contemplados na revisão da literatura, na discussão teórica, no aporte das experiências nacionais e internacionais e nos resultados obtidos no estudo de caso.

INTRODUCTION: The medical geographical distribution is a matter that challenges the nationals systems of health and, Brazil, its becoming one of the main challenges to face to consolidate the SUS (Sitema Único de Saúde Unique System of Health). OBJECTIVE: The analysis of the determinative ones of this distribution is based on approaches about the work market in health and the doctor his formation or offer inserted in the historical context, politician, economic, social and institutional where they are constructed. The referential of analysis considered in this study has as its objective to make evident the factors and conditioning matters that interfere with the distribution and retention of doctors and to identify possible strategies of intervention that they can be applied to the Brazilian reality, in the context of the public politics. The motto for this discussion is the understanding of that the strong geographic concentration of the professionals and of the services it obstructs the concretion of the principles that conduct the SUS (Unique System of Health), particularly as for the universalization, to the integrality and to the proper decentralization. The attempted strategies by the Brazilian government also are focused, emphasizing the Rondon Project, the PIASS (Program of Actions of health and Sanitation in the interior area of Brazil rural areas). MATERIAL AND METHODS: This analysis is complemented with a case study on the recent experience in the field of the public health politics destined to minimize the bad distribution of doctors in the national territory: the PITS (a program to stimulate and increase work in the field of health in the interior area of Brazil), implemented by Ministry of Health in 2001. RESULTS: Its condition of unheard-of strategy in the politics of human resources in health in our country allowed identifying relevant aspects for any initiative that intends to fortify the distribution of health professionals towards out of the great urban centers. CONCLUSION: Finally, the study offers a referential of analysis for the distribution and retention of doctors, constructed from the elements contemplated in the bibliographic revision, in the theoretical discussion, in the related national and international experiences and in the results gotten in the case study.