Acceptability of Gynecologic e-Health Modalities by Hispanic/Latina Women of Reproductive Age.

Introduction: Electronic health (e-Health) modalities effectively address healthcare access limitations; however, there are limited data on their adoption by Hispanic/Latina women who are disproportionally affected by health disparities. Methods: We conducted a cross-sectional study by disseminating an anonymous electronic questionnaire via social media to assess the perception of Hispanic/Latina women of reproductive age regarding facilitators and barriers for using e-Health modalities, including telemedicine and mobile apps, to monitor gynecologic health. Results: The questionnaire was completed by 351 Hispanic/Latina participants with high levels (98.3%) of advanced technological expertise. Current use of a gynecologic mobile app was reported by 63.8%, primarily for menstruation (85.1%) and ovulation (46.3%) tracking. While only 17.6% of participants were offered the option of a gynecologic consultation via telemedicine, the majority (90.5%) would agree to one. Higher education and advanced technological expertise correlated with acceptance of telemedicine for gynecological consults. Being younger (<29 y/o), a student, not having a preferred gynecologist and having a lower income significantly correlated with gynecologic mobile app acceptability. Conclusions: We showed that e-Health modalities are highly acceptable for Hispanic/Latina women of reproductive age to facilitate gynecological care and documented factors that are significantly associated with e-Health acceptability. These findings are relevant to public health emergencies that cause access to care limitations disproportionally affecting this already underserved population.

Anxiety and e-health literacy levels of patients scheduled for thoracic surgery.

OBJECTIVE: This study was conducted to examine the relationship between the pre-operative anxiety levels of patients scheduled for thoracic surgery and their e-health literacy levels pertaining to skills such as finding and evaluating electronic health information about health problems. METHODS: This study was a descriptive and correlational study. One hundred and two patients scheduled for thoracic surgery were interviewed in Izmir. The Amsterdam pre-operative anxiety and information scale (APAIS), the Visual Analog Scale for anxiety (VAS-A), the eHealth literacy scale (eHEALS), and a patient information form were used to collect data. RESULTS: The mean VAS-A score of the patients was 6.02 ± 2.51, their mean APAIS score was 18.73 ± 5.85, and their mean eHEALS score was 24.84 ± 9.21. There was no significant relationship between the anxiety and e-health literacy levels of the patients. Significant differences were found in the e-health literacy levels of the patients according to their ages and reasons for surgery. CONCLUSION: Patients scheduled for thoracic surgery were determined to experience moderate anxiety and need moderate levels of information. The patients were also found to have moderate e-health literacy levels. There was no significant relationship between the anxiety and e-health literacy levels of the patients.

OBJETIVO: Examinar la relación entre los niveles de ansiedad pre-operatoria de los pacientes que se someterán a una cirugía torácica y la alfabetización en salud electrónica, como encontrar y evaluar información de salud electrónica sobre problemas de salud. MÉTODOS: Estudio descriptivo y relacional. Para recopilar datos se utilizaron la Escala de Ansiedad e Información Pre-operatoria de Amsterdam (APAIS), la Escala de Ansiedad Analógica Visual (EVA-A) y la Escala de Alfabetización en E-salud, y un formulario de información descriptiva del paciente. RESULTADOS: Según la EVA-A, los niveles de ansiedad de los pacientes fueron de 6.02 ± 2.51. La puntuación APAIS fue de 18.73 ± 5.85. La puntuación de la escala de alfabetización en salud electrónica de los pacientes fue de 24.84 ± 9.21. No hubo una relación significativa entre los niveles de ansiedad de los pacientes y su alfabetización en salud electrónica. Se encontró una diferencia significativa entre los niveles de alfabetización en salud electrónica de los pacientes según su edad y el motive de la cirugía. CONCLUSIONES: Los pacientes que serán sometidos a cirugía torácica experimentan ansiedad moderada y se determinó que necesitan información moderada. También se descubrió que los pacientes tenían niveles moderados de conocimientos sobre cibersalud. No hubo una relación significativa entre la ansiedad y los niveles de alfabetización en salud electrónica de los pacientes.

Telemedicine for Patients with COVID-19: A Telehealth Experience in the Elderly at a Center in Southern Brazil.

Background: Telemedicine has shown benefits in continuous care during the COVID-19 pandemic. This article discusses its practice in elderly patients with COVID-19, considering its limitations and benefits. Methods: Patients with COVID-19, aged 60 years or older, were followed up through phone calls three times a week for 10 days at the Telemedicine Section of the Clinical Center of the University of Caxias do Sul (UCS) in the south of Brazil. The outcomes evaluated were referrals to hospital, basic health unit (BHU)/emergency care unit (ECU), and psychology and physiotherapy services; instructions about vaccination, isolation period, tests for COVID-19, taking a specific medication, and measuring oxygen saturation; guidance to family members; and avoiding going to hospitals. Results: A total of 64 patients were followed up, the mean age was 69.28 years and 15.62% had at least one comorbidity. Among the patients, 7.81% were instructed about the vaccine, 23.43% about post-diagnostic tests, 25% about medication, 62.5% about isolation, 31.35% received guidance on saturation monitoring and 28.12% received guidance for family members, and 3.12% were referred to the hospital and 7.81% to the BHU/ECU (n = 5/64). Physiotherapy and psychology services were indicated for 4.68% of patients each, hospital visits were avoided in 31.25% and 93.75% recommended telemonitoring. Discussion: In this experience, it is suggested that the telehealth service maximizes patient care and the health care effectiveness for patients with COVID-19. Furthermore, the sample studied showed good adherence and suggested the need for more guidance than face-to-face consultation.

Mobile Technologies for Monitoring Sleep Time: A Systematic Search of App Stores in Brazil.

Introduction Decreased sleep time is detrimental to physical and mental health, exerting negative impacts on daily functioning and quality of life. Mobile health (mHealth) applications can be useful for improving sleep quality. Objective To perform a systematic search of mHealth applications for monitoring sleep time at Brazilian online stores and evaluate the selected applications in terms of engagement, functionality, aesthetics, and quality of information. Methods A systematic search was performed at the Google Play Store and the App Store developed or updated between 2020 and 2022. The mobile app rating scale (MARS) was used to assess their quality. The characteristics and information of these applications were presented. Data were analyzed descriptively. Results Among the 2,264 relevant mHealth apps identified, 11 were eligible for inclusion. There was one app that offered only sleep time recordings, three offered sleep recordings and educational content, three monitored sleep time with audiovisual resources, two offered sleep time recordings with a focus on monitoring snoring, and two offered sleep time monitoring with individual content customizations. The apps scored fair on MARS, with a mean of 3.5 points (standard deviation: 0.8) on a scale of 1 to 5. Most apps scored low due to poor evidence-based information, aesthetics, and engagement. Conclusion Although the use of mHealth technologies for monitoring sleep time has considerable potential for investigation, it is a relatively new, underexplored topic. Collaboration between researchers, clinical professionals, patients, and application developers is necessary for the creation of new evidence-based mHealth applications focused on Brazilian users.

The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial.

BACKGROUND: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. OBJECTIVE: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. METHODS: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. RESULTS: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. CONCLUSIONS: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54783.

Patient Perceptions on Telepsychiatry as an In-Consult Alternative During COVID-19 Pandemic: Peruvian Adaptation of the Telehealth Usability Questionnaire.

Objective: To identify the perceptions of the patients who received alternative care by telepsychiatry at the Cayetano Heredia Hospital (HCH). Methods: This research consisted of two phases: (1) transcultural adaptation of the Telehealth Usability Questionnaire (TUQ) with three experts and (2) application of the questionnaire in 183 patients from psychiatry in HCH. Nonparametric tests were used to determine the association between variables. Results: We applied 20 questions to 60 men and 123 women, with a median age of 45. The ease of using the virtual consultation service, the comfort with its use, and the general satisfaction had a score of 6 out of 7 and are associated with the number of devices that patients have and their degree of education. The usefulness, communication by virtual means, and the solution of technical problems had scores higher than 6, being considered acceptable by the patients. Willingness to have a teleconsultation again was high and was associated with patient satisfaction with the consultation. Conclusions: Most patients were satisfied with telepsychiatry via telemonitoring during the COVID-19 pandemic. The usage of validated tools such as TUQ might be included as part of evaluations of new telemedicine services.

Is telehealth useful in the management of placenta accreta spectrum in low-resource settings? Results of an exploratory survey.

OBJECTIVE: The optimal management of placenta accreta spectrum (PAS) requires the participation of multidisciplinary teams that are often not locally available in low-resource settings. Telehealth has been increasingly used to manage complex obstetric conditions. Few studies have explored the use of telehealth for PAS management, and we aimed evaluate the usage of telehealth in the management of PAS patients in low-resource settings. METHODS: Between March and April 2023, an observational, survey-based study was conducted, and obstetricians-gynecologists with expertise in PAS management in low- and middle-income countries were contacted to share their opinion on the potential use of telehealth for the diagnosis and management of patients at high-risk of PAS at birth. Participants were identified based on their authorship of at least one published clinical study on PAS in the last 5 years and contacted by email. This is a secondary analysis of the results of that survey. RESULTS: From 158 authors contacted we obtained 65 responses from participants in 27 middle-income countries. A third of the participants reported the use of telehealth during the management obstetric emergencies (38.5%, n = 25) and PAS (36.9%, n = 24). Over 70% of those surveyed indicated that they had used "informal" telemedicine (phone call, email, or text message) during PAS management. Fifty-nine participants (90.8%) reported that recommendations given remotely by expert colleagues were useful for management of patients with PAS in their setting. CONCLUSION: Telehealth has been successfully used for the management of PAS in middle-income countries, and our survey indicates that it could support the development of specialist care in other low resource settings.

Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions?

In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.

Technological development in telemedicine: bibliometric analysis, research gaps, and literature trends / Desenvolvimento tecnológico na telemedicina: análise bibliométrica, lacunas de pesquisa e tendências na literatura / Desarrollo tecnológico en telemedicina: análisis bibliométrico, lagunas en la investigación y tendencias en la literatura

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19.

O objetivo deste artigo foi analisar a literatura acerca do desenvolvimento tecnológico na telemedicina, por meio da bibliometria, ao identificar o estado da arte, lacunas de pesquisa e tendências na literatura. Analisou-se 67 artigos relacionados ao campo de estudo, publicados entre 2010-2020 nas bases de dados Springer Link, Science Direct, Wiley Online Library, Web of Science e Scopus. O tratamento dos dados se deu por meio dos softwares StArt, Excel, IBM SPSS Statistics e Iramuteq. Os resultados apresentaram a análise bibliométrica dos artigos, classificados nas áreas de Gestão (52,2%), TI (25,4%) e Medicina (22,4%), e uma tabela com 34 sugestões para pesquisas futuras. As tendências da literatura envolveram seis classes de estudo (saúde, estudo, serviço, tecnologia, paciente e telemedicina), que se subdividiram em nove temas de pesquisa (plataforma digital, gestão do serviço de telemedicina, operação do serviço de telemedicina, percepção do usuário final, oportunidades de negócios, percepção de profissionais de saúde, covid-19, regulamentação e robótica). Observou-se aumento significativo no número de publicações na área devido à covid-19.

El objetivo de este artículo fue analizar la literatura sobre el desarrollo tecnológico en la telemedicina me-diante bibliometría, identificando el estado del arte, las lagunas de investigación y las tendencias en la literatura. Se analizaron un total de 67 artículos relacionados con el campo de estudio, publicados entre 2010-2020 en las bases de datos de Springer Link, Science Direct, Wiley Online Library, Web of Science y Scopus. Los datos fueron procesados utilizando los programas StArt, Excel, IBM SPSS Statistics e Iramuteq. Los resultados presentaron un análisis bibliométrico de los artículos, clasificados en las áreas de Gestión (52,2%), TI (25,4%) y Medicina (22,4%), junto con una tabla de 34 sugerencias para futuras investiga-ciones. Las tendencias en la literatura abarcaron seis clases de estudio (salud, estudio, servicio, tecnología, paciente y telemedicina), que se subdividieron en nueve temas de investigación (plataforma digital, gestión del servicio de telemedicina, operación del servicio de telemedicina, percepción del usuario final, oportuni-dades de negocio, percepción de los profesionales de la salud, covid-19, regulación y robótica). Un resultado observado fue un aumento significativo en el número de publicaciones en el área debido al covid-19.

Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial.

BACKGROUND: Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. OBJECTIVE: The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. METHODS: This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. RESULTS: Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. CONCLUSIONS: This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. TRIAL REGISTRATION: ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50371.

Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

E-Health technologies for treatment of depression, anxiety and emotional distress in person with diabetes mellitus: A systematic review and meta-analysis.

OBJECTIVE: This systematic review of randomized clinical trials (RCT) summarized the available evidence regarding the use of e-Health technologies for the treatment of depression, anxiety, and emotional distress in person with diabetes mellitus. METHODS: The Cochrane CENTRAL, MEDLINE, EMBASE, Web of Science and LILACS databases searched were up to January 11th, 2023. The primary outcomes were improvement of depression, anxiety, diabetes-related emotional distress and quality of life. Reviewers, in pairs and independently, selected the studies and extracted their data. RESULTS: A total of 10 RCT involving 2,209 participants were analyzed. The methodological quality of the studies reviewed was high. Results showed improvements in depression with the use of Internet-Guided Self-Help (SMD = -0.74, 95%CI = -1.04 to -0.43) or Telephone-Delivered Cognitive Behavioral Therapy (CBT) (SMD = -0.42, 95%CI = -0.65 to -0.19); in anxiety with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.42) or Diabetes-specific-CBT (SMD = -0.60, 95%CI = -1.18 to -0.02); and in emotional distress with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.41) or Healthy Outcomes through Patient Empowerment (SMD = -0.26, 95%CI = -0.53 to 0.01) compared to usual care. CONCLUSION: Due to heterogeneity in interventions, populations, follow-up time and outcomes, future RCT should be conducted to confirm these findings.

Reacting, Sharing, and Commenting: How Many Facebook Users Are Engaging with Posts Related to Dental Caries That Contain Misinformation?

Recent studies have been concerned about the vast amount of misinformation detected on social media that directly hampers the prevention and control of chronic diseases. Based on these facts, the aim of this study was to identify and characterize misinformation about dental caries-related content found on Facebook, regarding the predictive factors of user interaction with posts. Then, CrowdTangle retrieved 2,436 posts published in English, ordered by the total interaction of the highest users. A total of 1,936 posts were selected for inclusion and exclusion criteria to select a sample of 500 posts. Subsequently, two independent investigators characterized the posts by their time of publication, author's profile, motivation, the aim of content, content facticity, and sentiment. The statistical analysis was performed using Mann-Whitney U and χ2 tests and multiple logistic regression models to determine differences and associations between dichotomized characteristics. p values <0.05 were considered significant. In general, posts were predominantly originated from the USA (74.8%), related to business profiles (89%), presented preventive content (58.6%), and noncommercial motivation (91.6%). Furthermore, misinformation was detected in 40.8% of the posts and was positively associated with positive sentiment (OR = 3.43), business profile (OR = 2.22), and treatment of dental caries (OR = 1.60). While the total interaction was only positively associated with misinformation (OR = 1.44), the overperforming score was associated with posts from the business profile (OR = 5.67), older publications (OR = 1.57), and positive sentiment (OR = 0.66). In conclusion, misinformation was the unique predictive factor of increased user interaction with dental caries-related posts on Facebook. However, it did not predict the performance of the diffusion of posts such as business profiles, older publications, and negative/neutral sentiment. Therefore, it is essential to promote the development of specific policies toward good quality information on social media, which includes the production of adequate materials, the increase of the critical sense of consuming health content, and information filtering mediated by digital solutions.

Evaluation of mobile applications focused on the care of patients with anxiety disorders: A systematic review in app stores in Brazil.

OBJECTIVE: To identify and evaluate the quality of mobile apps available in Brazil focused on the care of patients with anxiety disorders. METHODS: A comprehensive search was conducted until October 2021 on Play Store (Android) and Apple Store (iOS) in Brazil, using the terms "anxiety," "phobia," "panic attack," and "social phobia." Two independent authors identified the apps and performed data extraction and quality assessment using the Mobile App Rating Scale (MARS). Pearson's correlation was used to analyze the relationship between user star rating and the quality defined by the MARS instrument. RESULTS: A total of 3,278 potential apps were identified, of which 71 fully met the eligibility criteria. Most apps were made available on the Play Store (91.74%), in English (69.01%), and updated in the last two years (90.14%). Approximately half of the apps (50.70%) did not inform the developer's country and most of them did not report the user star rating (70.42%). The target population was indicated as free by most apps (85.92%), with generalized anxiety disorder being the most addressed disorder (74.65%), followed by panic disorder (33.80%). The three main purposes of the apps were education (83.10%), self-assessment (38.03%), and meditation/breathing (32.39%). Only 31 apps (43.66%) had acceptable quality (above 3.0) and the average total MARS quality score of 2.93 (2.20 to 3.90), with the functionality section receiving the highest score (3.90) and the lowest scoring sections being engagement (2.16). The apps that were rated stars by users (29.58%) showed a negative Pearson correlation (ρ = -0.100), evidencing a difference in the user's evaluation and that performed using the MARS instrument. CONCLUSION: Gaps in the quality of apps focused on the care of patients with anxiety disorders were evidenced since most were classified as having low quality through the MARS instrument. Thus, users are recommended to use these apps with caution.

Perception of Health Care Providers and Users on Teleconsultation in Times of COVID-19 in Brazil: An Exploratory Interview Study.

Background: In the context of the COVID-19 pandemic in Brazil, teleconsultation was considered an important instrument in the fight against the health crisis, with temporary mandates changing the current legislation to expand its use. This study examined the perceptions of health care providers and users regarding teleconsultation. Methods: The study consisted of a national survey of 1,089 participants, of which 480 were health care providers and 609 were users, carried out through two semistructured questionnaires administered between June and August 2020, using six categories of analysis for teleconsultation-quality, remuneration, duties and responsibilities, experience and positioning regarding use, and technology-and an additional question about the benefits and harms of telemedicine. Results: The research indicated that, although face-to-face care is favored, there is an important movement toward accepting virtual care, even though there are relative differences in perception regarding the six categories analyzed. Discussion: Regarding the benefits of telemedicine, issues such as access, practicality, agility, convenience, easiness, and speed stood out as well as concerns such as contact, quality, impersonality, distance, errors, and falsehood, among others. Conclusions: Although there is evidence of benefits and limitations, bringing to light that contributions from the perception of health care providers and users can help promote debates to establish teleconsultation on a permanent basis in Brazil.

A história da telemedicina no Brasil: desafios e vantagens / The history of telemedicine in Brazil: challenges and advantages

Resumo A utilização de novas tecnologias de informação para um atendimento mais efetivo e à distância é algo que se impõe no contexto de serviços em saúde, no atual panorama sociopolítico. Entretanto, o Brasil ainda está receoso em integrar de forma permanente esses avanços. Esta pesquisa tem como objetivo revisar os marcos da história da telemedicina no Brasil, destacando as questões éticas e legislativas, bem como evidenciar os desafios para sua implantação e gerar uma proposta para superá-los. Trata-se de uma revisão integrativa da literatura acerca da história, dos desafios e da realidade da telemedicina no cenário brasileiro. A telemedicina é uma atividade recente no Brasil, defrontando-se com resistências por parte dos profissionais, em especial médicos, que diversas vezes não vislumbram claramente seus benefícios. Apesar das dificuldades previstas em aceitar este modelo, é relevante ressaltar as vantagens que esse padrão abarca, como ampliar e facilitar o acesso à assistência de saúde. Propor alternativas para superar resistências e alcançar um padrão otimizado é essencial e abrange maior abertura no campo político, legislativo e educacional.

Abstract The use of new information technologies for a more effective remote service is required in the context of health services, especially when it comes to the current socio-political panorama. Nevertheless, Brazil is still afraid to permanently integrate these advances. This research aims to review the milestones in the history of telemedicine in Brazil, highlighting the ethical and legislative issues, as well as evidencing the challenges for its implementation and generating a proposal to overcome them. It is an integrative literature review about the history, challenges, and reality of telemedicine in the Brazilian scenario. Telemedicine is a recent activity in Brazil, facing resistance from professionals, especially doctors, who often do not clearly see its benefits. Despite the anticipated difficulties in accepting this model, it is important to highlight the advantages that this standard encompasses, such as expanding and facilitating access to health care. Proposing alternatives to overcome resistance and reach an optimized standard is essential and encompasses greater openness in the political, legislative, and educational fields.

Elaboração e validação de um portal de informações sobre prevenção combinada da infecção pelo HIV / Development and validation of an information portal on combined prevention of HIV infection

Introdução: A infecção pelo Vírus da Imunodeficiência Humana (HIV) ainda constitui um desafio global capaz de gerar impactos sociais, econômicos e de saúde, assim como de repercutir nos custos hospitalares, nos indicadores de morbimortalidade e nas diferentes dimensões que constituem a qualidade de vida da população. Por ser considerada uma condição crônica, complexa e difícil controle, a incorporação de tecnologias nas práticas assistenciais é amplamente referenciada, podendo refletir na ampliação do acesso à informação e na combinação entre duas ou mais estratégias para prevenção. Objetivo: Construir e validar um portal de informações sobre prevenção combinada da infecção pelo HIV. Método: Estudo metodológico conduzido em quatro etapas: definição, arquitetura, design e implementação. A estruturação do conteúdo foi fundamentada na literatura científica, assim como nas diretrizes, recomendações clínicas e protocolos assistenciais para prevenção combinada do HIV. Participaram do processo de validação 24 enfermeiros com conhecimento, atuação clínica e produção científica na área de interesse, bem como 23 juízes de informática que avaliaram a qualidade da interface, layout, diagramação, formato das telas, disposição dos botões de navegação, qualidade estética e audiovisual. Ainda, a tecnologia foi apreciada pelo público-alvo, expresso por 24 pessoas consideradas como população chave. A coleta de dados foi realizada por meio da plataforma virtual Research Electronic Data Capture, empregando-se uma escala do tipo Likert para fins de consenso. Para análise, utilizou-se o Índice de Validade de Conteúdo, sendo considerado satisfatórios os escores iguais ou superiores a 0,80. Este estudo obteve aprovação pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, e o parecer favorável à realização foi emitido por meio do processo número 5.068.52. Resultados: A versão final do portal de comunicação e informação foi denominado PREVINAIDST e direcionada para prevenção combinada do HIV na população geral. O processo de validação por especialistas em saúde evidenciou indicador global de concordância satisfatório (0,94), assim como boa impressão geral (0,96), conteúdo (0,98) e linguagem (1,00) adequados, relevância (0,96), elevado potencial de atratividade (0,91) e inovação (0,90). Para os juízes de informática, a tecnologia também foi considerada válida ao apresentar escore global de concordância de 0,97. Outras dimensões avaliadas indicam que o recurso informacional é de fácil navegação (0,96), apresentando qualidade de interface (0,96), estética e audiovisual (0,99). Na mesma perspectiva das avaliações anteriores, o portal foi considerado válido, inovador (0,98), atrativo (0,98) e de fácil uso (0,83) pela população alvo. Conclusão: A trajetória percorrida para desenvolvimento do portal conferiu sustentação científica, tecnológica e operacional, configurando-o como recurso assistencial inovador e relevante por reunir evidências válidas, seguras, precisas, objetivas e favoráveis à educação combinada, à informação e à prevenção combinada do HIV em diferentes contextos e níveis de atenção à saúde

Introdution: The Human Immunodeficiency Virus (HIV) infection still poses a global challenge capable of generating social, economic, and health impacts, as well as impacting hospital costs, morbidity and mortality indicators, and the different dimensions that constitute the quality of life of the population. As it is considered a chronic, complex, and difficult to control condition, the incorporation of technologies into care practices is widely referenced, which may reflect in the expansion of access to information and in the combination of two or more prevention strategies. Objective: Therefore, this study aimed to construct and validate an information portal on combined prevention of HIV infection. Method:This is a methodological study conducted in four stages: definition, architecture, design, and implementation. The content structure was based on scientific literature, as well as guidelines, clinical recommendations, and care protocols for combined HIV prevention. Twenty-four nurses with knowledge, clinical practice, and scientific production in the area of interest, as well as 23 computer judges who evaluated the quality of the interface, layout, diagramming, screen format, navigation button layout, aesthetic and audiovisual quality, participated in the validation process. Additionally, the technology was appreciated by the target audience, expressed by 24 people considered as a key population. Data collection was carried out through the virtual platform Research Electronic Data Capture, using a Likert scale for consensus purposes. Content Validity Index was used for analysis, and scores equal to or greater than 0.80 were considered satisfactory. This study was approved by the Research Ethics Committee of the Ribeirão Preto School of Nursing, University of São Paulo, and the favorable opinion for its implementation was issued through process number 5.068.52. Results: The final version of the communication and information portal was named PREVINAIDST and directed towards combined HIV prevention for both HIV-negative people and people living with HIV. The validation process by health experts showed a satisfactory overall agreement indicator (0.94), as well as good overall impression (0.96), adequate content (0.98) and language (1.00), relevance (0.96), high potential for attractiveness (0.91) and innovation (0.90). For the computer judges, the technology was also considered valid, with a global agreement score of 0.97. Other evaluated dimensions indicate that the informational resource is easy to navigate (0.96), presenting interface quality (0.96), aesthetic and audiovisual quality (0.99). In the same perspective as the previous evaluations, the portal was considered valid, innovative (0.98), attractive (0.98), and easy to use (0.83) by the target population. Conclusion: PREVINAIDST constitutes a valid, innovative digital information portal, enabling it as an innovative technology, accessible for the approach of combined prevention of HIV infection, and it can be of broad access in different contexts and levels of health care

Estudio piloto de un programa basado en Internet para la prevención e intervención temprana de la depresión en adolescentes / Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet "Cuida tu Ánimo", mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto).

Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial.

Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

Salud móvil: conceptos generales y potencialidades de implementación en Cuba

Introducción: Actualmente el uso de las Tecnologías de la Información y las Comunicaciones forma parte del quehacer diario de la sociedad. La salud móvil es una de las que más desarrollo presenta, por un lado, debido a la nueva normalidad generada por la pandemia de la COVID-19, pero en gran medida, por las ventajas que tienen los dispositivos móviles frente a otras tecnologías. Objetivo: Sistematizar las teorías acerca de la salud móvil y evaluar las potencialidades de desarrollo en Cuba. Método: Se realizó un análisis documental respondiendo a las necesidades informativas de los autores, comprendido en tres fases: exploración del área de interés y problemática actual, determinación de las ideas esenciales de los documentos consultados y que aportan el significado general de estos y, la tercera fase, que incluyó la sistematización de la información para actualizar la nueva información contenida en el actual artículo. Resultados: Se describieron aspectos generales, tales como: Salud móvil en Cuba de la mano del desarrollo tecnológico del país, Seguridad y compatibilidad de uso, Aspectos legales de desarrollo; aspectos que inciden en el proceso de creación de las aplicaciones de salud móvil. Se propuso, además, la plataforma Mobincube, como herramienta de fácil aprendizaje y manejo para los profesionales de salud, permitiéndoles crear sus propias aplicaciones sin necesidad de programar. Conclusiones: Cuba cuenta con el desarrollo tecnológico e intelectual suficiente para incursionar en el desarrollo de la salud móvil. El reto fundamental es ganar en cultura informática suficiente por parte de los profesionales de la salud cubanos en materia de salud móvil.

Introduction: The use of Digital and Communication Technologies are currently part of the daily activities of society. Mobile health (mHealth) is one of the most developed nowadays, on one hand, due to the new normality generated by the COVID-19 pandemic, but also far away, due to the relevant advantages acquired for mobile telephone technologies over other technologies. Objective: To systematize the theories concerning mobile health and to assess its developing potential in Cuba. Method: A documentary analysis was carried out in response to the authors' information needs, comprising three phases: exploration of the priority areas and the current problematic issues, determination of the essential ideas sit in the documents consulted and which provide the general meaning included in those documents and, as a third phase implemented, it was included the systematization of the information obtained to update the new information contained in the current article. Results: General aspects, such as: Mobile health in Cuba in line with the country's technological development, Safety and use compatibility, legal aspects for properly development were described; aspects which help in the process of creating mobile health applications. It was also proposed the Mobincube platform, as an easy to learn and use tool for health professionals, allowing them to create their own applications without the need for programming. Conclusions: Cuba has sufficient technological and intellectual development to venture into the development of mobile health field. The main challenge is to gain sufficient informatics culture among Cuban health professionals in the field of mobile health.

Introdução: Atualmente o uso das Tecnologias de Informação e Comunicação faz parte do cotidiano da sociedade. A saúde móvel é uma das mais desenvolvidas, por um lado, devido à nova normalidade gerada pela pandemia do COVID-19, mas, em grande medida, pelas vantagens que os dispositivos móveis têm sobre outras tecnologias. Objetivo: Sistematizar as teorias sobre saúde móvel e avaliar o potencial de desenvolvimento em Cuba. Método: Foi realizada uma análise documental respondendo às necessidades informativas dos autores, composta por três fases: exploração da área de interesse e problemas atuais, determinação das ideias essenciais dos documentos consultados e que fornecem o significado geral de estas e, a terceira fase, que incluiu a sistematização das informações para atualização das novas informações contidas no artigo atual. Resultados: Foram descritos aspectos gerais, tais como: Saúde móvel em Cuba de mãos dadas com o desenvolvimento tecnológico do país, Segurança e compatibilidade de uso, Aspectos legais do desenvolvimento; aspectos que afetam o processo de criação de aplicativos móveis de saúde. Além disso, a plataforma Mobincube foi proposta como uma ferramenta de fácil aprendizado e gerenciamento para profissionais de saúde, permitindo que eles criem seus próprios aplicativos sem programação. Conclusões: Cuba tem desenvolvimento tecnológico e intelectual suficiente para se aventurar no desenvolvimento da saúde móvel. O desafio fundamental é ganhar suficiente cultura informática por parte dos profissionais de saúde cubanos no campo da saúde móvel.