Artificial intelligence applied to analyzes during the pandemic: COVID-19 beds occupancy in the state of Rio Grande do Norte, Brazil.

The COVID-19 pandemic is already considered one of the biggest global health crises. In Rio Grande do Norte, a Brazilian state, the RegulaRN platform was the health information system used to regulate beds for patients with COVID-19. This article explored machine learning and deep learning techniques with RegulaRN data in order to identify the best models and parameters to predict the outcome of a hospitalized patient. A total of 25,366 bed regulations for COVID-19 patients were analyzed. The data analyzed comes from the RegulaRN Platform database from April 2020 to August 2022. From these data, the nine most pertinent characteristics were selected from the twenty available, and blank or inconclusive data were excluded. This was followed by the following steps: data pre-processing, database balancing, training, and test. The results showed better performance in terms of accuracy (84.01%), precision (79.57%), and F1-score (81.00%) for the Multilayer Perceptron model with Stochastic Gradient Descent optimizer. The best results for recall (84.67%), specificity (84.67%), and ROC-AUC (91.6%) were achieved by Root Mean Squared Propagation. This study compared different computational methods of machine and deep learning whose objective was to classify bed regulation data for patients with COVID-19 from the RegulaRN Platform. The results have made it possible to identify the best model to help health professionals during the process of regulating beds for patients with COVID-19. The scientific findings of this article demonstrate that the computational methods used applied through a digital health solution, can assist in the decision-making of medical regulators and government institutions in situations of public health crisis.

Analysis of the Impact of Communication Campaigns under the Project "Syphilis No": A National Tool for Inducing and Promoting Health.

Syphilis is increasingly prevalent around the world as a result of complex factors. In Brazil, the government declared a syphilis epidemic in 2016 and then set a strategic agenda to respond to this serious public health problem. In a joint effort, Brazil's Federal Court of Accounts (TCU) recommended that novel and diversified health communication strategies should be developed, which the "Syphilis No" project (SNP) later conducted through nationwide mass communication campaigns. We performed exploratory data analysis to identify and understand the results of three health communication campaigns by considering syphilis data trends in Brazil. The SNP, by using traditional and innovative means of communication, focused on multiple target audiences to encourage behavior changes through awareness and syphilis knowledge acquisition via the internet. In addition, the SNP disseminated information on syphilis testing, prevention, and treatment through social media and multiple media outlets. We observed that the period of the health campaigns corresponded to the period when the syphilis testing uptake increased and the number of reported cases dropped. Thus, our findings indicate that public health responses could substantially benefit from the use of health communication campaigns as a tool for health promotion, education, and transformation.

Physical therapy for the management of motor symptoms in amyotrophic lateral sclerosis: protocol for a systematic review.

INTRODUCTION: The prescription of an intervention plan can be challenging for the physical therapist, considering clinical phenotypes, individual prognosis and the rapid, progressive and deteriorating nature of amyotrophic lateral sclerosis (ALS). In this context, therapeutic exercises (eg, resistance and aerobic exercises) for patients with ALS remain controversial and may influence the treatment plan. Therefore, this review aims to critically assess whether physical therapy interventions are effective for improving functional capacity, quality of life and fatigue of individuals with ALS. METHODS AND ANALYSIS: Studies will be selected according to eligibility criteria, and language, geographical area or publication date will not be restricted. Four databases will be used: MEDLINE, EMBASE, Cochrane Library (CENTRAL) and Physiotherapy Evidence Database (PEDro). Searches will also be conducted on ClinicalTrials.gov and references from included studies. We plan to conduct the searches between October and December 2022. Two independent authors will examine titles and abstracts and exclude irrelevant studies and duplicates. We will assess the quality of studies and quality of evidence, and disagreements will be resolved with a third researcher. The findings will be presented in the text and tables; if possible, we will perform meta-analyses. ETHICS AND DISSEMINATION: No ethical approval is required because this study does not involve human beings. We will publish our findings in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42021251350.

Clinical Protocols and Treatment Guidelines for the Management of Maternal and Congenital Syphilis in Brazil and Portugal: Analysis and Comparisons: A Narrative Review.

(1) Background: Maternal syphilis (MS) and congenital syphilis (CS) are serious public health problems worldwide due to their high morbidity and mortality rates. (2) Objective: Evaluating the applicability of Clinical Protocols and Treatment Guidelines on case incidence trends in Brazil and Portugal. (3) Methods: The review was done through bibliographic research in two public databases and government websites from both countries, published between 2007 and 2022. All guidelines that contained CS and MS were selected. (4) Results and discussion: After evaluation, we found that Brazil and Portugal have adequate protocols for screening and treating congenital and maternal syphilis. (5) Conclusion: The results suggest that CS and MS incidence are notably higher in Brazil than in Portugal due to economic, cultural, and social disparities and the differences in territory size. Therefore, these demographic and socioeconomic factors could strongly influence efforts to fight against syphilis and thus control the infection.

Impact of physiotherapy with telerehabilitation on caregivers of patients with neurological disorders: A systematic review protocol.

Introduction: Caregivers are essential during and after rehabilitation but exhibit intense physical and mental burdens due to responsibilities, resulting in stress, irritability, depression, anxiety, pain, and financial distress. Telerehabilitation offers several remote health services that improve time, engagement, and physical and mental health care access. Thus, we outlined a systematic review protocol to evaluate the impact of telerehabilitation on the burden, stress, pain, and quality of life of caregivers of patients with neurological disorders. Methods: Searches will be conducted in Ovid MEDLINE, Pubmed, Scopus, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and PsycINFO databases. Clinical trials evaluating the burden, stress, pain, and quality of life of caregivers of patients with neurological disorders using telerehabilitation will be included without publication date or language restriction. Two reviewers will independently select studies from titles, abstracts, and reference lists. The quality of evidence and risk of bias will be assessed according to Cochrane recommendations. Results: This systematic review to be developed will evaluate the impact of telerehabilitation on the burden, stress, pain, and quality of life of caregivers of patients with neurological disorders. Discussion: Caregivers, especially of patients with neurological disorders, need more attention since the overload, stress, duties with other personal responsibilities, and low remuneration may impact the quality of life. Therefore, they need intervention, especially physical therapy via telehealth, which values the time of caregivers and may change their perception of health and quality of life. PROSPERO registration number: CRD42022278523.

Remote versus face-to-face home-based exercise programme in people with amyotrophic lateral sclerosis: protocol for a randomised clinical trial.

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease with variable and complex clinical manifestations that requires a multidisciplinary approach. However, face-to-face treatment in this population may experience barriers, such as difficulty accessing physical therapists or other professionals. As a result, strategies (eg, telerehabilitation) emerged to facilitate treatment and physical therapy monitoring. This study aims to evaluate the effects of remote versus face-to-face home-based exercise programmes on clinical outcomes and treatment adherence of people with ALS. METHODS AND ANALYSIS: This is a single-blind randomised clinical trial protocol that will include 44 people with clinical diagnosis of ALS at any clinical stage and aged between 18 and 80 years. Participants will be randomised into two groups after face-to-face evaluation and perform a home-based exercise programme three times a week for 6 months. A physical therapist will monitor the exercise programme once a week remotely (phone calls-experimental group) or face-to-face (home visits-control group). The primary outcome measure will be functional capacity (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised). Secondary outcomes will include disease severity (Amyotrophic Lateral Sclerosis Severity Scale), fatigue (Fatigue Severity Scale), pain (Visual Analogue Scale and body pain diagram), adverse events and adherence rate. Outcomes will be initially evaluated face-to-face and revaluated remotely every 2 months and 1 month after interventions. Linear mixed models will compare outcome measures between groups and evaluations (α=5%). ETHICS AND DISSEMINATION: This study was approved by the research ethics committee of Hospital Universitário Onofre Lopes/Universidade Federal do Rio Grande do Norte (no. 3735479). We expect to identify the effects of an exercise programme developed according to ALS stages and associated with remote or face-to-face monitoring on clinical outcomes using revaluations and follow-up after interventions. TRIAL REGISTRATION NUMBER: Brazilian Registry Clinical Trials (RBR-10z9pgfv).

As regulamentações de proteção de dados pessoais no Brasil e em Portugal: o tratamento de dados relativos à saúde no âmbito do Projeto "Sífilis Não" / Regulations for the protection of personal data in Brazil and Portugal: the processing of health data under the "No Syphilis" Project / Normativa para la protección de datos personales en Brasil y Portugal: el tratamiento de datos sanitários em el marco del Proyecto "Sífilis Não"

Objetivo: discutir se replicar o Projeto "Sífilis Não", naquilo que se refere ao tratamento de vastas quantidades de dados pessoais relativos à saúde sem o consentimento dos titulares, seria possível em solo português. Metodologia: análise da legislação referente à proteção de dados pessoais brasileira, portuguesa e europeia, tendo o Projeto "Sífilis Não" como o caso em estudo. Resultados: o tratamento de dados pessoais sensíveis sem o consentimento do titular é, em regra, proibido pelo Regulamento Geral de Proteção de Dados, entretanto, o tratamento por motivo de interesse público na área da saúde e para fins de pesquisa científica é autorizado, desde que sejam garantidas as liberdades fundamentais dos titulares. Conclusão: tendo em vista que o Projeto "Sífilis Não" é um projeto de pesquisa que envolve o enfrentamento e erradicação da sífilis em todas as suas formas, hipóteses específicas da legislação portuguesa e europeia autorizam o tratamento de dados pessoais sensíveis mesmo sem o consentimento dos titulares, notadamente o tratamento de dados pessoais por motivos de interesse público no domínio da saúde pública e para fins de investigação científica.

Objective: to discuss whether the reproduction of the "No Syphilis" Project regarding the processing of large scale of personal data related to health without the consent of the holders would be possible in Portugal. Methods: analysis of the Brazilian, Portuguese, and European legislation on personal data protection, with the "No Syphilis" Project as a case study. Results: the processing of sensitive personal data without the consent of the owner is, as a rule, prohibited by the General Data Protection Regulation, however the processing for reasons of public interest in the field of health and scientific research purposes is authorized, provided that the fundamental freedoms of the holders are guaranteed. Conclusion: considering that the "No Syphilis" Project is a research project that involves addressing and eradicating syphilis in all its forms, specific hypotheses of Portuguese and European legislation authorize the processing of sensitive personal data even without the consent of the holders, specifically, the processing of personal data for reasons of public interest in the field of public health and scientific research purposes.

Objetivo: discutir si la reproducción del Proyecto "Sífilis No", con respecto al procesamiento de grandes cantidades de datos personales relacionados con la salud sin el consentimiento de los titulares, sería posible en el terreno portugués. Metodología: análisis de la legislación sobre protección de datos personales brasileños, portugueses y europeos, con el Proyecto "Sífilis No" como caso en estudio. Resultados: el tratamiento de datos personales sensibles sin el consentimiento del titular está, por regla general, prohibido por el Reglamento General de Protección de Datos, sin embargo, el tratamiento por razones de interés público en el ámbito de la salud y con fines de investigación científica está autorizado, siempre que se garanticen las libertades fundamentales de los titulares. Conclusión: considerando que el Proyecto "Sífilis No" es un proyecto de investigación que implica hacer frente y erradicar la sífilis en todas sus formas, hipótesis específicas de la legislación portuguesa y europea autorizan el procesamiento de datos personales sensibles incluso sin el consentimiento de los titulares, en concreto, el tratamiento de datos personales por razones de interés público en el ámbito de la salud pública y con fines de investigación científica.

Educommunication as a strategy to face Syphilis: an analysis of the open educational resources available at AVASUS / Educomunicação como estratégia de enfrentamento à Sífilis: uma análise dos recursos educacionais abertos disponíveis no AVASUS

Introduction: Syphilis is a problem for the Brazilian Public Health. Therefore, the Brazilian Ministry of Health has been promoting actions to fight this disease; among them, the "No Syphilis Project" stands out, and develops open educational resources (OER), among several activities. Objective: To analyze the open educational resources available in the SUS (the Brazilian Unified Health System) Virtual Learning Environment, focused on syphilis. Methods: This qualitative study, based on epistemology in the field of phenomenology, is a content analysis operated with the meanings constructed to parts of a set of texts and the objects of its analysis were the teaching plans of 19 educational resources available at AVASUS, which dealt with the theme "Syphilis". The analysis was organized into two unitss: The main purpose of the educational resource and Thematic focus of the educational resource. Results: The overlapping of clinical aspects of the disease to the detriment of socio-environmental aspects and the prevalence of informational objectives can be observed, with the exception of one resource that presented an objective that sought a more active action by the course participant. In the analysis unit 1 it was possible to identify the prevalence of objectives such as 'presenting' or 'conveying' content/information related to the disease. In the analysis unit 2 it was possible to identify the "classic" biomedical cycle of approaching a disease, focusing on diagnosis. Conclusion: The study contributed to the identification of gaps from the thematic and methodological point of view that can guide the planning for the construction of new educational resources.

Introdução: A sífilis é um problema de saúde pública do Brasil, que via seu Ministério da Saúde vem promovendo ações de enfrentamento da doença, entre as quais se destaca o "Projeto Sífilis Não", que desenvolve, entre diversas atividades, recursos educacionais abertos. Objetivo: Analisar os recursos educacionais abertos, disponíveis no ambiente virtual de aprendizagem do Sistema Único de Saúde (AVASUS), circunscritos na temática da sífilis. Métodos: Este estudo qualitativo, com base espistemológica no campo da fenomenologia, constitui-se em uma análise de conteúdo que operou com os significados contruídos com base em um conjunto de textos e teve como objetos de análise os planos de ensino de 19 recursos educacionais disponíveis no AVASUS e que versavam sobre o tema "sífilis". A análise foi organizada em duas unidades: objetivo principal do recurso educacional; e foco femático do recurso educacional. Resultados: Pode-se observar a sobreposição de aspectos clínicos da doença aos aspectos socioambientais e a prevalência de objetivos informacionais ­ com exceção de um recurso, cujo objetivo buscava uma ação mais ativa por parte do cursista. Na unidade de análise 1, foi possível identificar a prevalência de objetivos como "apresentar" ou "dar a conhecer" conteúdos/informação relacionados à doença. Na unidade de análise 2, foi possível verificar o ciclo biomédico "clássico" de abordagem de uma doença, com foco no diagnóstico. Conclusão: O estudo contribuiu para a identificação de lacunas dos pontos de vista temático e metodológico, que pode orientar o planejamento para a construção de novos recursos educacionais.

Accuracy of affordable instruments for hearing screening in adults and the elderly. / Acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos.

PURPOSE: To evaluate the accuracy of affordable instruments for hearing screening of adults and the elderly. METHODS: This study was carried out with users of a Hearing Health Service of the Unified Health System. All were screened with the MoBASA smartphone application, the Telehealth audiometer (TH) and the electronic version of the Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S. The examiners were blinded to the results of the screening tests and pure tone audiometry (PTA). Hearing impairment was considered for those with a PTA quadritonal mean greater than 40 dB in the best ear. Sensitivity, specificity and positive and negative predictive values (PPV and NPV, respectively) were calculated. The Kappa index was used as an agreement indicator between the PTA and the screening results. RESULTS: The sample consisted of 80 individuals between 18 and 94 years old (55.18 ± 20.21). In the PTA test, 21 individuals (26.25%) had typical hearing and 59 (73.75%) hearing loss. In the hearing screening tests, sensitivity, specificity, PPV and NPV values greater than 75% were observed with the MoBASA as well as in terms of sensitivity and NPV of the TH and the eHHIE-S. The TH and the eHHIE-S specificity and PPV were less than 75%. The Kappa index indicated a substantial agreement (0.6) between the PTA and the MoBASA screening results. The TH and the eHHIE-S showed regular agreement (0.3). CONCLUSION: MoBASA proved to be an accurate method for hearing screening of adults and the elderly with disabling hearing loss.

OBJETIVO: Avaliar a acurácia de instrumentos de custo acessível para triagem auditiva de adultos e idosos. MÉTODO: Este estudo foi realizado com usuários de um Serviço de Saúde Auditiva do SUS. Todos foram submetidos a triagem com o aplicativo de smartphone MoBASA, o audiômetro Telessaúde (TS) e a versão eletrônica do Questionário de Handicap da Audição para Idosos (Hearing Handicap Inventory for the Elderly ­ screening version - eHHIE-S). Os examinadores foram cegos quanto aos resultados dos testes de triagem e para os dados de audiometria de tom puro (ATP). Foram considerados com deficiência auditiva aqueles com média quadritonal na ATP maiores que 40 dB na melhor orelha. Sensibilidade, especificidade e valores preditivos positivo (VPP) e negativo (VPN) foram calculados. O índice Kappa foi usado como um indicador de concordância entre ATP e os resultados da triagem. RESULTADOS: A amostra constou de 80 indivíduos entre 18 a 94 anos (55,18 ± 20,21). Na ATP, 21 indivíduos (26,25%) apresentaram audição normal e 59 (73,75%) perda auditiva incapacitante. Nos testes de triagem auditiva observou-se valores de sensibilidade, especificidade, VPP e VPN maiores do que 75% no MoBASA e na sensibilidade e VPN do TS e eHHIE-S. Já a especificidade e VPP do TS e eHHIE-S foram inferiores a 75%. O índice Kappa indicou concordância substancial (0,6) entre o ATP e os resultados do MoBASA. No TS e eHHIE-S foi constatada regular concordância (0,3). CONCLUSÃO: O MoBASA demonstrou ser um método acurado para triagem auditiva de adultos e idosos com perda auditiva incapacitante.

The relevance a technology ecosystem in the Brazilian National Health Service's Covid-19 response: the case of Rio Grande do Norte, Brazil. / A relevância de um ecossistema tecnológico no enfrentamento à Covid-19 no Sistema Único de Saúde: o caso do Rio Grande do Norte, Brasil.

Technological advances play an undeniable role in strengthening health systems. With regard to digital technologies, information systems and the analysis of health data are playing a growing role in health surveillance and preparing for and responding to disease outbreaks, the theme addressed by this article within the context of the Covid-19 pandemic in the State of Rio Grande do Norte. This study departs from the assumption that digital health interventions can increase Covid-19 response capacity. We developed a technology ecosystem that integrates different information systems to meet the needs outlined in international regulations governing the response to the pandemic. In addition to the main elements of the ecosystem, this article describes the application of this instrument by different institutional actors. The main decision making tool used in the state government's Covid-19 response, the ecosystem is a model for digital health interventions in Brazil's national health service. This experience in Rio Grande do Norte brings together elements that can contribute to studies investigating the resilience of health systems and analyzing health policies in emergency situations.

É inegável o papel dos avanços tecnológicos para o fortalecimento da saúde. No tocante às tecnologias digitais, trata do uso crescente dos sistemas de informação e análise de dados em saúde nas ações de preparo, vigilância e resposta a surtos epidemiológicos, tema abordado neste artigo no contexto da pandemia provocada pelo vírus Sars-CoV-2 no estado do Rio Grande do Norte. Este estudo parte do pressuposto de que é possível potencializar a gestão da resposta à Covid-19 por meio da saúde digital. Assim, a pesquisa desenvolveu um Ecossistema tecnológico que integra diferentes sistemas de informação para atender as necessidades previstas nas normativas internacionais frente à pandemia. Este artigo descreve, além do Ecossistema e sua estrutura, um conjunto de análises sobre a aplicação desse dispositivo por diversos atores institucionais. O Ecossistema foi a principal ferramenta em uso no estado para o processo decisório em resposta à Covid-19, sendo um modelo para a intervenção de saúde digital no Sistema Único de Saúde. A experiência do Rio Grande do Norte reúne, portanto, elementos que contribuem para os estudos sobre resiliência de sistemas e análises de políticas públicas em saúde em situações de emergência.

A relevância de um ecossistema tecnológico no enfrentamento à Covid-19 no Sistema Único de Saúde: o caso do Rio Grande do Norte, Brasil / The relevance a technology ecosystem in the Brazilian National Health Service's Covid-19 response: the case of Rio Grande do Norte, Brazil

Resumo É inegável o papel dos avanços tecnológicos para o fortalecimento da saúde. No tocante às tecnologias digitais, trata do uso crescente dos sistemas de informação e análise de dados em saúde nas ações de preparo, vigilância e resposta a surtos epidemiológicos, tema abordado neste artigo no contexto da pandemia provocada pelo vírus Sars-CoV-2 no estado do Rio Grande do Norte. Este estudo parte do pressuposto de que é possível potencializar a gestão da resposta à Covid-19 por meio da saúde digital. Assim, a pesquisa desenvolveu um Ecossistema tecnológico que integra diferentes sistemas de informação para atender as necessidades previstas nas normativas internacionais frente à pandemia. Este artigo descreve, além do Ecossistema e sua estrutura, um conjunto de análises sobre a aplicação desse dispositivo por diversos atores institucionais. O Ecossistema foi a principal ferramenta em uso no estado para o processo decisório em resposta à Covid-19, sendo um modelo para a intervenção de saúde digital no Sistema Único de Saúde. A experiência do Rio Grande do Norte reúne, portanto, elementos que contribuem para os estudos sobre resiliência de sistemas e análises de políticas públicas em saúde em situações de emergência.

Abstract Technological advances play an undeniable role in strengthening health systems. With regard to digital technologies, information systems and the analysis of health data are playing a growing role in health surveillance and preparing for and responding to disease outbreaks, the theme addressed by this article within the context of the Covid-19 pandemic in the State of Rio Grande do Norte. This study departs from the assumption that digital health interventions can increase Covid-19 response capacity. We developed a technology ecosystem that integrates different information systems to meet the needs outlined in international regulations governing the response to the pandemic. In addition to the main elements of the ecosystem, this article describes the application of this instrument by different institutional actors. The main decision making tool used in the state government's Covid-19 response, the ecosystem is a model for digital health interventions in Brazil's national health service. This experience in Rio Grande do Norte brings together elements that can contribute to studies investigating the resilience of health systems and analyzing health policies in emergency situations.

Uma análise das teleconsultorias assíncronas em saúde auditiva do Núcleo de Telessaúde do Rio Grande do Norte / An analysis of asynchronous hearing health teleconsulting at the Rio Grande do Norte Telehealth Center

RESUMO Objetivo identificar o perfil das teleconsultorias assíncronas na área da saúde auditiva do Núcleo Técnico Científico de Telessaúde do Rio Grande do Norte (RN). Métodos este estudo é retrospectivo e descritivo. Foram analisados os registros das teleconsultorias de janeiro de 2015 a dezembro de 2019 na plataforma de teleconsultoria do Núcleo de Telessaúde do RN. As teleconsultorias foram filtradas e categorizadas por dois fonoaudiólogos quanto a estado de origem, gênero e profissão do solicitante, tema e objetivo da questão. Resultados entre as teleconsultorias realizadas no período, foram incluídas, neste estudo, as teleconsultorias na área da saúde auditiva. Em ordem decrescente de frequência, os profissionais solicitantes foram: agentes comunitários de saúde, fonoaudiólogos, agentes de combate a endemias, médicos, enfermeiros, agentes de saúde pública, técnicos e auxiliares de enfermagem e outros. Quanto aos objetivos das teleconsultorias, de maior a menor frequência, foram constatadas perguntas sobre condutas, avaliação, tratamento, relações entre fatores, etiologias, prevenção, sintomas, implantação, acesso ao sistema de saúde e outras. Em relação às temáticas, em ordem descendente, foram observadas perguntas sobre hipoacusia, dispositivos auxiliares de audição, zumbido, otite, programa saúde na escola, emissões otoacústicas, otalgia, labirintite e perfuração timpânica. Conclusão as teleconsultorias assíncronas sobre saúde auditiva tiveram maior frequência por solicitantes do gênero feminino, agentes comunitários de saúde e fonoaudiólogos, sobre a temática da hipoacusia e de dispositivos auxiliares de audição, com objetivo de tomada de decisões para condutas e avaliação na área da saúde auditiva.

ABSTRACT Objective To identify the profile of asynchronous hearing health teleconsulting ​​ at the Scientific-Technical Center for Telehealth in Rio Grande do Norte (RN). Methods This study is retrospective and descriptive. Teleconsulting records from January 2015 to December 2019 on the telehealth platform of the Telehealth Center of RN were analyzed. The teleconsultations were filtered and categorized by two speech-language therapists regarding the applicant's state of origin, gender and profession, theme and objective of the question. Results Among the teleconsultations carried out in the period, the ones regarding the hearing health area were included in this study. In decreasing order of frequency, the requesting professionals were: community health agents, speech-language therapists, endemic disease control agents, doctors, nurses, public health agents, nursing technicians and assistants and others. As for the objectives of teleconsulting, from higher to lower frequency, were identified questions about: conduct, evaluation, treatment, relations among factors, etiologies, prevention, symptoms, implementation, access to the health system and others. Concerning the themes, in descending order, were observed questions about hearing loss, hearing aid devices, tinnitus, otitis, school health program, otoacoustic emissions, otalgia, labyrinthitis and tympanic perforation. Conclusion Asynchronous teleconsulting on hearing health was more frequent on female applicants, community health agents and speech-language therapists, concerning the theme of hearing loss and hearing aid devices, to make decisions for conducts and evaluation in the health area hearing.

The influence of the No Syphilis Project on congenital syphilis admissions between 2018 and 2019 / A influência do Projeto Sífilis Não nos internamentos por Sífilis congênita entre 2018 e 2019

Introduction: The syphilis epidemic in Brazil, as evidenced by the Indicators and Basic Data on Syphilis in Brazilian Municipalities, published and updated annually by the Ministry of Health, shows that the growing number of cases dates back to 2010 and 2019 was the first in the long series of ten years to show a retreat. Over the years 2017 and 2018, from an agreement signed between the Brazilian Ministry of Health, the Universidade Federal do Rio Grande do Norte (UFRN), and the Pan American Health Organization (PAHO), policies to fight syphilis related to diagnosis, treatment, prevention and management are being implemented. Objective: The objective of the work was to test the hypothesis that the No Syphilis Project has influenced the decline of Congenital Syphilis hospitalizations in Brazilian municipalities since May 2018. Methods: This is an ecological study that compared time series of Congenital Syphilis hospitalizations before and after the implementation of the No Syphilis Project in the Priority municipalities for the project and in Other municipalities. The variables were analyzed by the Chi-square test to rule out the randomness of the results. The series were also analyzed by Linear Regression to measure the degrees of correlation between them. Results: Significance was identified for the reduction of admissions by congenital syphilis occurred after the implementation of the project (p<0.00001). The coefficient of determination R2 among the variables that measured admissions for congenital syphilis in the Priority municipalities and in the Other municipalities fell in the period from 0.884 to 0.261 attesting to the disassociation of the series from the project's performance. Conclusion: The results obtained in the work are compatible with the effectiveness of the actions developed by the No Syphilis Project in the fight against congenital syphilis in Brazil.

Introdução: A epidemia de sífilis no Brasil, como atestam os Indicadores e Dados Básicos da Sífilis nos Municípios Brasileiros, publicados e atualizados anualmente pelo Ministério da Saúde, apresentou crescente número de casos em 2010, sendo o ano de 2019 o primeiro da longa série de dez anos a apresentar recuo. Ao longo dos anos de 2017 e 2018, a partir de um convênio firmado entre o Ministério da Saúde do Brasil, a Universidade Federal do Rio Grande do Norte (UFRN) e a Organização Pan-americana da Saúde (OPAS), foram implantadas políticas de enfrentamento da sífilis relacionadas ao diagnóstico, ao tratamento, à prevenção e à gestão. Objetivo: O objetivo do trabalho foi testar a hipótese de que o Projeto Sífilis Não tenha influenciado o declínio das hospitalizações por sífilis congênita nos municípios brasileiros a partir de maio de 2018. Métodos: Trata-se de estudo ecológico que comparou séries temporais de internamentos por sífilis congênita anteriores e posteriores à implantação do Projeto Sífilis Não nos Municípios prioritários e nos Demais municípios. As variáveis foram analisadas pelo teste do χ2 , para descartar a aleatoriedade dos resultados. As séries foram também analisadas por regressão linear, para medir os graus de correlação entre elas. Resultados: Foi identificada significância para a redução dos internamentos por sífilis congênita ocorrida após a implantação do projeto (p<0,00001). O coeficiente de determinação R2 entre as variáveis que mediram os internamentos por sífilis congênita nos Municípios Prioritários e nos Demais municípios caiu no período de 0,884 para 0,261, atestando a desassociação das séries a partir da atuação do projeto. Conclusão: Os resultados obtidos no trabalho são compatíveis com a efetividade das ações desenvolvidas pelo Projeto Sífilis Não no enfrentamento da sífilis congênita no Brasil.

SMART: a service-oriented architecture for monitoring and assessing Brazil's Telehealth outcomes

Abstract Introduction Brazilian Telehealth Program was instituted by the Ministry of Health in 2007. Its initial structure was composed by nine telehealth centers administered by public higher education institutions. No standards, processes, applications or quality indicators had been defined since its creation. All this, combined with the decentralization of the centers, led each one of them to develop their own system, with different programming languages and architectures. The lack of regulation and integration of the information with the Ministry of Health made it difficult to evaluate the program. In this context, this paper describes the specification, implementation and validation of an architecture, entitled SMART, to integrate the various telehealth platforms developed by the centers. Such architecture aims to standardize information so that the Ministry of Health can monitor and evaluate the results of Telehealth actions. Methods SMART's architecture consists of four main components: a web tool for data manipulation; a web service to receive the center's production data; a component responsible for converting the received data into decision support data; and a component that collects data from external sources to compose the data warehouse. Results The architecture was validated with performance tests, which were executed under extreme workloads. The results of the experiments were summarized in order to attest SMART's effectiveness. Conclusion The analysis of the results obtained on real data shows that the project's performance remained stable under the workloads and its high quality was proven due to the absence of errors during the experiments.

Real-time premature ventricular contractions detection based on Redundant Discrete Wavelet Transform

Abstract Introduction Premature Ventricular Contraction (PVC) is among the most common types of ventricular cardiac arrhythmia. However, it only poses danger if the person suffers from a heart disease, such as heart failure. Hence, this is an important factor to consider in heart disease people. This paper presents an ECG real-time analysis system for PVC detection. Methods This system is based on threshold adaptive methods and Redundant Discrete Wavelet Transform (RDWT), with a real-time approach. This analysis is based on wavelet coefficients energy for PVC detection. It is presented also a study to find the most indicated wavelet mother for ECG analysis application among the following wavelet families: Daubechies, Coiflets and Symlets. The system detection performance was validated on the MIT-BIH Arrhythmia Database. Results The best results were verified with db2 wavelet mother: the Sensitivity Se = 99.18%, Positive Predictive Value P+ = 99.15% and Specificity Sp = 99.94%, on 80.872 annotated beats, and 61.2 s processing speed for a half-hour record. Conclusion The proposed system exhibits reliable PVC detection, with real-time approach, and a simple algorithmic structure that can be implemented in many platforms.

ILITIA: telehealth architecture for high-risk gestation classification

Abstract Introduction According to the World Health Organization, about 9.2% of the 28 million newborns worldwide are stillborn. Besides, about 358,000 women died due to complications related to pregnancy in 2015. Part of these deaths could have been avoided with improving prenatal care agility to recognize problems during pregnancy. Based on that, many efforts have been made to provide technologies that can contribute to offer better access to information and assist in decision-making. In this context, this work presents an architecture to automate the classification and referral process of pregnant women between the basic health units and the referral hospital through a Telehealth platform. Methods The Telehealth architecture was developed in three components: The data acquisition component, responsible for collecting and inserting data; the data processing component, which is the core of the architecture implemented using expert systems to classify gestational risk; and the post-processing component, in charge of the delivery and analysis of cases. Results Acceptance test, system accuracy test based on rules and performance test were realized. For the tests, 1,380 referral forms of real situations were used. Conclusion On the results obtained with the analysis of real data, ILITIA, the developed architecture has met the requirements to assist medical specialists on gestational risk classification, which decreases the inconvenience of pregnant women displacement and the resulting costs.

SOA-BD: Service Oriented Architecture for Biomedical Devices

Introduction: The communication of information systems with biomedical devices has become complex not only due to the existence of several private communication protocols, but also to the immutable way that software is embedded into these devices. In this sense, this paper proposes a service-oriented architecture to access biomedical devices as a way to abstract the mechanisms of writing and reading data from these devices, thus contributing to enable the focus of the development team of biomedical software to be intended for its functional requirements, i.e. business rules relevant to the problem domain. Methods The SOA-BD architecture consists of five main components: A Web Service for transport and conversion of the device data, Communication Protocols to access the devices, Data Parsers to preprocess data, a Device Repository to store data and transmitted information and Error handling, for error handling of these information. For the development of SOA-BD, technologies such as the XML language and the Java programming language were used. Besides, Software Engineering concepts such as Design Patterns were also used. For the validation of this work, data has been collected from vital sign monitors in an Intensive Care Unit using HL7 standards. Results The tests obtained a difference of about only 1 second in terms of response time with the use of SOA-BD. Conclusion SOA-BD achieves important results such as the reduction on the access protocol complexity, the opportunity for treating patients over long distances, allowing easier development of monitoring applications and interoperability with biomedical devices from diverse manufacturers.

Wi-Bio: management policy aimed at the establishment of networks for patient monitoring using IEEE 802.11

INTRODUCTION: Patient monitoring will tend to decline in the coming years due to a shortage of physical and human resources in hospitals. Therefore, several studies define alternatives to improve patient monitoring using wireless networks. In these studies, a wireless network is used to transfer data generated by medical sensors without interacting with the traffic in the data network of the hospital. However, this approach should be avoided because there are demands for integration between user applications and patient monitoring. Therefore, this paper defines a patient monitoring system, called Wi-Bio, directed to the establishment of IEEE 802.11 networks that allows traffic generated by user applications. METHODS: The formal validation of Wi-Bio was made through the design of Petri nets, and performance analysis was performed through simulations of the Network Simulator 2 tool. The adoption of this approach is justified by the fact that Petri nets allow verification of logical correctness of the designed systems, while simulations allow behavioral analysis of Wi-Bio in overload scenarios where many patients are monitored. RESULTS: The results confirmed the validity of the designed Petri nets and showed that Wi-Bio is able to accomplish the temporal goals imposed by medical sensors, thereby promoting efficient integration of traffic present in the data network and the patient monitoring network. CONCLUSION: As described, Wi-Bio fulfilled its objectives and motivates future studies aimed at complementing the obtained results.

O grupo especial de interesse em educação médica como estratégia facilitadora da aprendizagem colaborativa à distância para os profissionais da saúde / The medical education special interest group as a facilitating strategy of collaborative distance learning for healthcare professionals

Este artigo apresenta o êxito da implementação do grupo de interesse especial em educação médica que promoveu 37 atividades colaborativas para aprimoramento de processo de ensinoaprendizagem no Sistema Único de Saúde, com a participação de 34 palestrantes de 16 instituições de ensino superior. Esta iniciativa representa atualmente uma estratégia nacional exitosa de desenvolvimento docente para o ensino na saúde.

This paper presents the successful implementation of the special interest group on medical education that promoted 37 collaborative activities for improvement of teaching-learning experiences in the Health System, with participation of 34 speakers from 16 different higher education institutions. This innovative initiative is currently a successful national strategy to developed teachers and healthcare providers for health education.

ISE-SPL: uma abordagem baseada em linha de produtos de software aplicada à geração automática de sistemas para educação médica na plataforma E-learning / ISE-SPL: a software product line approach applied to automatic generation of systems for medical education in E-learning platform

INTRODUÇÃO: O e-learning surgiu como uma forma complementar de ensino, trazendo consigo vantagens como o aumento da acessibilidade da informação, aprendizado personalizado, democratização do ensino e facilidade de atualização, distribuição e padronização do conteúdo. Neste sentido, o presente trabalho tem como objeto apresentar uma ferramenta, intitulada de ISE-SPL, cujo propósito é a geração automática de sistemas de e-learning para a educação médica, utilizando para isso sistemas ISE (Interactive Spaced-Education) e conceitos de Linhas de Produto de Software. MÉTODOS: A ferramenta consiste em uma metodologia inovadora para a educação médica que visa auxiliar o docente da área de saúde na sua prática pedagógica por meio do uso de tecnologias educacionais, todas baseadas na computação aplicada à saúde (Informática em Saúde). RESULTADOS: Os testes realizados para validar a ISE-SPL foram divididos em duas etapas: a primeira foi feita através da utilização de um software de análise de ferramentas semelhantes ao ISE-SPL, chamado S.P.L.O.T; e a segunda foi realizada através da aplicação de questionários de usabilidade aos docentes da área da saúde que utilizaram o ISE-SPL. CONCLUSÃO: Ambos os testes demonstraram resultados positivos, permitindo comprovar a eficiência e a utilidade da ferramenta de geração de softwares de e-learning para o docente da área da saúde.

INTRODUCTION: E-learning, which refers to the use of Internet-related technologies to improve knowledge and learning, has emerged as a complementary form of education, bringing advantages such as increased accessibility to information, personalized learning, democratization of education and ease of update, distribution and standardization of the content. In this sense, this paper aims to present a tool, named ISE-SPL, whose purpose is the automatic generation of E-learning systems for medical education, making use of ISE systems (Interactive Spaced-Education) and concepts of Software Product Lines. METHODS: The tool consists of an innovative methodology for medical education that aims to assist professors of healthcare in their teaching through the use of educational technologies, all based on computing applied to healthcare (Informatics in Health). RESULTS: The tests performed to validate the ISE-SPL were divided into two stages: the first was made by using a software analysis tool similar to ISE-SPL, called S.P.L.O.T and the second was performed through usability questionnaires to healthcare professors who used ISE-SPL. CONCLUSION: Both tests showed positive results, allowing to conclude that ISE-SPL is an efficient tool for generation of E-learning software and useful for teachers in healthcare.