EstomatoNet: A 5-year experience of an oral medicine telediagnosis service.

OBJECTIVE: EstomatoNet is an online service driven by primary health care professionals to support diagnosis and decision-making for oral lesions. This study aimed to describe the experience of the service, depicting use cases and its impact on the referral to specialised services. MATERIALS AND METHODS: Patient/applicant demographics and information related to their oral lesions and/or complaints were retrieved from the service's cloud-based platform. The differential diagnosis provided by the applicants, their level of satisfaction and the teleconsultant's opinion in terms of diagnosis and management were also reported. The teleconsultant's suggestion was cross-referenced with the data from the regulation system to verify the avoidance of referral. RESULTS: Out of 2,002 teleconsultations, most patients were women (55.1%) and 50.1% were aged between 20 and 59 years. Applicants (96.5%) generally considered the service very satisfying/satisfying. Potentially malignant disorders were reported in 19.6% of cases and 7.7% were suspected to be malignant. The referral of 37.3% of patients was avoided after the suggestion of keeping the patient in the primary health care system (k = 0.234; p < 0.001; 62.2% agreement). CONCLUSION: The use of EstomatoNet for oral mucosal lesions improves support for primary health care professionals in the management of lesions and reduces referral to specialised services.

Eighteen years in two days: the next steps for remote consultation in Brazil / Dieciocho años en dos días: los próximos pasos para la consulta remota en Brasil / Dezoito anos em dois dias: os próximos passos para a consulta remota no Brasil

This is an opinion article that aims to support the Disease caused by the New Coronavirus of 2019 (COVID-19) post-pandemic regarding the regulation of care through digital resources. Through a literature review, an attempt was made to conceptualize remote consultation and to survey both the historical evolution of technological appropriation by health and the regulation on the subject. Texts covering the pre-pandemic and pandemic periods in Brazil, the United States, the European Union and Australia were evaluated. We tried to highlight the main fallacies, sophisms and dissensions that orbit the theme, as well as the real points where there is a need for greater commitment for decision makers: data security and privacy, reimbursement parity and interstate licensing. It is concluded that the technological appropriation by health has divided the world into at least three segments: those that maintained the autonomy of professionals and patients; those who retarded technological advancement through bureaucracy; and those who forbade advances. The pandemic has generated positive reallocations among these groups and there is a need to refine progress and avoid setbacks.

Este es un artículo de opinión que tiene como objetivo apoyar la discusión pospandémica de la Enfermedad causada por el Nuevo Coronavirus de 2019 (COVID-19) en cuanto a la regulación de la atención a través de recursos digitales. A través de una revisión de la literatura, se intentó conceptualizar la consulta remota y relevar tanto la evolución histórica de la apropiación tecnológica por parte de la salud como la regulación sobre el tema. Se evaluaron los textos que cubren los períodos prepandémico y pandémico en Brasil, Estados Unidos, la Unión Europea y Australia. Intentamos resaltar las principales falacias, sofismas y disensiones que orbitan el tema, así como los puntos reales donde existe la necesidad de un mayor compromiso de los tomadores de decisiones: seguridad y privacidad de los datos, paridad de reembolso y licencias interestatales. Se concluye que la apropiación tecnológica por parte de la salud ha dividido al mundo en al menos tres segmentos: los que mantenían la autonomía de profesionales y pacientes; los que retrasaron el avance tecnológico a través de la burocracia; y los que prohibieron los avances. La pandemia ha generado reasignaciones positivas entre estos grupos y es necesario perfeccionar el progreso y evitar retrocesos.

Este é um artigo de opinião que objetiva subsidiar a discussão pós-pandemia da Doença causada pelo Novo Coronavírus de 2019 (COVID-19) a respeito da regulamentação do atendimento por meio de recursos digitais. Buscou-se, por meio de revisão de literatura, conceituar a consulta remota e fazer um levantamento tanto da evolução histórica da apropriação tecnológica pela saúde como da regulamentação sobre o tema. Foram avaliados textos cobrindo os períodos pré-pandêmico e pandêmico no Brasil, Estados Unidos, União Europeia e Austrália. Procurou-se evidenciar as principais falácias, sofismas e dissensos que orbitam o tema, bem como os reais pontos onde há necessidade de maior empenho para os tomadores de decisão: segurança de dados e privacidade, paridade de reembolso e licenciamento interestadual. Conclui-se que a apropriação tecnológica pela saúde dividiu o mundo em pelo menos três segmentos: os que mantiveram a autonomia de profissionais e pacientes; os que retardaram o avanço tecnológico por meio de burocracia; e os que proibiram os avanços. A pandemia gerou realocações positivas entre esses grupos e existe a necessidade de refinar avanços e evitar retrocessos.

Depressive symptoms of the elderly people and caregiver's burden in home care.

OBJECTIVES: To characterize the elderly population and their caregivers and to verify the association of depressive symptoms of the elderly and the caregiver's burden with the variables of interest. METHODS: A cross-sectional study with 80 elderly people and 78 caregivers in a Primary Health Service in southern Brazil. Retrospective collection conducted in a structured database based on the multidimensional evaluation tool applied to home care for the elderly participants and their caregivers. RESULTS: Most elderly participants were women (71.3%), with an average age of 82.1 years and 52.6% reported sadness or discouragement. Systemic arterial hypertension was the most frequent morbidity (68.8%). Most caregivers were women (85.7%), daughters of the elderly person (53.2%), mean age 57.8 years and 38.7% reported feeling the burden. The presence of depressive symptoms in the elderly was associated with Parkinson's disease (p=0.016) and to have a male caregiver (p=0.006). Caregiver's burden was associated with daily life activities such as bathing (p=0.021). CONCLUSIONS: There was evidence of differences in caregiver's gender in the presence of depressive symptoms and differences in the assistance in daily life activities for the caregiver's burden.