Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service.

Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.

Social networking website increases efficacy and engagement in a distance learning course about oral lesions.

PURPOSE: Distance learning appears to be an attractive approach to continuing education courses, but one barrier is maintaining learner engagement throughout the course. The primary aim of this research was to evaluate the operational efficacy of a private Facebook™ group (FG) in serving as a support mechanism for distance learning courses, and its impact on three fundamental dimensions: the attrition rates of participants who did not complete the course (commonly referred to as dropout rates), the rates of course completion and approval, and the overall performance of the participants. METHODS: The participants of this quasi-experimental study comprised 159 dental students and 565 dentists enrolled in an e-learning course on oral mucosal lesion diagnosis. Prior to the initiation of the course, all participants were provided with the option to join a private FG. Within this group, moderators shared motivational messages and provided reminders concerning deadlines. Moreover, participants had the opportunity to engage in interactive discussions pertaining to topics related to the course. The course itself followed a self-guided format, employing the flipped-classroom methodology, spanning a total of 50 instructional hours. In order to assess the effectiveness of the course, participants were presented with photographs illustrating 30 oral lesions and were asked to propose diagnostic hypotheses both before and after the educational intervention (pre-tests and post-tests). RESULTS: Dentists who participated in the FG exhibited a significantly lower rate of discontinuation. As for dental students, their involvement in the group was positively associated with better performance, as determined by the percentage of accurate diagnostic hypotheses (a minimum of 70% correct responses was required for their approval in the course). CONCLUSIONS: Facebook™ demonstrates promise as a supplementary pedagogical tool in distance education courses. The interactive nature of the platform has the potential to alleviate the inherent challenges of remote learning.

Clinical Features Associated with the Demand of In-Person Care by Dermatologists: An Observational Cross-Sectional Study.

Background: The factors necessitating the need for referrals for in-person evaluations by a dermatologist are not adequately understood and have not been studied using automated text mining so far. The objective of this study was to compare the prevalence of required in-person dermatologist care in the presence or absence of certain clinical features. Methods: Observational cross-sectional study of 11,661 teledermatology reports made from February 2017 to March 2020. Results: The need for dermoscopy was associated with a 348% increase in the possibility of referral for in-person dermatologist evaluations (prevalence ratio [PR]: 4.48, 95% confidence interval [CI]: 4.17-4.82). Infectious diseases were associated with a 64% lower possibility of referral (PR: 0.36, 95% CI: 0.30-0.43). Discussion: Some lesions and poorly documented cases are challenging to assess remotely. This study presents a different approach to research more detailed data from teledermatology reports, using text mining, and points out the risk magnitude for demanding dermatologic in-person care of which feature analyzed. As limitations, the variables related to lesion location, size, and extension were not analyzed and the dictionaries used were originally in Brazilian Portuguese. Conclusions: Teledermatology seems sufficient for the management of 75% of clinical cases, especially acute in young patients with inflammatory or infectious lesions. Referrals for in-person dermatologist consultations were not only strongly associated with the need for dermoscopy, but also for therapeutic reasons like surgical procedures, phototherapy, and the use of some systemic medications.

Sphenoid sinuses' volume and area analysis of Brazilian individuals' CBCTs, related to sex, age, skin color, and nutritional status using DDS-Pro™ software.

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

Effect of Mobile Health Interventions on Lifestyle and Anthropometric Characteristics of Uncontrolled Hypertensive Participants: Secondary Analyses of a Randomized Controlled Trial.

Our objective was to evaluate the effect of a mobile health (mHealth) intervention on lifestyle adherence and anthropometric characteristics among individuals with uncontrolled hypertension. We performed a randomized controlled trial (ClinicalTrials.gov NCT03005470) where all participants received lifestyle counseling at baseline and were randomly allocated to receive (1) an automatic oscillometric device to measure and register blood pressure (BP) via a mobile application, (2) personalized text messages to stimulate lifestyle changes, (3) both mHealth interventions, or (4) usual clinical treatment (UCT) without technology (control). The outcomes were achieved for at least four of five lifestyle goals (weight loss, not smoking, physical activity, moderate or stopping alcohol consumption, and improving diet quality) and improved anthropometric characteristics at six months. mHealth groups were pooled for the analysis. Among 231 randomized participants (187 in the mHealth group and 45 in the control group), the mean age was 55.4 ± 9.5 years, and 51.9% were men. At six months, achieving at least four of five lifestyle goals was 2.51 times more likely (95% CI: 1.26; 5.00, p = 0.009) to be achieved among participants receiving mHealth interventions. The between-group difference reached clinically relevant, but marginally significant, reduction in body fat (-4.05 kg 95% CI: -8.14; 0.03, p = 0.052), segmental trunk fat (-1.69 kg 95% CI: -3.50; 0.12, p = 0.067), and WC (-4.36 cm 95% CI: -8.81; 0.082, p = 0.054), favoring the intervention group. In conclusion, a six-month lifestyle intervention supported by application-based BP monitoring and text messages significantly improves adherence to lifestyle goals and is likely to reduce some anthropometric characteristics in comparison with the control without technology support.

Chronology of permanent teeth mineralization in Brazilian individuals: age estimation tables.

BACKGROUND: Age is important in forming the uniqueness of individuals. When chronological age is not available, age estimation is required, particularly in court cases. The mineralization chronology of permanent teeth is a valuable tool for age estimation of subadults. This study aimed to evaluate the mineralization stages of permanent teeth of Brazilian subjects from imaging exams, using the classification by Moorrees et al. modified by the authors, to verify the existence of correlation between the chronology of mineralization stages and sex and to prepare numerical tables of the chronology of dental mineralization stages for Brazilian individuals. METHODS: Digital panoramic radiographs of 1100 living Brazilian individuals of both sexes, aged between 2 and 25 years, born between 1990 and 2018, from the image bank of a Dental Radiographs and Documentations clinic located in the city of Araraquara, SP, Brazil. The images were evaluated according to the level of crown and root development and classified according to the stages proposed by Moorrees et al. (Am J Phys Anthropol 21: 205-213, 1963) adapted by the authors. All analyses were performed in the R software. Descriptive and exploratory analyses were performed on all data. For intra- and inter-examiner analyses, the rate of agreement and Kappa statistics at a 95% confidence interval were used. Kappa was interpreted according to Landis and Koch. RESULTS: Only upper and lower canines showed significant differences between the sexes (p < 0.05), with higher average ages for men. The findings were presented in tables, as well as age estimates with 95% confidence intervals for each mineralization stage and each tooth. CONCLUSION: In the present study, we evaluated the mineralization stages of permanent teeth of Brazilian subjects from digital panoramic radiographs and found no correlation between the chronology of mineralization stages and sex, except for canines. From the obtained results, numerical tables of the chronology of dental mineralization stages were prepared.

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.

Orientação à atenção primária à saúde em uma equipe de saúde da família em Aracaju, Sergipe / The adequacy of primary health care in a family health team in Aracaju, Sergipe

A Atenção Primária à Saúde (APS) é componente chave para o fortalecimento dos sistemas de saúde, que visam alcançar os princípios de integralidade e equidade. No Brasil, a organização da APS é norteada pela Estratégia de Saúde da Família (ESF), que utilizacomo um dos principais instrumentos avaliativos o Primary Care Assessment Tool(PCAT). Esse instrumento mede a orientação da APS à luz dos atributos essenciais (acesso de primeiro contato, longitudinalidade, integralidade e coordenação do cuidado) e derivados (orientação familiar e comunitária e competência cultural). O objetivo deste estudo é analisar o desempenho de uma Equipe de Saúde da Família (EqSF) no município de Aracaju, SE, à luz do PCAT, a fim de se obter o grau de orientação da APS. Foram entrevistados 310 adultos cadastrados maiores de 20 anos. Destes, 254 (81,9%) mostraram-se afiliados à Unidade de Saúde, sendo essa amostra utilizada para o cálculo do grau de orientação. O escore geral obtido foi de 6,8, com o valor de 6,66 sendo considerado indicativo de uma boa orientação para APS. Apesar desse resultado, foi percebido que os atributos de acesso, integralidade e orientação comunitária precisam de ajustes para que a equipe possa ofertar um serviço mais resolutivo e de qualidade.

Primary health care (PHC) is the key feature to enhance the world's health systems as it pursues major goals such as integrality and equality. In Brazil, the PHC system is ruled by the Family Health Strategy (FHS) which uses the Primary Care Assessment Tool (PCAT) as its main assessment instrument. This tool measures the adequacy of PHC (APHC) within the scope of four core PHC domains (first contact accessibility, longitudinality, comprehensiveness, and coordinated care) and its three sub-domains (family orientation, community orientation, and cultural competence). The purpose of this study is to analyze the performance of a Family Health Team (FHT) in the city of Aracaju, by applying the PCAT, in order to obtain their APHC level. A total of 310 adults over 20 years of age were interviewed, of which 254 (81.9%) were affiliated with the FHT. This number was the sample used to calculate the APHC level. The general score obtained was 6.8 -a number higher than 6.66 is considered a good APHC level. Despite this result, the domains of accessibility, integrality, and community orientation call for some adjustments so the team can offer a higher quality of PHC services.

Distance learning course improves primary care dentists' diagnosis and self-efficacy in the management of oral lesions.

Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: A study with live Brazilian subjects using cone-beam computed tomography.

OBJECTIVE: To perform three-dimensional measurements (volume and area) of the maxillary sinus, from cone-beam computed tomography (CBCT) images, and to assess potential differences between the left and right sides and a correlation of the measurements to sex, age, skin color, and nutritional status. DESIGN: CBCT images of 161 living Brazilian subjects of both sexes (89 women and 72 men) were used, and three-dimensional measurements of volume and area were made with the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland). The inter- and intra-examiner reproducibility of measurements was evaluated with TEM, rTEM, and R. RESULTS: Both maxillary sinus volume and area did not show significant differences between the left and right sides and between the sexes. Volume and area were significantly lower in the age group from 6 to 11 years than in the other two groups (p < 0.05). The measurements obtained for maxillary sinus volume and area were significantly higher in white individuals (p < 0.05), but they did not show significant differences (p > 0.05) regarding nutritional status (considering the body mass index - BMI). CONCLUSION: There were no statistically significant differences between the sexes, which does not allow recommending the use of maxillary sinus volume and area measurements to analyze sexual dimorphism, and the same occurs for BMI. However, such measures can help to estimate the age and skin color of individuals.

Overhydration in acute kidney injury: Is it always a menace to critically ill patients? A survival study using bioimpedance spectroscopy.

INTRODUCTION: The hydration status is a predictor of survival in critically ill patients. However, it is unclear whether this association depends on the patient clinical condition. This study was designed to analyze the impact of hydration status on survival of critically ill patients with acute kidney injury (AKI) with or without sepsis. METHODS: A prospective cohort study following critically ill patients with AKI consecutively admitted over a one-year period to a teaching hospital intensive care unit (ICU). All patients with AKI stage three or higher of the KDIGO score were included. The hydration status was evaluated through the overhydration (OH) parameter of spectroscopy bioimpedance and sepsis was defined according Sepse-3 criteria. The survival analysis used adjusted competing-risks regression. RESULTS: Forty-eight patients were included, 27 (56%) with a sepsis diagnosis. The main negative predictors of survival among sepsis patients, adjusted by SAPS3 score, were higher OH (SHR 1.1, 95% CI 1.0-1.2, p = 0.02), mechanical ventilation (SHR 6.9, 95% CI 1.0-47.8, p = 0.04) and older age (SHR 1.1, 95% CI 1.0-1.1, p = 0.005). The predictors in non-sepsis patients were lower OH (SHR 0.82, 95% CI 0.71-0.95, p = 0.008) and mechanical ventilation (SHR 12, 95% CI 2.4-6.6, p < 0.001). CONCLUSIONS: This finding suggests that extracellular overhydration is an independent predictor of survival in critically ill patients with sepsis, but it seems to have opposite effect in non-sepsis patients.

Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis.

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P < 0.01), and in women, heart failure (P < 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178.

Avaliação de adequabilidade de um serviço de telespirometria / Suitability assessment of a telespirometry service / Evaluación de la adecuación de un servicio de telespirometría

Introdução: As doenças respiratórias crônicas estão entre os principais problemas de saúde pública no mundo. Mesmo sendo sensíveis ao tratamento na Atenção Primária à Saúde, são a terceira principal causa de morte no Brasil. Os serviços de telemedicina apresentam-se como aliados importantes dos profissionais de saúde no que tange ao manejo de doenças respiratórias como a asma e a doença pulmonar obstrutiva crônica. Objetivo: Avaliar a adequabilidade de um serviço de telemedicina diagnóstica em espirometria considerando os indicadores de oferta, utilização e cobertura populacional no estado do Rio Grande do Sul. Resultados: No período estudado, o serviço ofertou 27.672 exames de telespirometria aos usuários do Sistema Único de Saúde do Rio Grande do Sul encaminhados por médicos da Atenção Primária à Saúde. A utilização esteve abaixo de 50% da oferta em todas as macrorregiões de saúde do estado. Conclusões: O estudo demonstrou que a capacidade instalada pelo serviço esteve adequada para atender à demanda populacional do Rio Grande do Sul, no entanto a baixa utilização do serviço pode estar associada ao desconhecimento sobre ele e à dificuldade em reconhecer essas doenças por parte dos profissionais de saúde da Atenção Primária à Saúde.

Introduction: Chronic respiratory diseases are among the main public health problems in the world. Despite being sensitive to treatment in Primary Health Care, they are the third leading cause of deaths in Brazil. Telemedicine services present themselves as important allies of health professionals regarding the management of respiratory diseases such as asthma and chronic obstructive pulmonary disease. Objective: to evaluate the adequacy of a telemedicine diagnostic service in spirometry considering the indicators of supply, use and population coverage in the state of Rio Grande do Sul. Results: In the studied period, the service offered 27,672 telespirometry tests to users of the Brazilian Unified Health System referred by Primary Health Care physicians; the use was under 50% in relation to the offer in all health macro-regions of the state. Conclusions: The study demonstrated that the capacity installed by the service was adequate to meet the demand of the population in Rio Grande do Sul. However, the low usage of the service may be associated with lack of knowledge about the service and the difficulty to recognize these diseases by health professionals in Primary Health Care.

Introducción: Las enfermedades respiratorias crónicas están entre los principales problemas de salud pública en el mundo. Aunque son sensibles al tratamiento en la Atención Primaria de Salud, son la tercera principal causa de muerte en Brasil. Los servicios de telemedicina se presentan como aliados importantes de los profesionales de la salud en lo que respecta al manejo de enfermedades respiratorias como asma y Enfermedad Pulmonar Obstructiva Crónica. Objetivo: evaluar la adecuación de un servicio de telemedicina diagnóstica en espirometría considerando los indicadores de oferta, utilización y cobertura poblacional en el estado de Rio Grande do Sul. Resultados: En el período estudiado, el servicio ofertó 27.672 exámenes de telespirometría a los usuarios del Sistema Único de Salud del RS encaminados por médicos de la atención primaria de salud, la utilización estuvo por debajo del 50% de la oferta en todas las macrorregiones de salud del Rio Grande do Sul. Conclusiones: El estudio demostró que la capacidad instalada por el servicio estuvo adecuada para atender la demanda poblacional de Rio Grande do Sul, sin embargo, la baja utilización del servicio puede estar asociada al desconocimiento del servicio y a la dificultad de reconocer estas enfermedades por parte de los profesionales de salud de la atención primaria de salud.

Lucio phenomenon in an adolescent female.

INTRODUCTION: LP is an uncommon reaction characterized by outbreaks of erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration that occurs in patients with Lucio leprosy and lepromatous leprosy; it can be considered a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs, and pregnancy. CASE REPORT: A 17-year-old female presented with fever, tachycardia, adynamia, extensive hyperchromic and purplish macular lesions, erythematous plaques, multiple blisters with serohematic content, and necrotic exulcerations and ulcers on the lower and upper limbs, ears, nose, palms, and soles. Past medical history included leprosy and a first trimester miscarriage. The patient was diagnosed with borderline lepromatous leprosy in reactional state (ie, LP) and MDT was restarted in association with systemic corticosteroid and pentoxifylline. Local therapy was performed with cleansing solution (0.9% sodium chloride), dressing with silver sulfadiazine ointment, and surgical debridement of the necrotic lesions. CONCLUSION: LP is a rare manifestation that may be fatal because of considerable inflammatory activity and the extent and severity of dermatologic lesions. Pregnancy is strongly associated with exacerbation of symptoms. Debridement is required to excise nonviable tissue and promote wound healing.

Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting.

OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Oral Medicine Experience and Attitudes Toward Oral Cancer: An Evaluation of Dentists Working in Primary Health Care.

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis.

BACKGROUND: Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. METHODS: We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. RESULTS: The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. CONCLUSION: These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.

Distance learning course improves primary care dentists' diagnosis and self-efficacy in the management of oral lesions

Abstract Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy.

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.