Diagnostic evaluation of institutions as a basis for designing the Brazilian maturity model of telehealth services.

BACKGROUND: The number and specificities of telehealth service units that expanded their services and diversified with the COVID-19 pandemic in Brazil need to be discovered. The objective of this manuscript is to present a methodology for the diagnostic evaluation of 19 telehealth units from different regions of the country for federal governmental decision-making. METHODS: A cross-sectional quantitative and qualitative study was carried out in the form of a census based on administrative records with an online survey and in-depth interviews with local telehealth managers. RESULTS: Despite the discontinuity of regular funding, the results point to a diversity of initiatives and advances. Citizenship, sustainability, security, and budget management are recurring themes in the maturity analysis of telehealth services after the advent of the pandemic. CONCLUSION: It is necessary for Brazil to build a resilient model of the maturity of telehealth services that contemplates the different regional scenarios.

Addressing discrimination and violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: a mobile health intervention.

BACKGROUND: Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons globally. Herein, we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance-Dandarah app. METHODS: We conducted community-based participatory research (CBPR) between 2019 and 2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a 'word cloud', to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019. RESULTS: Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks. CONCLUSIONS: Rainbow Resistance-Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.

Lei Geral de Proteção de Dados e o controle social da saúde / General Data Protection Law and the social control of health

A proteção dos dados pessoais é um tema crucial para o controle social da saúde nesses tempos de capitalismo de vigilância em que há uma troca constante da privacidade dos indivíduos por serviços. Os capítulos dessa publicação são fruto de autores especialistas e convidados que participaram do Seminário online e gratuito intitulado "LGPD na Saúde: o CNS como articulador dos interesses da sociedade brasileira em Defesa da Vida", realizado em 2021. O evento foi promovido pelo Conselho Nacional de Saúde e nove mesas redondas conformaram três eixos de discussão: Acesso Universal à Saúde na Sociedade da Informação; Governo, Transformação Digital, Cidadania e o Controle Social da Saúde e Aspectos da Saúde Digital e da Ética em Pesquisa à Luz da LGPD. Enfim, esta coletânea visa contribuir com o cenário da governança das informações em saúde e a literacia dos atores do controle social na transição digital da saúde, suas práticas e tecnologias emergentes associadas.

Telehealth service maturity model for the Brazilian scenario (TMSMM.br) / Modelo de madurez de servicios de telemedicina para el escenario brasileño (TMSMM.br) / Modelo de maturidade de serviços de telessaúde para o cenário brasileiro (TMSMM.br)

This article describes a proposed framework called Telehealth Service Maturity Model (TMSMM.br) for evaluating the current stage of telehealth centers in the Brazilian context. The steps included literature review, compilation and interpretation, data collection instrument, survey with center coordinators, model development, and evaluation process. The review resulted in 857 quality aspects for telehealth services, grouped into 12 themes with 34 topics. TMSMM.br consists of defining 3 foundational dimensions (themes, services, stages) and provides a standardized set of 200 requirements ordered across 5 thematic domains (structure, organization, user, operation and community) for 8 services (consultation, consultation, diagnosis, treatment and referral, education and training, social control and communication, healthcare network, and research, development, and innovation). TMSMM.br enables telehealth centers to identify and compare essential characteristics and their maturity stages.

Este artículo describe una propuesta de marco de referencia llamado Modelo de Madurez de Servicios de Telemedicina (TMSMM.br) para evaluar la etapa actual de los centros de telemedicina en el contexto brasileño. Las etapas incluyeron revisión de literatura, compilación e interpretación, instrumento de recolección, encuesta a coordinadores de centros, desarrollo del modelo y proceso de evaluación. La revisión resultó en 857 aspectos de calidad para servicios de telemedicina, agrupados en 12 temas con 34 tópicos. TMSMM.br consiste en la definición de 3 dimensiones estructurales (temas, servicios, etapas) y proporciona un conjunto estandarizado de 200 requisitos ordenados en 5 dominios temáticos (estructura, organización, usuario, operación y comunidad) para 8 servicios (consulta, asesoría, diagnóstico, tratamiento y remisión, educación y capacitación, control social y comunicación, red de atención de salud e investigación, desarrollo e innovación). TMSMM.br ayuda a los centros de telemedicina a identificar y comparar características esenciales y sus etapas de madurez

Este artigo descreve uma proposta de framework denominado Modelo de Maturidade de Serviços de Telessaúde (TMSMM.br) para avaliação do estágio corrente dos núcleos de telessaúde no contexto brasileiro. As etapas incluíram revisão da literatura, compilação e interpretação, instrumento de coleta, inquérito com coordenadores de núcleos, elaboração do modelo e do processo de avaliação. A revisão resultou 857 aspectos de qualidade para serviços de telessaúde, agrupados em 12 temas com 34 tópicos. TMSMM.br consiste na definição de 3 dimensões estruturantes (temas, serviços, estágios) e provê um conjunto padronizado de 200 requisitos ordenados em 5 domínios temáticos (estrutura, organização, usuário, operação e comunidade) para 8 serviços (consulta, consultoria, diagnóstico, tratamento e encaminhamento, formação e capacitação, controle social e comunicação, rede de atenção à saúde, e pesquisa, desenvolvimento e inovação). TMSMM.br colabora para que núcleos de telessaúde possam identificar e comparar características essenciais e seus estágios de maturidade.

Addressing Discrimination and Violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: A mobile Health intervention.

Background: Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons in the world. Herein we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance - Dandarah app. Methods: We conducted community-based participatory research (CBPR) between 2019-2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a 'word cloud', to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019. Results: Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible strategy for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks. Conclusions: Rainbow Resistance - Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.

Racial discrimination and health: health professionals' actions in providing care women in the induced abortion process. / Discriminação racial e saúde: ações dos profissionais de saúde na assistência à mulher em processo de abortamento provocado.

This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.

Este artigo tem como objetivo avaliar as desigualdades raciais na assistência de profissionais de saúde ao abortamento provocado. Estudo de revisão sistemática, seguindo o modelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a partir das seguintes bases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), National Library of Medicine and National Institutes of Health (PubMed), Science Direct, Portal de Periódicos Capes, com os descritores: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", escolhidos mediante consulta ao DeCS e Medical Subject Heading (MeSH). Seguindo os critérios de inclusão e exclusão, analisaram-se 18 artigos, publicados entre os anos de 2005 a 2020 na literatura nacional e internacional. A maioria dos estudos encontrou uma relação significativa entre discriminação racial e violência institucional, incluindo o acesso e qualidade da assistência de pacientes em abortamento provocado. A discriminação racial é um fator de risco significativo para resultados adversos no atendimento.

Discriminação racial e saúde: ações dos profissionais de saúde na assistência à mulher em processo de abortamento provocado / Racial discrimination and health: health professionals' actions in providing care women in the induced abortion process

Resumo Este artigo tem como objetivo avaliar as desigualdades raciais na assistência de profissionais de saúde ao abortamento provocado. Estudo de revisão sistemática, seguindo o modelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a partir das seguintes bases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), National Library of Medicine and National Institutes of Health (PubMed), Science Direct, Portal de Periódicos Capes, com os descritores: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", escolhidos mediante consulta ao DeCS e Medical Subject Heading (MeSH). Seguindo os critérios de inclusão e exclusão, analisaram-se 18 artigos, publicados entre os anos de 2005 a 2020 na literatura nacional e internacional. A maioria dos estudos encontrou uma relação significativa entre discriminação racial e violência institucional, incluindo o acesso e qualidade da assistência de pacientes em abortamento provocado. A discriminação racial é um fator de risco significativo para resultados adversos no atendimento.

Abstract This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.

COVID-19 Remote Consultation Services and Population in Health Inequity-Concentrating Territories: A Scoping Review.

Background: This review aimed to map initiatives for measuring the satisfaction of vulnerable populations with teleconsultation services offered by public and private health care providers in their territories, during the coronavirus disease (COVID-19) pandemic. Systematic studies on the opinions of people most affected by health inequities are limited. Therefore, we included evaluations of teleconsultation-based services offered to socioeconomically disadvantaged and clinically vulnerable populations globally, with a focus on surveillance, treatment, and prevention of COVID-19. Materials and Methods: This review includes analytical and descriptive observational studies primarily from MEDLINE, EMBASE, SCOPUS, and Web of Science databases, published after the World Health Organization received the first warnings about COVID-19 from Chinese authorities in December, 2019, until December 2020. The search strategy combined aspects of COVID-19, telemedicine, patient satisfaction, and key concepts of vulnerable populations. Results: We selected 33 studies for full-text reading and 10 for critical appraisal. Two categories emerged from the qualitative analysis: telehealth evaluation and services during COVID-19, and opinions of vulnerable populations. Television and social networks play a crucial role in providing information. Although teleconsultations are practical and cost effective for patients, the majority preferred receiving in-person treatment in primary care clinics. Conclusions: Listening to the opinions of vulnerable groups and their caregivers is critical both before and during adoption of COVID-19 control measures. Health managers need to monitor the health of and delivery of services to socioeconomically and clinically vulnerable people closely, to improve services, and provide care from a human rights perspective.

Three decades of telemedicine in Brazil: Mapping the regulatory framework from 1990 to 2018.

This study characterized the evolution of Brazilian public telemedicine policy in the Brazilian Unified Health System for 30 years from 1988 to 2019 by analyzing its legal framework. We identified 79 telemedicine-related legislations from the federal government (laws, decrees, and ordinances) and 31 regulations of federal councils of health professionals. Three historical phases were established according to the public policy cycle, and material was classified according to the purpose of the normative documents. The content analysis was based on the advocacy coalition framework model. Of the federal legislations, 8.9% were for the Formulation/Decision-Making phase, 43% for the Organization/Implementation phase, and 48.1% for the Expansion/Maturation phase of telemedicine policy in Brazil. The Federal Council of Medicine was the most active in standardizing telemedicine and was responsible for 21 (67.7%) regulations. The first legislations were passed in 2000; however, the coalitions discussed topics related to telemedicine and created their belief systems from the 1990's. The time cycle which included formulation and decision making for Brazilian telemedicine policy, extended until 2007 with the creation of several technical working groups. The expansion and maturation of telemedicine services began in 2011 with the decentralization of telemedicine policy actions across the country. Telemedicine centers which performed telediagnosis influenced the computerization of primary health care units. We conclude that Brazilian telemedicine field has greatly grown and changed in recent years. However, despite the proliferation of legislations and regulations in the period studied, there is still no fully consolidated process for setting up a wholly defined regulatory framework for telemedicine in Brazil.

Educação e informação em saúde: iniciativas dos núcleos de telessaúde para o enfrentamento da covid-19 / Educação e informação em saúde: iniciativas dos núcleos de telessaúde para o enfrentamento da covid-19 / Health education and information: initiatives of telehealth centers to combat covid-19

Objetivo: Identificar as iniciativas de teleducação e informações em saúde direcionadas ao enfrentamento da pandemia da COVID-19 oferecidas pelos Núcleos Estaduais de Telessaúde vinculados ao Programa Telessaúde Brasil Redes. Método: Estudo exploratório, transversal, de abordagem quali-quantitativa, na forma de casos múltiplos, usando informações disponíveis nos sítios eletrônicos e mídias sociais. Resultados: Informações e iniciativas de tele-educação voltadas à COVID-19 estavam presentes em 15 dos 23 Núcleos existentes. Verificouse produção de amplo leque de materiais diversos, que incluem cursos a distância, webpalestras, webaulas, cartilhas, infográficos e outros materiais informativos. Destaca-se a existência de forte tendência das ações de teleducação com foco nas redes sociais (YouTube, Facebook, Twitter e Instagram), como coadjuvantes na divulgação de produtos e serviços para a população, fortalecendo a democratização e o acesso a informações úteis para usuários, enfermeiros e profissionais dos serviços de saúde. Conclusão: Acesso à informação de forma ágil e transparente, durante o isolamento social é crítico no enfrentamento da pandemia. A web revela-se como importante ferramenta para obter informações sobre a COVID nos Núcleos de Telessaúde. Os resultados mostram papel relevante a ser exercido pelos serviços de telessaúde, considerando a necessidade de qualificação profissional e de acesso à informação de qualidade demandada pela pandemia.(AU)

Objective: To identify the health education and information initiatives aimed at coping with the COVID-19 pandemic, offered by state Telehealth Centers associated with the Brazilian Telehealth Network Program. Method: This is an exploratory, cross-sectional study with a qualitative and quantitative approach, in the form of multiple case study, using information available on websites and social media. Results: COVID-19-related Information and tele-education initiatives were present in 15 of the 23 existing Centers. The production of a wide range of different materials was verified, including online courses, web lectures, manuals, infographics, and other informational material. It is worth mentioning the existence of a strong trend in tele-education actions focused on social networks (YouTube, Facebook, Twitter, and Instagram) as assistants in the disclosure of products and services to the population, strengthening democratization and access to useful information for users, nurses and health service professionals. Conclusions: Access to information in a fast and transparent way during social isolation is critical in facing the pandemic. The websites are an important tool to obtain information about COVID-19 on Telehealth Centers. The results show an important role to be played by telehealth services, considering the need for professional qualification and access to quality information required by the pandemic(AU)

Objetivo: Identificar las iniciativas de teleducación e información de salud destinadas a hacer frente a la pandemia de SARS-CoV-2 ofrecidas por los Centros estaduales de Telesalud vinculados al "Programa Telessaúde Brasil Redes". Método: Estudio exploratorio, transversal, con enfoque cuali-cuantitativo, en forma de casos múltiples, con base en sus páginas web. Resultados: Las iniciativas de información y teleducación dirigidas al nuevo coronavirus estuvieron presentes en 15 centros. Se verificó la producción de una amplia gama de materiales diferentes, incluidos cursos a distancia, conferencias web, folletos, infografías y otros materiales informativos. Se destaca la existencia de una fuerte tendencia en acciones de teleducación centradas en redes sociales (YouTube, Facebook, Twitter e Instagram), como asistentes en la difusión de servicios a la población, fortaleciendo la democratización y el acceso a informaciones útiles para usuarios, enfermeros y profesionales de salud. Conclusión: El acceso a la información ágil y transparente durante el aislamiento social es crítico para enfrentar la pandemia. La web se revela como una herramienta importante para obtener información sobre SARS-CoV-2 en estos centros. Los resultados muestran un papel relevante de los servicios de telesalud, considerando la necesidad de calificación profesional y el acceso a la información de calidad requerida por la pandemia.(AU)

Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context. / Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro.

COVID-19 has created enormous challenges for health systems worldwide, with the rapidly growing number of deaths and critical patients with pneumonia requiring ventilatory support. Alternative methods to control the spread of the disease such as social isolation, extreme quarantine measures, and contact tracing have been used around the world. However, these measures may not be totally effective to fight COVID-19, in step with the necessary national preparations to meet the new patient care demands. A wide range of digital technologies can be used to enhance these public health strategies, and the pandemic has sparked increasing use of telehealth. This field has grown considerably in Brazil in recent years. Still, despite the intense proliferation of recommendations and rules, until the current pandemic the country still lacked a fully consolidated regulatory framework. The emergence of COVID-19 marks a key moment in the expansion of applications and use of telehealth for improving the health system's response to the current crisis. The article discusses telehealth's contribution to the fight against COVID-19 and the recent initiatives triggered in Brazil as opportunities for the consolidation of telemedicine and improvement of the Brazilian Unified National Health System. The authors conclude that telehealth offers capabilities for remote screening, care and treatment, and assists monitoring, surveillance, detection, prevention, and mitigation of the impacts on healthcare indirectly related to COVID-19. The initiatives triggered in this process can reshape the future space of telemedicine in health services in the territory.

Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro / Desafíos y oportunidades para la telesalud en tiempos de la pandemia por la COVID-19: una reflexión sobre los espacios e iniciativas en el contexto brasileño / Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context

Resumo: A COVID-19 tem representado um desafio global aos sistemas de saúde, expandindo em velocidade crescente de óbitos, de pacientes críticos com pneumonia e necessidade de suporte respiratório. Métodos alternativos para controlar a propagação da doença, como o isolamento social, medidas extremas de quarentena e o rastreio dos contactantes dos casos têm sido utilizados no mundo. Contudo, essas medidas podem não ser totalmente eficazes para combater a escalada da COVID-19 em compasso às preparações nacionais necessárias às novas demandas de cuidado. Ampla gama de tecnologias digitais pode ser usada para aprimorar essas estratégias de saúde pública, e a pandemia gerou um frenesi relacionado à telessaúde. No Brasil, esse campo tem crescido acentuadamente nos últimos anos. Todavia, a despeito da intensa proliferação de normativas, ainda inexistia, até a epidemia, um marco regulatório plenamente consolidado no país. O surgimento da COVID-19 marca um momento profícuo de expansão das aplicações e usos da telessaúde, como forma de melhorar a resposta do sistema de saúde à crise em curso. O artigo discute a contribuição da telessaúde para o enfrentamento da COVID-19 e as iniciativas recentes desencadeadas no país, como oportunidades para a consolidação da telemedicina e de aperfeiçoamento do Sistema Único de Saúde. Concluiu-se que a telessaúde oferece capacidades para triagem, cuidado e tratamento remotos, auxilia o monitoramento, vigilância, detecção e prevenção, e para a mitigação dos impactos aos cuidados de saúde indiretamente relacionados a COVID-19. As iniciativas desencadeadas nesse processo podem reconfigurar o espaço futuro da telemedicina na prática dos serviços no território.

Resumen: La COVID-19 ha representado un desafío global para los sistemas de salud, expandiéndose rápidamente y provocando fallecimientos a una velocidad creciente de pacientes críticos con neumonía y necesidad de ventilación mecánica. Se han utilizado en el mundo métodos alternativos para controlar la propagación de la enfermedad como: aislamiento social, medidas extremas de cuarentena y rastreo de los contactos de casos positivos. No obstante, estas medidas pueden no ser totalmente eficaces para combatir la escalada de la COVID-19, en paralelo con los preparativos nacionales indispensables para las nuevas necesidades de cuidado. Por ello, se puede usar una amplia gama de tecnologías digitales para perfeccionar esas estrategias de salud pública, además, la pandemia ha generado un frenesí relacionado con la telesalud. En Brasil, este campo ha crecido acentuadamente durante los últimos años. Todavía hasta la epidemia, y a pesar de la intensa proliferación de normativas, no existía un marco regulatorio plenamente consolidado en el país. El surgimiento de la COVID-19 marca un momento fructífero de expansión de las aplicaciones y usos de la telesalud, como forma de mejorar la respuesta del sistema de salud para la crisis en curso. Este trabajo discute la contribución de la telesalud para combatir la COVID-19, así como las iniciativas recientes desencadenadas en el país como oportunidades para la consolidación de la telemedicina y del perfeccionamiento del Sistema Único de Salud. Se concluyó que la telesalud ofrece capacidades para: triaje, cuidado y tratamiento a distancia, ayuda a la supervisión, vigilancia, detección y prevención, así como para la mitigación de los impactos a los cuidados de salud indirectamente relacionados con la COVID-19. Las iniciativas desencadenadas en ese proceso pueden reconfigurar el espacio futuro de la telemedicina en la práctica de los servicios dentro de Brasil.

Abstract: COVID-19 has created enormous challenges for health systems worldwide, with the rapidly growing number of deaths and critical patients with pneumonia requiring ventilatory support. Alternative methods to control the spread of the disease such as social isolation, extreme quarantine measures, and contact tracing have been used around the world. However, these measures may not be totally effective to fight COVID-19, in step with the necessary national preparations to meet the new patient care demands. A wide range of digital technologies can be used to enhance these public health strategies, and the pandemic has sparked increasing use of telehealth. This field has grown considerably in Brazil in recent years. Still, despite the intense proliferation of recommendations and rules, until the current pandemic the country still lacked a fully consolidated regulatory framework. The emergence of COVID-19 marks a key moment in the expansion of applications and use of telehealth for improving the health system's response to the current crisis. The article discusses telehealth's contribution to the fight against COVID-19 and the recent initiatives triggered in Brazil as opportunities for the consolidation of telemedicine and improvement of the Brazilian Unified National Health System. The authors conclude that telehealth offers capabilities for remote screening, care and treatment, and assists monitoring, surveillance, detection, prevention, and mitigation of the impacts on healthcare indirectly related to COVID-19. The initiatives triggered in this process can reshape the future space of telemedicine in health services in the territory.

Cross-cultural adaptation of the Zero Mothers Die (ZMD App) in Brazil: contributing to digital health with the approach on care centred for e-pregnant woman / Adaptação transcultural do aplicativo Zero Mothers Die para dispositivos móveis no Brasil: contribuições para a saúde digital com abordagem do cuidado centrado na e-gestante

Abstract Objectives: to describe the adaptation process of the Zero Mothers Die app, developed in Europe, is to combat maternal mortality, was brought into the Brazilian context with an individualized auscultation methodology for pregnant women and mothers who attended a high complexity referred teaching hospital. Methods: the research consisted of two parts: the participant observation technique was used by health professionals to translate the platform; with an approach in the service with online forms for pregnant women, and the content analysis was performed by grounded theory of the data. During five months, 109 pregnant women and mothers installed the app, but only 17 completed the questionnaire. Results: the women and health professionals pointed out questions such as interactivity, application interface, content, pregnancy and childcare clinical management, which contributed for the Brazilian version. Conclusions: the participatory medicine and e-pregnant woman are new premises of a humanization policy for women and childcare. The insertion of an app with information based on the best evidence in the prenatal routine in the health establishments with teaching activities that can provide new dialogue connections with the pregnant women and chances to update the professional in training.

Resumo Objetivos: descrever o processo de adaptação do aplicativo para combate à mortalidade materna Zero Mothers Die, desenvolvido na Europa, ao contexto brasileiro com metodologia de ausculta individualizada das gestantes e mães usuárias em hospital referência de alta complexidade e de ensino. Métodos: a pesquisa contou com duas partes: utilizou-se a técnica de observação participante para a tradução da plataforma pelos profissionais de saúde; abordagem no serviço com formulários online direcionados a gestantes e análise de conteúdo à luz da teoria fundamentada nos dados. Durante cinco meses, 109 gestantes e mães instalaram o aplicativo, 17 preencheram o questionário. Resultados: as mulheres e os profissionais de saúde apontaram questões de interatividade, interface do aplicativo, conteúdo, manejo clínico da gravidez e do cuidado à criança, que contribuíram para a versão brasileira. Conclusões: a medicina participatória e a e-gestante são novas premissas de uma política de humanização para o cuidado da mulher e da criança. A inserção de um aplicativo com informação baseada na melhor evidência em rotina pré-natal de estabelecimentos de saúde com atividades de ensino pode oportunizar novos canais de diálogo com a gestante e atualização do profissional em treinamento.

Cultura dos povos originários da floresta amazônica na gestação e no puerpério: uma revisão de escopo sob o ponto de vista da segurança alimentar e nutricional / Culture of people originating from the Amazon rainforest during pregnancy and the puerperium: a scope review from the point of view of food and nutrition security

RESUMO A desnutrição na população indígena é um problema de saúde pública atual e uma das principais causas de morbimortalidade das crianças desses grupos no Brasil. Para subsidiar ações de promoção da educação alimentar e nutricional, abrangendo povos da floresta do estado do Amazonas, Brasil, cujo território faz fronteira com a Colômbia, além da visita de campo em 2018, fez-se necessário, concomitantemente, mapear na literatura como essa população vive e de que maneira o cuidado é prestado. A revisão de escopo buscou tópicos referentes ao modo de vida das mulheres e crianças na Amazônia, à dieta durante o período gestacional e do puerpério, a práticas de aleitamento, à introdução de alimentos sólidos ao bebê e aos cuidados dos serviços de saúde. Como resultado, foram recuperados 21 estudos multidisciplinares. Encontrou-se que a comida tradicional tem valor nutricional maior do que a industrializada, a culinária local é uma fonte de renda das mulheres indígenas no meio urbano e um elo entre etnias. Conclui-se que as pesquisas devem incorporar o paradigma da promoção da saúde e abranger temas como a aculturação indígena nos centros urbanos amazônicos, a chegada da internet nas aldeias e o papel do cuidado à distância, que necessitam ser investigados para melhor enfrentamento do problema.

ABSTRACT Malnutrition in the indigenous population is a current public health problem and a major cause of morbidity and mortality of children in these groups in Brazil. In order to support actions to promote food and nutrition education, including forest peoples from the state of Amazonas, Brazil, whose territory borders Colombia, in addition to the field visit in 2018, it was necessary, at the same time, to map the literature as this one. Population lives and how care is provided. The scope review sought topics related to the lifestyle of women and children in the Amazon, diet during pregnancy and the postpartum period, breastfeeding practices, the introduction of solid foods to the baby, and the care of health services. As a result, 21 multidisciplinary studies were retrieved. Traditional food has been found to have higher nutritional value than industrialized food, and local cuisine is a source of income for indigenous women in the urban environment and a link between ethnicities. It is concluded that the researches should incorporate the health promotion paradigm and cover themes such as indigenous acculturation in the Amazonian urban centers, the arrival of the internet in the villages and the role of distance care, which needs to be investigated to better address the problem.

[Electronic health records in high complexity hospitals: a report on the implementation process from the telehealth perspective]. / Registro eletrônico de saúde em hospital de alta complexidade: um relato sobre o processo de implementação na perspectiva da telessaúde.

The implementation of electronic records in healthcare establishments has led to isolated solutions, which contribute to the fragmentation of the Brazilian Unified Health System (SUS). This research uses a strategic planning tool in order to monitor the trajectory of implementation of the records in medium and high complexity hospitals, which are a benchmark for the health of women and children. The scope was to outline possible contributions for the computerization of health facilities in general. The methodology is based on the ethnography practices in hospitals. The study was qualitative, descriptive with document analysis. The sources consulted were the minutes of the electronic records kept between 2012 and 2015. The synthetic narrative points to the lack of infrastructure, resources and the conflict of interests involving several actors in the process. The electronic record legitimizes the institutional design and organizes the work, besides mapping the hospital geography. The association of physical and digital records demands a change of institutional culture. Registration is an act of citizenship and becomes a key document in quality control and hospital accreditation.

A implantação do registro eletrônico nos estabelecimentos de saúde tem refletido soluções isoladas, que contribuem para a fragmentação do Sistema Único de Saúde (SUS). Essa investigação utiliza ferramenta de planejamento estratégico, a fim de acompanhar o percurso da implantação do registro em instituto nacional de média e alta complexidade, referência na área da saúde da mulher e da criança. O objetivo foi delinear possíveis contribuições para a informatização de estabelecimentos de saúde em geral. A metodologia se baseia nas práticas da etnografia nos hospitais. O desenho do estudo foi qualitativo, descritivo com análise documental. As fontes consultadas foram as atas dos encontros para implementação do prontuário eletrônico realizados entre 2012 e 2015. Uma narrativa síntese aponta a falta de infraestrutura, de recursos e a ocorrência de conflito de interesses, envolvendo vários atores no processo. O registro eletrônico legitima o desenho institucional e organiza o trabalho, além de mapear a geografia hospitalar. A associação do prontuário físico com o digital exige uma mudança de cultura institucional. O registro é um ato de cidadania e se torna um documento fundamental no controle de qualidade e na acreditação hospitalar.

Registro eletrônico de saúde em hospital de alta complexidade: um relato sobre o processo de implementação na perspectiva da telessaúde / Electronic health records in high complexity hospitals: a report on the implementation process from the telehealth perspective

Resumo A implantação do registro eletrônico nos estabelecimentos de saúde tem refletido soluções isoladas, que contribuem para a fragmentação do Sistema Único de Saúde (SUS). Essa investigação utiliza ferramenta de planejamento estratégico, a fim de acompanhar o percurso da implantação do registro em instituto nacional de média e alta complexidade, referência na área da saúde da mulher e da criança. O objetivo foi delinear possíveis contribuições para a informatização de estabelecimentos de saúde em geral. A metodologia se baseia nas práticas da etnografia nos hospitais. O desenho do estudo foi qualitativo, descritivo com análise documental. As fontes consultadas foram as atas dos encontros para implementação do prontuário eletrônico realizados entre 2012 e 2015. Uma narrativa síntese aponta a falta de infraestrutura, de recursos e a ocorrência de conflito de interesses, envolvendo vários atores no processo. O registro eletrônico legitima o desenho institucional e organiza o trabalho, além de mapear a geografia hospitalar. A associação do prontuário físico com o digital exige uma mudança de cultura institucional. O registro é um ato de cidadania e se torna um documento fundamental no controle de qualidade e na acreditação hospitalar.

Abstract The implementation of electronic records in healthcare establishments has led to isolated solutions, which contribute to the fragmentation of the Brazilian Unified Health System (SUS). This research uses a strategic planning tool in order to monitor the trajectory of implementation of the records in medium and high complexity hospitals, which are a benchmark for the health of women and children. The scope was to outline possible contributions for the computerization of health facilities in general. The methodology is based on the ethnography practices in hospitals. The study was qualitative, descriptive with document analysis. The sources consulted were the minutes of the electronic records kept between 2012 and 2015. The synthetic narrative points to the lack of infrastructure, resources and the conflict of interests involving several actors in the process. The electronic record legitimizes the institutional design and organizes the work, besides mapping the hospital geography. The association of physical and digital records demands a change of institutional culture. Registration is an act of citizenship and becomes a key document in quality control and hospital accreditation.

Formación para profesionales de unidades de telesalud: además de la capacitación de profesional / Formation for professionals in telehealth units: beyond professional training / Formação para profissionais de unidades de telessaúde: para além da capacitação profissional

Introducción: La Telesaud es fundamental para ampliar y calificar la atención a la salud. Se estima que hay dos mil puntos de telesalud en el territorio brasileño, cubriendo la atención básica, especificamente el Programa de Salud de la Familia, prestando apoyo a médicos y sus equipos en zonas aisladas. Métodos: Estrategias de educación permanente de profesionales habilitados para manejar las tecnologias, que actúen en la perspectiva de la universalidad, equidad e integralidad de la atención de acuerdo con este contexto. Resultados: Se presenta la experiencia en la consolidación de un modelo de formación en telesalud, contemplando la dimensión técnica y política-administrativa del sistema de salud con vistas a ampliar el campo de acción sobre los modos de formar la telesaud. Discusión: Se prioriza la dimensión de internalización del profesional en el modelo de colaboración interprofesional, contemporizando el saber técnico y la conducta ética.

Introduction: Telehealth is important to add and qualify the local healthcare systems. There are more than two thousand telehealth centres in Brazil, covering the primary care services, in special, the Family Health Care Program. They provide support to physicians and their teams in remote areas. Methods: Training and continuing education strategies for professionals qualified to handle telehealth technologies, which, in addition to the technical knowledge related to the equipment, act in the perspective of the universalization, equity and integrality of health care according to their context. Results: We present the experience in consolidating a telehealth training model, considering the technical and political-administrative dimension of the health system, broadening the field of action and reflection on ways of thinking and practice in telehealth. Discussion: It prioritizes the internalization dimension of the technician in the model of interprofessional collaboration, by compromising technical knowledge and ethical conduct.

Introdução: A telessaúde é fundamental para ampliar e qualificar a atenção à saúde. Estima-se haver mais de dois mil pontos de telessaúde no Brasil, cobrindo a atenção básica, em especial, o Programa de Saúde da Família, prestando suporte clínico e pedagógico a médicos e equipes em diversos rincões. Métodos: Estratégias de formação e educação permanente de profissionais habilitados a manejar tecnologias de telessaúde, que, além do conhecimento técnico relativo aos equipamentos, atuem na perspectiva da universalização, equidade e integralidade da atenção à saúde foram delineadas de acordo com esse contexto. Resultados: Apresenta-se a estruturação e consolidação de um modelo de formação em telessaúde, contemplando o eixo técnico-político-administrativo do sistema de saúde com vistas a estender o campo de ação e reflexão sobre os modos de pensar/ fazer telessaúde. Discussão: Prioriza-se a dimensão de internalização do profissional no modelo de colaboração interprofissional, contemporizando saber técnico e conduta ética.