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Objective: considering the behavioral and paradigm changes due to the social isolation imposed by the new coronavirus pandemic, patients and orthodontists also have anxieties and insecurities in face of the new reality in dental clinics and educational institutions. This study aimed to evaluate, by means of an online questionnaire, the applicability of tele-orthodontics and tele-assistance, the behavior of patients regarding the initiation of or return to orthodontic treatment, and the new changes in clinical care. Material and Methods: the questionnaire was based on the Google Forms platform and consisted of three parts: the first one involved study presentation and informed consent form; the second one involved demographic data collection and characterization of the respondents, and the third one was the questionnaire itself. The questionnaire was sent by email and instant-messaging apps, with data being submitted for descriptive analyzis. Results: a total of 116 replies were returned, and most of the respondents were aged between 18 and 30 years old, female, and residents of the Southeast region. The results showed that tele- orthodontics is still unknown to a significant number of patients (66.4%) and almost half of them (41.4%) want their treatments to be monitored in person, even those whose devices do not require activation. They also prefer the first consultation and diagnosis to be done in person (55.2%). However, they are receptive to the idea of having their data and images transmitted via the Internet, including some remote consultations interspersed with in-person ones, understanding that costs can be lowered. Conclusion: tele-orthodontics is a reality, but for orthodontic patients, its applicability remains restricted to sending images and records (AU)

Objetivo: considerando as mudanças comportamentais e de paradigmas decorrentes do isolamento social imposto pela pandemia do novo coronavírus, pacientes e ortodontistas também apresentam ansiedades e inseguranças diante da nova realidade nas clínicas odontológicas e instituições de ensino. Este estudo teve como objetivo avaliar, por meio de questionário online, a aplicabilidade da teleortodontia e da teleassistência, o comportamento dos pacientes quanto ao início ou retorno do tratamento ortodôntico e as novas mudanças no atendimento clínico. Material e Métodos: o questionário baseou-se na plataforma 'Google Forms" e foi constituído por três partes: a primeira envolveu a apresentação do estudo e o termo de consentimento livre e esclarecido; a segunda envolveu a coleta de dados demográficos e caracterização dos respondentes, e a terceira foi o próprio questionário. O questionário foi enviado por e-mail e aplicativos de mensagens instantâneas, sendo os dados encaminhados para análise descritiva. Resultados: foram devolvidas 116 respostas, sendo a maioria dos respondentes com idade entre 18 e 30 anos, do sexo feminino e residentes na região Sudeste. Os resultados mostraram que a teleortodontia ainda é desconhecida por um número significativo de pacientes (66,4%) e quase metade deles (41,4%) deseja que seus tratamentos sejam acompanhados presencialmente, mesmo aqueles cujos aparelhos não requerem ativação. Preferem também que a primeira consulta e diagnóstico seja presencial (55,2%). No entanto, eles estão receptivos à idéia de ter seus dados e imagens transmitidos pela Internet, incluindo algumas consultas à distância intercaladas com as presenciais, entendendo que os custos podem ser reduzido. Conclusão: a teleortodontia é uma realidade, mas para os pacientes ortodônticos sua aplicabilidade permanece restrita ao envio de imagens e registros (AU)

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Sexual and reproductive health needs and access are often neglected during health emergencies. The 2015/2016 Zika epidemic is an example of priorities shifting to the detriment of women's health needs. The internet is a key tool for abortion knowledge sharing and seeking in countries where abortion is not legally available and it is also a key resource for tele-health. Yet, we know very little about how people use the internet, and the type of information searched for, to access abortion information and services. The aim of this study is to analyse to what extent and how the internet was used as a resource for abortion information during the Zika outbreak and its aftermath in Brazil in 2015/2016. Using Google Trends and Analytics data, we analyse contextually-specific abortion searches using standardised terms that reflect the overall representation of searches at that time alongside weekly levels of Zika incidence. The results show a heightened use of combined search terms for abortion and Zika, as well as abortion and microcephaly, suggesting a rise in abortion information searching linked to the epidemic. These searches were highly correlated with the level of Zika incidence. This study confirms the use of the internet for information seeking during a public health emergency. It demonstrates the need for appropriate internet resources to improve access to abortion information, especially in countries where abortion is highly restricted and stigmatised.

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Teledermatology has been proving to be of great help for delivering healthcare, especially now, during the SARS-CoV-2 pandemic. It is crucial to assess how accurate this method can be for evaluating different dermatoses. Such knowledge can contribute to the dermatologists' decision of whether to adhere to teledermatology or not. Our objective was to determine the accuracy of teledermatology in the 10 most frequent skin neoplasms in our population, comparing telediagnosis to histopathological report and in-person dermatologists' diagnosis. A retrospective cohort study was conducted in São Paulo, Brazil, where a store-and-forward teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen teledermatologists who participated in the project had three options to refer the patients: send them directly to biopsy, to the in-person dermatologist, or back to the general physician with the most probable diagnosis and management. In the groups referred to the in-person dermatologist and biopsy, we looked for the 10 most frequent International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) of skin neoplasms, which resulted in 289 histopathologic reports and 803 in-person dermatologists' diagnosis. We were able to compare the ICD-10 codes filled by teledermatologists, in-person dermatologists, and from histopathological reports. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's, histopathologic report, and the teledermatologist's diagnosis was assessed. We also calculated Cohen's kappa, for complete and complete plus partial agreement. The mean complete agreement rate comparing telediagnosis to histopathological report was 54% (157/289; kappa = 0.087), being the highest for malign lesions; to in-person dermatologists was 61% (487/803; kappa = 0.213), highest for benign lesions. When accuracy of telediagnosis for either malign or benign lesions was evaluated, the agreement rate with histopathology was 70% (kappa = 0.529) and with in-person dermatologist, 81% (kappa = 0.582). This study supports that teledermatology for skin neoplasms has moderate accuracy. This result reassures that it can be a proper option for patient care, especially when the goal is to differentiate benign from malign lesions.

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El cáncer infantil se considera mayoritariamente una enfermedad crónica. La información acerca de la enfermedad y los tratamientos es una necesidad presente en todos los miembros de la familia, en los primeros momentos puede ser difícil de entender y recordar por lo cual una información clara y sencilla permitirá una mejor comprensión. Las nuevas tecnologías de la información hacen posible establecer conexiones infinitas y el campo de la salud no ha escapado a este fenómeno, han aparecido términos como "Tele cuidados" o "Tele-Enfermería", refiere al uso de las tecnologías de la información y las comunicaciones. Objetivo: evaluar los beneficios que brinda la implementación del Tele cuidado en la continuidad de los cuidados en pacientes pediátricos oncológicos y su familia. Material y Método: estudio descriptivo - evaluativo, la población fué de 9 pacientes incorporados al Proyecto de Telecuidado. Se utilizaron entrevistas, telefonía celular, fichas y listas de cotejo. El programa lleva implementado 6 meses en la institución, esta evaluación corresponde a una primera etapa de desarrollo del mismo. Resultados: según las dimensiones de Evaluación de necesidades, Evaluación de conceptualización y lógica del programa, Evaluación de proceso y Evaluación de resultados. Conclusión: El presente estudio nos ha permitido determinar al Tele Cuidado como una herramienta que nos ayuda a mejorar la atención de enfermería, además incrementa los procesos de comunicación y apoya la continuidad de los cuidados en el hogar[AU]

Childhood cancer is mostly considered a chronic disease. Information about the disease and treatments is a necessity present in all family members, in the first moments it can be difficult to understand and remember why clear information and simple it will allow a better understanding. The new information technologies make it possible to establish infinite connections and the field of Health, has not escaped this phenomenon, they have jumped into the health arena terms such as "Tele care" or "Tele-Nursing" , which refers to the use of information and communications technologies. Objective: to evaluate the benefits of implementing Tics in the continuity of care in pediatric cancer patients and their family. Material and Method: descriptive - evaluative study, the population was of 9 patients who joined the Telecare Project. Interviews, records and checklist were used. The program has been implemented for 6 months in the institution, this evaluation corresponds to a first stage of its development. Results: these are analyzed according to the dimensions of Needs Assessment, Evaluation of conceptualization and logic of the program, Process evaluation and Evaluation of results. Conclusion: This study has allowed us to determine Tele Care as a tool that helps us improve nursing care, also increases communication processes and allows continuity of care[AU]

O câncer infantil é considerado principalmente uma doença crônica. Informações sobre a doença e tratamentos são uma necessidade presente em todos os membros da família; nos primeiros momentos, pode ser difícil entender e lembrar, razão pela qual informações claras e simples permitirão uma melhor compreensão. As informações possibilitam o estabelecimento de conexões infinitas e o campo da Saúde, não escapou a esse fenômeno, foram destacados termos como "Telecare" ou "Tele- Nursing", que se referem ao uso das tecnologias da informação. e comunicações. Objetivo: avaliar os benefícios proporcionados pela implementação das TICs na continuidade do atendimento em pacientes com câncer pediátrico e sua família. Material e Método: estudo descritivo-avaliativo, a população foi de 9 pacientes que ingressaram no Projeto Telecare. Foram utilizadas entrevistas, arquivos e uma lista de verificação. O programa foi implementado por 6 meses na instituição, esta avaliação corresponde a um primeiro estágio de desenvolvimento. Resultados: são analisados de acordo com as dimensões Avaliação de Necessidades, Conceitualização de Programas e Avaliação Lógica, Avaliação de Processos e Avaliação de Resultados. Conclusão: Este estudo nos permitiu determinar o TeleCare como uma ferramenta que nos ajuda a melhorar os cuidados de enfermagem, também aumenta os processos de comunicação e permite a continuidade dos cuidados[AU]

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BACKGROUND: Teledermatology may be used for triage in primary care to address skin conditions, improving access and reducing time to treat the most severe or surgical cases. We aimed to evaluate the proportion of individuals who could be assessed in primary care using teledermatology, and how this affected the waiting time for an in-person dermatologist appointment. METHODS: A cross-sectional retrospective study, involving 30,976 individuals and 55,624 skin lesions, was performed from July 2017 to July 2018 We assessed the frequency of diagnoses and referrals to biopsy, to in-person dermatologists, or to primary care, and compared the waiting time for an in-person dermatologist appointment before and after the teledermatology implementation. FINDINGS: 53% of the patients were managed with the primary care physician, 43% were referred to in-person dermatologists and 4% directly to biopsy, leading to a reduction of 78% in the waiting time for in-person appointments when compared to the previous period. The most frequent diseases were: melanocytic nevus, seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis, solar lentigo, melasma, xerosis, and epidermoid cyst, with significant differences according to sex, age and referrals. The most frequent treatment prescribed was emollient. INTERPRETATION: The use of teledermatology as a triage tool significantly reduced the waiting time for in-person visits, improving health care access and utilizing public resources wisely. Knowledge of sex, age, diagnoses and treatment of common skin conditions can enable public policies for the prevention and orientation of the population, as it can be used to train general physicians to address such cases. FUNDING: None.

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Novos desafios epidemiológicos e demográficos demandam novas formas de organizar os sistemas de saúde. O presente ensaio propõe a telessaúde como ferramenta organizativa, capaz de suavizar o triângulo de ferro da atenção à saúde e de facilitar a busca pelo triple aim, pelo seu potencial de aumento do acesso e qualidade com redução de custo. A integração da telessaúde ao processo de referência e transição entre serviços assistenciais aumenta a resolutividade da Atenção Primária à Saúde (APS), favorece a coordenação do cuidado, promove adesão terapêutica, diminui reinternações e estimula a prevenção quaternária. Este ensaio propõe a telessaúde como metasserviço que confere densidade tecnológica à APS e permite que ela se torne coordenadora efetiva do cuidado, passando a organizar o fluxo de informações, pessoas e insumos. Frente às inovações propostas, é essencial avaliar o impacto de ações já existentes de telessaúde para viabilizar a sua aplicação como metasserviço de saúde.

New epidemiological and demographic challenges require new ways of organizing healthcare systems. This essay proposes telehealth as an organizational tool, capable of smoothing the iron triangle of health care and facilitating achievement of the triple aim, namely greater access and quality with cost reduction. The integration of telehealth into the referral process and the transition between care services increases the resolvability of primary health care (PHC), facilitates the coordination of care, promotes treatment adherence, decreases readmissions, and stimulates quaternary prevention. This essay introduces the notion of telehealth as a meta-service that confers technological density to PHC and allows it to become an effective coordinator of care, organizing the flow of information, people and supplies. In view of the innovations proposed, it is essential to evaluate the impact of existing telehealth initiatives so as to extend their applicability as meta-service.

Nuevos desafíos epidemiológicos y demográficos demandan nuevas formas de organizar los sistemas de salud. El presente ensayo propone la telesalud como herramienta organizacional, capaz de suavizar el triángulo de hierro de la atención a la salud y de facilitar la búsqueda por el triple aim, por su potencial de aumento del acceso y calidad con reducción de costo. La integración de la telesalud al proceso de referencia y transición entre servicios asistenciales aumenta la capacidad resolutiva de la Atención Primaria a la Salud (APS), favorece la coordinación del cuidado, promueve la adhesión terapéutica, disminuye reinternaciones y estimula la prevención cuaternaria. Este ensayo propone la telesalud como metaservicio que confiere densidad tecnológica a la APS y permite que ella se convierta en coordinadora efectiva del cuidado, pasando a organizar el flujo de informaciones, personas e insumos. Frente a las innovaciones propuestas, es esencial evaluar el impacto de acciones ya existentes de telesalud para viabilizar su aplicación como metaservicio de salud.

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OBJETIVOS: Avaliar as qualidades psicométricas de validade e confiabilidade da Escala CARDIOSATIS-Equipe, elaborada especificamente para avaliar a satisfação dos médicos com o atendimento pré-hospitalar às doenças cardiovasculares em municípios participantes de um projeto em Telessaúde e mensurar a satisfação dos médicos antes e depois da implantação do Projeto. MÉTODO: Aplicação do instrumento na linha de base e pós-implantação de um sistema de telecardiologia em 82 municípios de Minas Gerais. O estudo das qualidades psicométricas da escala incluiu: Validade de construto, por meio de análise fatorial; Análise de consistência interna pelo Alfa de Cronbach; Correlação de Pearson entre os itens; Correlação de Spearman entre os domínios e a escala Global; e Validade discriminante. RESULTADOS: A análise fatorial por meio da extração de componentes principais indicou a distribuição dos itens da escala em dois fatores que explicaram 66,5 por cento da variância dos escores de satisfação, identificados como Estrutura de atendimento e diagnóstico e Satisfação com o cuidado prestado. O coeficiente alfa de Cronbach mostrou valores elevados para a escala Global (0,92) e para os fatores (0,84). As correlações item-domínio e item-escala global também se mostraram adequadas, variando de 0,59 a 0,89 e de 0,73 a 0,85, respectivamente. A escala mostrou boa capacidade de discriminar os dois momentos da aplicação (antes e depois), mostrando um aumento significativo da satisfação dos médicos para a maioria dos itens avaliados pelo instrumento (p < 0,05). CONCLUSÃO: pode-se concluir com este estudo que a introdução do sistema de telecardiologia melhorou a satisfação dos profissionais avaliados e que a Escala CARDIOSATIS-Equipe é um bom instrumento para se mensurar a satisfação dos profissionais com o atendimento às DCV. As boas características de validade e confiabilidade da escala colaboram para sua utilização em outros estudos.

OBJECTIVE: To evaluate psychometric validity and reliability properties of the CARDIOSATIS-Team scale and measure physician satisfaction before and after the implementation of the project. This scale was designed to evaluate physician satisfaction with the healthcare delivered for cardiovascular diseases in cities that participate in a telemedicine system. METHODS: The scale was applied in 82 cities of Minas Gerais, before and after the implementation of a telecardiology system. The analysis of the psychometric properties of CARDIOSATIS-Team scale included: construct validity using factorial analysis; internal consistency reliability using Cronbach's Alpha; Pearson´s correlation between items; Spearman´s correlation between domains and global scale and; discriminant analysis. RESULTS: The factor analysis of the principal components extracted two factors that explained 66.5 percent of the variance in satisfaction scores: healthcare delivery and diagnosis structure and satisfaction with the care delivered. Cronbach´s Alfa for internal consistency reliability of the scale showed values of 0.92 for the global scale and up to 0.84 for factors. Inter-factor and inter-scale correlations were adequate, showing values of 0.59 to 0.89 and 0.73 to 0.85, respectively. The scale was able to distinguish the two moments of its application (before and after intervention), showing high satisfaction for most items measured afterwards (p < 0.05). CONCLUSIONS: We can conclude based on the present study that the telemedicine system improved provider satisfaction and that the CARDIOSATIS-Team scale is a good tool to evaluate provider satisfaction with care delivered for CVD. Its appropriate characteristics in terms of validity and internal consistency reliability justify its utilization in other studies.

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