Edson José Carpintero Rezende

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

UNLABELLED Starting in the 1990s, several authors sought to investigate the hypothesis that periodontitis during pregnancy may contribute towards the birth of low-weight children. However, this relationship is still not well established. The aim of this study was to evaluate whether this oral infection is associated with this gestational event. METHODS This was a case-control study among 548 puerperae, of whom 164 were the mothers of low-weight live births (case group) and 384 were the mothers of live births of normal gestational weight (control group). They were selected at two public hospital units in two municipalities in the State of Bahia. From interviews and data gathered using live birth cards or birth certificates, information was obtained regarding age, height, previous diseases, marital status, socioeconomic situation, smoking and alcohol use. Mothers who presented at least four teeth on which one or more sites had a probing depth of greater than or equal to 4 mm, clinical attachment loss of greater than or equal to 3 mm and bleeding on probing, at the same site, were deemed to present periodontal disease. The data were analysed by stratification from logistic regression. RESULTS Periodontal disease was diagnosed in 42.7% of the case group and 30% of the control group. A statistically significant association was found between periodontal disease and low birth weight (unadjusted OR = 1.74; 95% CI: 1.19-2.54), particularly among mothers with low schooling levels (adjusted OR = 2.30; 95% CI: 1.14-4.6). CONCLUSION The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels.

Ética e telessaúde: reflexões para uma prática segura

The term eHealth (or telemedicine, telehealth) has been used to describe activities that employ information and telecommunication technologies to deliver health care. Distance is an important factor hindering the delivery of many important services, such as diagnosis, treatment, prevention, health promotion, and health research assessment. Although eHealth can provide interesting solutions such as a second specialist opinion in geographically isolated areas, a large number of ethical and legal issues must be considered. It is essential to discuss, among others, aspects relating to safety and confidentiality; professional accountability; technical standards relating to digital recording, storage, and transmission of clinical data; copyright; authorization from professional regulatory bodies; and licensing for the remote practice of medicine. In Brazil, the Federal Council of Medicine has already established rules for telemedicine; however, it is still necessary to further this discussion to involve the entire health care sector. Since there are many eHealth projects being developed in Brazil, there is an urgent need to design protocols and training programs for all professionals involved.

Teleconsultations in Public Primary Care Units of the City of Belo Horizonte, Brazil: Profile of Patients and Physicians

OBJECTIVE The aim of this study is to report patient and physician profiles of those who used the teleconsultation system in the primary care health units of a health district in the city of Belo Horizonte, MG, Brazil. MATERIALS AND METHODS Data were collected from the telehealth attendance records of nine Primary Health Units (Unidade Básica de Saúde [UBS] in Portuguese) and from interviews carried out with the referring physicians. The criteria for inclusion required that data come from users seen by means of telehealth in the period between December 2004 and August 2010 and from the practitioners who saw them. The following were excluded: physicians who were not working in the UBS when the data were collected and a physician who did not agree to take part in the study. RESULTS Two hundred sixty-three teleconsultations were analyzed, and 20 referring physicians were interviewed. The offline method was the most common. The physicians were predominantly female and had graduated over 11 years ago. The patients were predominantly adult women. After teleconsultation, a prescription was not necessary for 9.8% of patients. When required, 83.2% of the medication was available in the UBS. In 68.3% of cases, additional tests were required. The incorporation of these technologies prevented the physical referral of patients in 64.2% of cases. CONCLUSIONS Telehealth resources can help to improve the provision of primary healthcare, reducing the number of physically referred patients. The number of teleconsultations is still small, and there is a need to encourage physicians to use the system.

Telehealth: confidentiality and informed consent

reSumO A sociedade vivencia avancos na area da informatica, com novos recursos que instrumentalizam a area da saude e oferecem outras modalidades de atendimento. Apesar dos beneficios dessas inovacoes, os principios eticos e legais devem ser preservados. Esta revisao da literatura pretende promover reflexao sobre a confidencialidade, privacidade, seguranca e veracidade das informacoes nos servicos que utilizam a telessaude. Foram pesquisadas as bases de dados Scielo e Lilacs para a busca de artigos publicados nos ultimos 12 anos em portugues, espanhol ou ingles e que abordassem a confidencialidade e o consentimento nos atendimentos por meio da telessaude. Para evitar a violacao e garantir que o procedimento seja etico nas informacoes relativas a saude, deve haver certificacao eletronica dos sistemas utilizados de acordo com padroes internacionais. Os usuarios dos sistemas devem utilizar assinatura digital conferida por autoridade publica. O termo de consentimento livre e esclarecido deve ser assinado pelo paciente para a realizacao de teleconsultorias. Palavras-chave: Telemedicina; Consulta Remota; Consulta Remota/etica; Consentimento Livre e Esclarecido; Etica Medica; Bioetica; Confianca; Validacao de Programas de Computador.