Maria do Carmo Barros de Melo

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.

Comparison of the effectiveness of polyethylene glycol 4000 without electrolytes and magnesium hydroxide in the treatment of chronic functional constipation in children

OBJECTIVE To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9% refused magnesium hydroxide. CONCLUSION The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Telehealth in Primary Healthcare: An Analysis of Belo Horizonte's Experience

BACKGROUND Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.

Comparação da efetividade entre polietilenoglicol 4000 sem eletrólitos e hidróxido de magnésio no tratamento da constipação intestinal crônica funcional em crianças

OBJECTIVE: To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS: Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS: Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9% refused magnesium hydroxide. CONCLUSION: The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

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.

Knowledge and Practices of Pediatricians Regarding Functional Constipation in the State of Minas Gerais, Brazil

Objectives: The aim of the study was to analyze the knowledge, approaches, and practices of pediatricians participating in a regional pediatric conference regarding functional constipation (FC) to identify knowledge gaps. Methods: Cross-sectional regional study based on a semistructured questionnaire related to the Rome III criteria and the participant profiles. Results: Of 400 questionnaires distributed, 264 (66.0%) were completed. Most pediatricians (76.7%) did not recognize the Rome III criteria, but the majority did recognize the following risk factors for FC: low-fiber diet (97.8%), family history (86.6%), onset of toilet training (76.4%), and weaning (62.4%). Foods considered high in fiber were oats (95.7%), leafy vegetables (95.3%), and wheat bran (93.2%). Digital rectal examination was not performed by 57.7% of nongastroenterologists. Complementary examinations were ordered in 27.5% and 72.5% of patients by general pediatricians and pediatric gastroenterologists, respectively, although the sample of gastroenterologists was not representative. The most prescribed drugs by nongastroenterologists were mineral oil (72.6%), magnesium hydroxide (52.1%), lactulose (41.0%), and polyethylene glycol (25.2%). Pediatric gastroenterologists prescribed magnesium hydroxide (91.7%), polyethylene glycol (91.7%), and mineral oil (58.3%). Most pediatricians (70.0%) considered the average treatment duration to be less than 1 year, although gastroenterologists considered it to be more than 1 year (54.6%). Conclusions: The knowledge of pediatricians regarding FC is inadequate. Constipation may not receive the public health attention it deserves within pediatric residency programs. The authors suggest that better education regarding FC should be included in medical school and residency program curricula to improve patient care.

Polietilenoglicol na constipação intestinal crônica funcional em crianças

OBJECTIVE: To review the literature about the use of the polyethylene glycol in the treatment of chronic functional constipation in children. DATA SOURCE: Articles published between 1998 and 2009 were selected from Medline and SciELO databases. Relevant articles concerning constipation, the use of polyethylene glycol in adults, the recent NASPGHAN guideline and the ROMA III criteria were also included. DATA SYNTHESIS: The treatment of functional constipa-tion in children is composed of several stages, among which is the long-term use of laxative drugs. The therapeutic options are limited and they carry problems related to long-term use, especially due to the adverse effects and childs low adherence to the treatment. Polyethylene glycol is an odorless, tasteless and minimally absorbed osmotic agent, available in 3350 and 4000 molecular weights, with or without electrolytes. Good results have been reported in controlled and randomized studies regarding the improve-ment of symptoms of constipation. It is considered safe, without significant side effects. CONCLUSIONS: Polyethylene glycol is superior to other osmotic agents as far as taste and childrens acceptance are concerned. Low daily doses are safe and effective. It is a good treatment option for chronic functional constipation in children.

Evaluation of the use of videoconferencing for distance training of doctors in the family health teams within the national telehealth project

Introduction: the National Telehealth Program aims at updating and training doctors in the Family Health Teams by means of videoconferencing (VCs), with potential impact on improving the health care in remote locations and reducing the displacement of patients. In addition, it proposes increased primary care interaction with specialized centers. Objectives: presentation and evaluation of the use of the videoconferencing system allowing for better planning of action in the project. Methods: 916 evaluation /feedback questionnaires were analyzed, completed by participants at the end of 84 VCs in Medicine, between 2009 and 2013. The VCs are a branch of the National Telehealth Project and reach 50 municipalities in Minas Gerais under the coordination of the FM-UFMG. They are held via web, requiring minimal equipment in diffuser and receiver centers. Results: in the study period, an average of 12.64 municipalities and 19.42 speakers were identified. Of these, the average number of doctors was 12.97. The quality parameters achieved positive assessment (“great” or “good”) in just 62% for the sound, and 84% for the image. The theme was considered “interesting” or “very interesting” by 98%. Conclusions: the VCs have been strengthened as an alternative to educational institutions. However, the participation of speakers and municipalities in this project was less than desired. The comparative analysis of VCs from other areas also reveals a reduced adhesion of doctors. Among the problems detected, especially regarding the sound quality, the low quality of internet connection in the municipalities may have contributed to this result.

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.

The Brazilian National Telehealth Program in the State of Minas Gerais - Brazil

The Brazilian National Telehealth Program was setup by the Brazilian Ministry of Health. In Minas Gerais state, the Federal University of Minas Gerais School of Medicine has joined the State Department of Health and 50 towns for this project development. This paper describes the implementation of the service and partial results and services available. The Nucleus of Telehealth of Minas Gerais has been developing teleducation and teleassistence. From 2007 to 2008 278 teleconsultations and 6295 ECG’s took place. A total of 1339 health professionals participated in the videoconferences. The professionals involved in this project were interviewed and talked about the difficulties and benefits. The Telehealth has improved patient’s assistance and decreased the patient’s needs for dislocation and for consultations with a specialist in big centers. Moreover it was noticed that there is a high cultural resistance concerning the use of information and communication technologies.