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This article explores telecare from telehealth developments and the recent acceleration of the digital health transformation caused by the COVID-19 pandemic, focusing on the Brazilian Unified Health System (SUS). It addresses terminological issues, the scope of actions, the potential use for healthcare, and constraints and contingencies for telecare in Brazil, focusing on teleconsultations and interactions between health professionals and patients. Finally, it presents a set of propositions for the development of telecare policies and practices in Brazil, considering SUS principles, in two central themes: organizational political guidelines and operational propositions to organise services and healthcare delivery. The importance of clarifying the scope and limits of new technologies is highlighted in the attempt to avoid idealizations with proposed solutions to complex health problems. Telecare solutions should be compatible with SUS principles and with the recommended model of care, with the healthcare network coordinated and organised by primary care, ensuring access to health services and integrated and quality healthcare for the Brazilian society.

O artigo explora a teleassistência a partir dos desenvolvimentos da telessaúde e da aceleração da transformação digital na saúde provocada pela pandemia de COVID-19, com foco no Sistema Único de Saúde (SUS). Aborda questões terminológicas, escopo de ações, potencialidades do uso para atenção à saúde e condicionantes e contingências para a utilização da teleassistência no Brasil, concentrando-se nas teleconsultas e nas interações entre profissionais de saúde e pacientes. Por fim, apresenta um conjunto de proposições para o desenvolvimento das políticas e práticas de teleassistência no Brasil, tendo em vista os princípios do SUS, organizados em dois eixos estratégicos centrais: diretrizes político organizacionais e proposições operacionais e de organização dos serviços e do cuidado. Destaca-se a importância de ponderar e elucidar os alcances e os limites das novas tecnologias para evitar idealizações e deslumbramentos com suas propostas de solução para os complexos problemas de saúde. As soluções de teleassistência devem ser compatíveis com princípios e diretrizes do SUS e com o modelo de atenção preconizado, que prevê a organização da rede a partir da atenção primária, para garantir acesso, integralidade e qualidade da atenção à saúde para a sociedade brasileira.

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En la actualidad, más de la mitad de las pacientes con cáncer de mama receptor hormonal positivo recibe algún esquema de quimioterapia adyuvante. Sin embargo, sólo algunas de ellas obtendrían un beneficio real en términos de sobrevida. Las plataformas genómicas permiten un mejor entendimiento de la heterogeneidad tumoral entre carcinomas con receptores hormonales positivos, Her2 negativos, habiendo sido validadas como herramientas para identificar aquellas. pacientes que obtendrían un beneficio claro con el tratamiento quimioterápico. El objetivo de nuestro estudio es describir el uso de la plataforma genómica Oncotype Dx® y evaluar su impacto sobre la indicación del tratamiento adyuvante, evaluado principalmente a través del cambio de conducta en relación con la indicación final del tratamiento adyuvante. Material y método: Estudio multicéntrico observacional de cohorte llevado a cabo en distintas Unidades de Mastología de la República Argentina que utilizaran el Oncotype Dx* para esclarecer la indicación del tratamiento adyuvante en pacientes luminales Her2neu negativas en estadio inicial. Se registraron las decisiones relacionadas con el tratamiento antes y luego de realizar la prueba genómica. El objetivo secundario consistió en describir los eventos en aquellas pacientes en quiénes se solicitó dicho estudio. Resultados: Entre enero de 2013 y diciembre de 2018, 211 pacientes con carcinomas luminales A o B, Her2neu negativas realizaron el Oncotype Dx* y fueron incluidas en el estudio. Según nuestros registros, 40% de las pacientes experimentó un cambio en la indicación del tratamiento adyuvante luego de realizada la plataforma genómica. De aquellas pacientes que tenían indicación inicial de hormonoterapia según parámetros tradicionales clínico-patológicos, 24% recibió adicionalmente quimioterapia. En relación con las pacientes que tenían indicación inicial de quimio y hormonoterapia, 49% experimentó un cambio en la indicación de su adyuvancia pudiendo realizar únicamente hormonoterapia. En relación a los eventos descriptos en las pacientes participantes del trabajo, se registraron 4 muertes específicas por la enfermedad, una muerte por otra causa, 2 recaídas a distancia y un cáncer de mama contralateral. Conclusiones: En nuestra población de estudio el uso del Score de Recurrencia (RS) resultó clínicamente significativo en relación al cambio de conducta en la toma de decisión para adyuvancia. En consecuencia, para este grupo de investigadores, ha demostrado ser una herramienta de significativa importancia en la decisión del tratamiento adyuvante de pacientes con cáncer de mama temprano, luminal, Her2neu negativo(AU)

Objetive: Currently, over half of all patients diagnosed with hormone-receptor positive early stage breast cancer will receive some type of adjuvant chemotherapy (CHT), but only a few of them will actually benefit in terms of survival. Genomic platforms allow a better understanding of the heterogeneity among the different types of hormone receptor positive, her2 negative breast cancer, and have proven their validity as tools for identifying those patients who will obtain a clear benefit from CHT. The aim of our study was to analyze the use of the genomic platform Oncotype Dx® in our population and describe its impact on the decision of adjuvant treatment assessed through change in treatment decision. Material and method: this was a real world collaborative observational study, which was performed across several Breast Units in Argentina. Patients who underwent Oncotype Dx® testing to determine adjuvant treatment were included. Decisions regarding treatment were settled before and after the oncotype was performed by the tumor boards of each Breast Unit. Results: From January 2013 to December 2018, 211 patients with luminal A or B, her 2 negative breast cancer who underwent Oncotype Dx" testing were included. We found that treatment decisions were modified after Oncotype DX in approximately 40% of patients. In 24% percent of cases, chemotherapy was added to the initial treatment plan although endocrine therapy alone had initially been considered (potential subtreatment); and on the other hand, 49% of all patients were able to receive endocrine therapy only when, due to traditional prognostic factors, they would have received chemotherapy (potential overtreatment). Conclusions: In our population, we found that the use of the Recurrence Score was associated with a significant change in treatment recommendation We therefore consider it to be a very important tool and a decisive factor for the selection of adjuvant treatment in patients with hormone receptor positive, her2neu negative early breast cancer(AU)

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During pregnancy, women undergo several metabolic changes to guarantee an adequate supply of glucose to the foetus. These metabolic modifications develop what is known as physiological insulin resistance. When this process is altered, however, gestational diabetes mellitus (GDM) occurs. GDM is a multifactorial disease, and genetic and environmental factors play a crucial role in its aetiopathogenesis. GDM has been linked to both macroscopic and molecular alterations in placental tissues that affect placental physiology. This review summarizes the role of the placenta in the development of GDM from a molecular perspective, including hormonal and pro-inflammatory changes. Inflammation and hormonal imbalance, the characteristics dominating the GDM microenvironment, are responsible for placental changes in size and vascularity, leading to dysregulation in maternal and foetal circulations and to complications in the newborn. In conclusion, since the hormonal mechanisms operating in GDM have not been fully elucidated, more research should be done to improve the quality of life of patients with GDM and their future children.

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Bovine mastitis is a disease wi th far - reaching consequences for the dairy industry. Staphylococcus aureus is a pathogen that is especially resistant to antibiotics. The objective of this study was to evaluate the antimicrobial activity of the essential oils Lippia citriodora (Lam.), Thy mus vulgaris (L), and a mixture of the essential oils Lippia citriodora and Thymus vulgaris (50/50 v/v), against isolates of oxacillin - resistant Staphylococcus aureus (n=15) of positive cases of bovine mastitis. For the statistical analysis, the IBM SPSS s tatistical package was used. The mixture of essential oils ( Lippia citriodora and Thymus vulgaris (50/50 v/v)) obtained the most significant antimicrobial activity in relation to pure essential oils. It is therefore concluded that the mixture of these oils boosts their antimicrobial activity ( p <0.05). The minimum inhibitory and bactericidal concentration of this mixture for the total isolations was 12 µL/L and 25 µL/mL, respectively.

La mastitis bovina es una enfermedad de gran impacto para la industria lechera. El Staphylococcus aureus es uno de los principales patógenos, especialmente aquellos resistentes a los antibióticos. El objetivo de este estudio fue evaluar la actividad antimicrobiana de los aceites esenciales de Lippia citriodora (Lam.), Thymus vulgaris (L), y una mezcla de aceites esenciales de Lippia citriodora y Thymus vulgaris (50/50 v/v), frente a aislamientos clínicos de Staph ylococcus aureus oxacilino - resistentes (n=15) de mastitis bovina. Se utilizó p rograma estadístico IBM SPSS y se concluyó la diferencia significativa a un p <0.05. La mezcla de aceites esenciales ( Lippia citriodora y Thymus vulgaris (50/50 v/v)), obtuvo la m ayor actividad antimicrobiana en relación a los aceites esenciales puros, se concluye que la mezcla de estos aceites potencia su actividad antimicrobiana ( p <0.019). La concentración mínima inhibitoria y bactericida de esta mezcla fue del 12 µL/mL y 25 µL/m L, respectivamente, y puede ser una alternativa terapéutica.

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INTRODUCTION: eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction. METHODS: Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis. RESULTS: Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service. CONCLUSION: Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.

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Photoaging (PA) is considered a silent disease affecting millions of people globally and is defined as skin damage due to prolonged exposure to ultraviolet radiation (UVR) from the sun. Physiologically, the skin is in a state of renewal and synthesis of components of the extracellular matrix (ECM). However, exposure to UVR affects the production of the ECM, and the functioning and response of skin cells to UVR begins to change, thus expressing clinical and phenotypic characteristics of PA. The primary mechanisms involved in PA are direct damage to the DNA of skin cells, increases in oxidative stress, the activation of cell signaling pathways responsible for the loss of skin integrity, and cytotoxicity. The medical and scientific community has been researching new therapeutic tools that counteract PA, considering that the damage caused by UVR exceeds the antioxidant defense mechanisms of the skin. Thus, in recent years, certain nutraceuticals and phytochemicals have been found to exhibit potential antioxidant and photoprotective effects. Therefore, the main objective of this review is to elucidate the molecular bases of PA and the latest pharmaceutical industry findings on antioxidant treatment against the progression of PA.

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Resumo O artigo explora a teleassistência a partir dos desenvolvimentos da telessaúde e da aceleração da transformação digital na saúde provocada pela pandemia de COVID-19, com foco no Sistema Único de Saúde (SUS). Aborda questões terminológicas, escopo de ações, potencialidades do uso para atenção à saúde e condicionantes e contingências para a utilização da teleassistência no Brasil, concentrando-se nas teleconsultas e nas interações entre profissionais de saúde e pacientes. Por fim, apresenta um conjunto de proposições para o desenvolvimento das políticas e práticas de teleassistência no Brasil, tendo em vista os princípios do SUS, organizados em dois eixos estratégicos centrais: diretrizes político organizacionais e proposições operacionais e de organização dos serviços e do cuidado. Destaca-se a importância de ponderar e elucidar os alcances e os limites das novas tecnologias para evitar idealizações e deslumbramentos com suas propostas de solução para os complexos problemas de saúde. As soluções de teleassistência devem ser compatíveis com princípios e diretrizes do SUS e com o modelo de atenção preconizado, que prevê a organização da rede a partir da atenção primária, para garantir acesso, integralidade e qualidade da atenção à saúde para a sociedade brasileira.

Abstract This article explores telecare from telehealth developments and the recent acceleration of the digital health transformation caused by the COVID-19 pandemic, focusing on the Brazilian Unified Health System (SUS). It addresses terminological issues, the scope of actions, the potential use for healthcare, and constraints and contingencies for telecare in Brazil, focusing on teleconsultations and interactions between health professionals and patients. Finally, it presents a set of propositions for the development of telecare policies and practices in Brazil, considering SUS principles, in two central themes: organizational political guidelines and operational propositions to organise services and healthcare delivery. The importance of clarifying the scope and limits of new technologies is highlighted in the attempt to avoid idealizations with proposed solutions to complex health problems. Telecare solutions should be compatible with SUS principles and with the recommended model of care, with the healthcare network coordinated and organised by primary care, ensuring access to health services and integrated and quality healthcare for the Brazilian society.

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RESUMO A segurança do paciente na Atenção Primária à Saúde (APS) preocupa-se em reduzir erros e eventos adversos relacionados a assistência à saúde, porém há poucos estudos elaborados com aplicação de modelos avaliativos sobre a temática neste contexto. Este trabalho objetivou desenvolver e propor um modelo avaliativo da segurança do paciente na APS. Realizou-se um estudo de avaliabilidade por meio da análise documental, revisão de literatura, proposição dos modelos e validação dos modelos por meio da conferência de consenso. Idealmente, a teoria do programa, apresentada no Modelo Teórico, evidencia que os recursos, a cultura de segurança, os processos assistenciais e a educação permanente são componentes que viabilizam a implantação do programa, que precisam ser discutidos e aprimorados com envolvimento da gestão, dos profissionais e dos próprios pacientes/familiares e cuidadores, sendo, portanto, explorados no Modelo Lógico e assumidos como fundamentais para a oferta de cuidados mais seguros na APS quando interagem articuladamente. Na Matriz de Análise e Julgamento, esses quatro componentes assumem o mesmo peso no cálculo que determinará o grau de implantação da segurança do paciente na APS. A modelização apresentada pode ser utilizada por diversos atores, de diferentes contextos, para explorar e aprimorar a segurança do paciente na APS.

ABSTRACT Patient safety in Primary Health Care (PHC) is concerned with reducing errors and adverse events related to health care, but there are few studies developed with the application of evaluative models on the subject in this context. This study aimed to develop and propose an evaluation model of patient safety in PHC. An evaluability study was carried out through document analysis, literature review, proposition of models and validation of models through consensus conference. Ideally, the theory of the program, presented in the Theoretical Model, shows that resources, safety culture, care processes and permanent education are components that enable the implementation of the program, which need to be discussed and improved with the involvement of management, professionals and the patients/family members and caregivers themselves, being, therefore, explored in the Logical Model and assumed as fundamental for the provision of safer care in PHC when they interact articulately. In the Analysis and Judgment Matrix, these four components assume the same weight in the calculation that will determine the degree of implementation of patient safety in PHC. The modeling presented can be used by different actors, from different contexts, to explore and improve patient safety in PHC.

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Preocupações com a segurança do paciente vêm crescendo em todo o mundo, sendo uma dimensão da qualidade do cuidado. O tema na Atenção Primária à Saúde (APS) está em ascensão e visa reduzir os riscos desnecessários aos pacientes ao longo do cuidado com a saúde. O objetivo deste estudo é analisar os aspectos fundamentais relacionados à segurança do paciente na APS. Trata-se de uma revisão integrativa da literatura sobre a segurança do paciente, realizada em agosto de 2021 em todas as bases de dados da BVS, Cinahl, Scielo, Scopus, PubMed, e Web of Science. Participaram 31 artigos publicados desde 2005 até os dias atuais, de 14 diferentes países. Os resultados foram organizados em três categorias temáticas: incidentes de segurança, cultura de segurança e instrumentos de avaliação da segurança do paciente, revelando que a prevenção de incidentes de segurança perpassa os componentes estruturais, processuais, de treinamento e cultura, que precisam ser constantemente acompanhadas e fortalecidas pela gestão, equipe de saúde e pacientes. Muitas ações fortalecedoras da segurança do paciente são viáveis de serem executadas e não impactam em novas demandas de trabalho para a equipe de saúde. Indicadores de segurança do paciente na APS precisam ser aprimorados, tornando-os representativos, viabilizando a construção de instrumentos e consequente avaliação. Sugere-se ampliar os estudos nessa temática devido sua importância durante a atenção à saúde.

Concerns about patient safety have been growing around the world, being a dimension of the quality of care. The theme in primary health care (PHC) is on the rise and aims to reduce unnecessary risks to patients throughout health care. The objective of this study is to analyze the fundamental aspects related to patient safety in PHC. This is an integrative review of the literature on patient safety, carried out in August/2021 in all VHL, Cinahl, Scielo, Scopus, PubMed, and Web of Science databases. 31 articles published from 2005 to the present day, from 14 different countries participated. The results were organized into three thematic categories: safety incidents, safety culture and patient safety assessment instruments, revealing that the prevention of safety incidents permeates the structural, procedural, training and culture components, which need to be constantly monitored. and strengthened by management, healthcare staff and patients. Many actions to strengthen patient safety are feasible to be carried out and do not impact new work demands for the health team. Patient safety indicators in PHC need to be improved, making them representative and enabling the construction of instruments and subsequent evaluation. It is suggested to expand studies on this topic due to its importance during health care.

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This study proposes a novel test method and corresponding procedure to evaluate how coconut fibres affect crack propagation rates resulting from plastic shrinkage during the accelerated drying of concrete slabs. The experiment employed concrete plate specimens, which were used to simulate slab structural elements with a surface dimension notably greater than their thickness. These slabs were reinforced with coconut fibre with 0.5%, 0.75%, and 1% fibre content. A wind tunnel was designed to simulate two significant climate parameters (wind speed and air temperature), which could impact the cracking behaviour of surface elements. The proposed wind tunnel allowed air temperature to be controlled alongside wind speed while monitoring moisture loss and the cracking propagation process. During testing, a photographic recording method was used to evaluate cracking behaviour, with the total crack length serving as a parameter to assess the impact of fibre content on the crack propagation of slab surfaces. Additionally, crack depth was measured using ultrasound equipment. The results indicate that the proposed test method was appropriate for future research, allowing for the evaluation of the effect of natural fibres on the plastic shrinkage behaviour of surface elements under controlled environmental conditions. Based on initial studies and the results obtained through the proposed test method, concrete containing 0.75% fibre content exhibited significantly reduced crack propagation on slab surfaces, as well as a reduction in the crack depth caused by plastic shrinkage during the early age of the concrete.

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The COVID-19 pandemic had a great impact on the process of integrating digital technologies in higher education and caused digital stress among professors, mainly in countries with a lower level of digitalization. In this work, quantitative research was carried out on the stress of professors in Venezuela due to the digitalization of their teaching activities caused by the pandemic, and gender gaps were identified in this regard. This digital stress was compared with that of professors in other countries with a low level of digitalization. For this purpose, a questionnaire designed by the authors was used. The questionnaire was distributed to a sample of 129 Venezuelan professors and 132 professors from countries with low digitalization levels. As a result, it was found that Venezuelan professors have lower digital competence and lower digital stress than their colleagues in weakly digitized countries, and that digital stress decreases as digital competence increases. Moreover, among Venezuelan professors, there was a strong gender gap in digital stress, which was higher among females in all subject areas, except for Health Sciences. This gender gap is specific to Venezuela since it differs from that in countries with low digital levels. According to the results, we urgently recommend investing resources in the digital training of faculty members, especially in regards to the integration of female professors.

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Objetivo: Describir las características epidemiológicas y clínicas de los pacientes con leucemia linfocítica aguda atendidos en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", que recibieron radioterapia externa, durante el periodo de enero de 2009 a diciembre de 2017. Métodos: Estudio observacional, descriptivo. Se revisaron retrospectivamente los expedientes clínicos de pacientes pediátricos (0-13 años) con leucemia linfocítica aguda, que recibieron radioterapia externa en el periodo mencionado. Se aplicó un análisis estadístico descriptivo de las variables cualitativas y cuantitativas. Resultados: Se analizó un total de 58 pacientes, de estos el 79,3% fueron hombres. La edad promedio fue de 7,3 años. El 84,2% fueron clasificados como L1, 84,2% con inmunofenotipo B común y el 56,9% eran grupo de alto riesgo al diagnóstico. La principal indicación de radioterapia fue recaída (67,7%). Aproximadamente la mitad se irradió a sistema nervioso central y la otra mitad a testículos. Los principales efectos adversos fueron cutáneos. Conclusiones: Los resultados obtenidos fueron comparables con los reportados en la literatura. La radioterapia es importante en el tratamiento de leucemias, especialmente en pacientes de recaída y de alto riesgo.

Aim: To describe the epidemiological and clinical characteristics of patients with acute lymphocytic leukemia, attended at the National Children´s Hospital "Dr. Carlos Sáenz Herrera" that received external radiation therapy between January 2009 and December 2017. Methods: It is an observational, descriptive study. Clinical records of pediatric patients (0-13 years) with acute lymphoblastic leukemia that received external radiotherapy in the study period were retrospectively reviewed. A descriptive statistical analysis of the qualitative and quantitative variables was applied. Results: 58 patients were studied, 79,3% were males. The mean age was 7,3 years. 84,2% were classified as L1, 84,2% had common B immunophenotype and 56,9% were in the high risk group at diagnosis. The main indication for radiotherapy was relapse (67,7%). About half the patients received radiotherapy to central nervous system and the other half to testicles. The main side effects were cutaneous. Conclusions: The results obtained were comparable to those seen in literature. Radiotherapy is important in leukemia treatment, particularly in relapse and high risk patients.

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BACKGROUND: The COVID-19 pandemic accelerated efforts to deploy and regulate medical teleconsultation in Brazil. Studying the Brazilian Unified Public Health System (SUS) experiences in implementing teleconsultations can help to inform their sustainability. This study identifies the changes required to integrate specialized teleconsultation in local workflows in SUS. METHODS: A case study of teleconsultation performed by a University Hospital and a Municipal Specialty Outpatient Clinic in the south of Brazil collected information from two focus groups with specialised doctors, two key informant interviews and associated documents. The Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework domains of condition, technology, proposal value, users and organization informed a qualitative thematic analysis of this data. RESULTS: Several forms of teleconsultation were used to manage paediatrics and endocrine conditions including instant messaging, WhatsApp, telephone calls and video consultations which were also used for dermatology. In Brazil, telephone interactions are not considered teleconsultation. In contrast, video consultations were longer than face-to-face appointments, facilitate the understanding and evaluation of conditions, and offered continuity of care, comfort, and safety, without the need for patients to travel, reducing the risk of infection. Patients accepted video consultations to varying degrees but some found it difficult to use the technology. The willingness of doctors to provide any form of teleconsultation was important. Management support was key to defining workflows, coordinating care pathways, and providing technical support. CONCLUSIONS: This study highlights particularities of teleconsultation uptake for the included specialities. The NASSS framework provides a useful means of identifying the changes to enable teleconsultation continuity for specialised care in SUS.

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Abstract Introduction: Placenta previa can cause bleeding during the second half of pregnancy and may compromise the health of both the mother and the fetus. Knowing the associated risk factors allows for the early identification of pregnant women at high risk of placenta previa. Objective: To describe the risk factors for placenta previa in a sample of pregnant women treated in Bogotá D.C., Colombia, as well as their maternal and perinatal morbidity and mortality. Materials and methods: Retrospective descriptive study. 17 pregnant women diagnosed with placenta previa and admitted to the High Obstetric Risk Unit of a tertiary care hospital between 2013 and 2017 were included. Medical records were reviewed to collect data on risk factors for placenta previa and clinical and sociodemo-graphic characteristics. In the descriptive analysis, means and standard deviations and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Results: The most frequent risk factors were >4 pregnancies (64.70%), maternal age >35 years (29.41%), and history of miscarriage (29.41%). Maternal morbidity was higher than fetal morbidity: three patients required transfusion of blood products, and another underwent a subtotal hysterectomy, while no perinatal complications were reported, with the exception of one stillbirth. Conclusions: A history of miscarriage, >4 pregnancies, and maternal age >35 years were the most frequent risk factors. Furthermore, the degree of maternal-perinatal complications did not depend on the type of placenta previa. Knowing which pregnant women are at higher risk of placenta previa as a result of the early identification of these risk factors allows for a better clinical approach, reducing morbidity and mortality rates in both the mother and the child.

Resumen Introducción. La placenta previa puede causar hemorragias en la segunda mitad del embarazo que pueden llegar a comprometer la salud materno-perinatal. Conocer los factores de riesgo asociados permite identificar tempranamente gestantes con alto riesgo de placenta previa. Objetivo. Describir los factores de riesgo de placenta previa en una muestra de gestantes atendidas en Bogotá D.C., Colombia, así como su impacto en la morbimortalidad materno -perinatal. Materiales y métodos. Estudio descriptivo retrospectivo. Se incluyeron 17 gestantes diagnosticadas con placenta previa que ingresaron entre 2013 y 2017 a la Unidad de Alto Riesgo Obstétrico de un hospital de tercer nivel. Se revisaron las historias clínicas para recolectar datos sobre factores de riesgo y características clínicas y sociodemográficas. En el análisis descriptivo, para las variables cuantitativas se calcularon medias y desviaciones estándar y para las cualitativas, frecuencias absolutas y relativas. Resultados. Los factores de riesgo más frecuentes fueron haber tenido >4 embarazos (64.70%), edad materna >35 años (29.41%) y aborto previo (29.41%). La morbilidad materna fue mayor que la fetal: 3 pacientes requirieron transfusión de hemoderivados y en otra fue necesario realizar histerectomía subtotal, mientras que no se reportaron complicaciones perinatales, a excepción de un mortinato. Conclusiones. Haber tenido >4 embarazos, tener una edad materna >35 años y el antecedente de aborto fueron los factores de riesgo más frecuentes; además, el grado de las complicaciones materno-perinatales fue independiente del tipo de placenta previa. Saber cuáles son las gestantes con mayor riesgo de presentar esta condición mediante la identificación temprana de estos factores permite brindarles un mejor abordaje clínico, lo que permitirá disminuir la morbimortalidad del binomio madre-hijo.

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INTRODUCTION: The use of online education strategies has been introduced as a tool to support health care in patients with rheumatic disease. However, it is important to consider the patient's sociocultural environment. OBJECTIVE: To design and assessment of bilingual audiovisual material acceptability, by means of two social networks, for patients with rheumatoid arthritis (RA) in the qom community in Argentina. METHODS: A qualitative study was performed in two stages: (1) audiovisual material design, development, and validation implementing a collaborative action research method. (2) Publishing of the material on two social networks at two different times. The selected topic was the coronavirus disease 2019 impact on patients with RA. A qualitative and quantitative data analysis was performed. RESULTS: Forty subjects participated into the initial validation stage with a 70% acceptance rate. First, 28 subjects (70%) participated on Facebook and 25 (62.5%) joined the WhatsApp group. Then, the same number of subjects participated on Facebook, while only 45% of subjects participated on WhatsApp. Most of them participated using short phrases such as "I like it." The 60% of the participants played the videos. However, less than 10% shared them. Videos in Spanish were the once most shared. Participation dramatically fell during the second time, and 40% of the WhatsApp subjects never participated. CONCLUSION: The strategies developed for this indigenous community were of no utility, probably because of socio-cultural, economic, and digital barriers. They should be designed and implemented identifying the target group and its environment. Key Points • Online education strategies should be designed with cultural sensitivity. • Technological barriers make digital inequality visible in vulnerable groups. • Educational interventions should have a collaborative design and they should be created together with the communities. • The COVID-19 pandemic has deepened inequalities in the health care and follow-up of patients with rheumatic diseases, especially between most socially and economically disadvantaged groups.

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BACKGROUND In cardiac amyloidosis (CA), misfolded proteins deposit in the extracellular space of cardiac tissue. These deposits classically cause restrictive cardiomyopathy with diastolic dysfunction. Although there are at least 30 proteins known to cause amyloid aggregates, 2 main types make up most diagnosed cases: light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Since CA is considered a rare condition, it is often underdiagnosed or recognized in the advanced stages. Once amyloid deposits involve the heart tissue, they are associated with a worse outcome and higher mortality rates, especially in patients presenting symptoms of heart failure. CASE REPORT We report a case of a 22-year-old man presenting with acute severe mitral regurgitation, secondary to posterior mitral leaflet chordae tendineae rupture (CTR). Surgical mitral valve replacement with a mechanical prosthesis was performed, and cardiac tissue biopsy samples were obtained. After surgery, the patient improved significantly but suddenly presented with hemodynamic deterioration, until he died due to severe hemodynamic compromise and multiorgan failure. Although the etiology of the CTR was not established before surgical intervention, the histopathological analysis suggested CA. CONCLUSIONS CA diagnosis can be complex, especially in a 22-year-old-man with atypical clinical and imaging manifestations. In this patient, other differential diagnoses were considered, since CA presenting in a young patient is a rare phenomenon and acute mitral regurgitation secondary to CTR presents more frequently in other heart conditions. Furthermore, rapid postoperative deterioration resulted in the patient's death before biopsy samples were available because suspicion of amyloidosis had not been raised until that point.

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Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients' access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.

Lay abstract Diagnosis and treatment of skin diseases through teledermatology avoid patient referrals, improves accessibility to specialized care, as well as the skin care provided by physicians. This study compared the costs of the teledermatology service of the State of Santa Catarina, Brazil with the costs of the provision of conventional care, to check which of them was more efficient. All costs related to direct patient care were considered in the calculation of costs. Totally, 40% of 79,411 dermatological tests performed could be locally managed in primary care, avoiding commuting, and expanding the patients' access to care. The teledermatology service had a cost per patient of US$196.04, compared with the cost of conventional care of US$245.66. In this evaluation, teledermatology proved to be cheaper than conventional care, reducing commuting costs.

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AIMS: To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. METHODS: A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. RESULTS: We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self-management requires a trustful PWD-HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self-manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence-based guidelines are important but can detract from personalised care. CONCLUSION: We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.

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Cervical Cancer (CC) is a significantly prevalent disease in developing countries. Currently, targeted therapies are not a primary standard of care in CC. This information could be crucial for developing directed therapies and patient screening for biomarkers that would allow personalised treatment of CC. This systematic review aimed to estimate the prevalence of potential therapeutic targets such as the epidermal growth factor receptor (EGFR) and the PI3K/Akt/mTOR and Ras/Raf/MAPK pathways in patients with CC, identified through genomic and non-genomic testing. Studies were identified through an ad-hoc search strategy from the available on MEDLINE (Ovid), CENTRAL, LILACS, SCOPUS, through the Clinical Trial registry on Clinicaltrials.gov, International Clinical Trials Registry Platform, RENIS (Argentine National Registry of Health Research) and grey literature sources. We included 74 studies which represented a total pool of 7,862 participants. Forty-five studies informed mutations of EGFR, with a combined positivity rate of 53% (95%CI: 45%-60%; I2 = 95%). Twenty studies informed the presence of mutations in PIK3CA with a combined positivity rate of 30% (95%CI: 21%-39%; I2 = 96%). Twenty-three studies reported a mutation in Ras, with a combined positivity rate of 14% (95%CI: 8%-21%; I2 = 95%). Raf mutations were informed in six studies. Six studies informed the presence of Akt mutations, two studies informed mTOR mutations and only one study reported mutations of MAPK. The most frequently described therapeutic targets were EGFR, and the PIK3CA and Ras pathways, though inconsistency in positivity rates was significant. Our study did not allow the identification of any specific clinical characteristics that might explain the observed heterogeneity. Despite the overall good quality of the included studies, the applicability of these results to patients' general population with CC is still unclear.

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OBJECTIVE: To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. METHODS: This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. RESULTS: 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. CONCLUSION: The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.

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